A study on effect of lactate versus acetate-based intravenous fluids on acid-base balance in patients undergoing free flap reconstructive surgeries in India

Abstract

Introduction: Fluid therapy is very important in managing the recovery of patients from major surgery and trauma. Postoperative fluid management comprises maintenance of fluid, replacement of on-going losses and correction of anemia or hypovolemia. Use of lactated intravenous fluids during long surgeries could cause lactate accumulation and lactic acidosis. We evaluated the comparative effects of administration of lactated versus no lactated solutions on serum lactate levels in patients undergoing free flap surgeries. Material and Methods: This was a prospective study conducted over a period of 3 years. 72 patients undergoing major head and neck surgeries with free flap reconstruction were recruited. No patient was forced to be a part of the study. Patients with hepatic and renal derangement, congestive cardiac failure, diabetics, and those unwilling to participate after explanation of the protocol were not included in the study. Result: Mean age of the patients in years in Groups SF and RL was 54.5±18.1 versus 48.2±16.5 (P=0.168) and weight in kg was 64.2±9.8 vs. 59.3±13.1, P =0.196, respectively, hence the demographic variables in both groups were comparable. The distribution of gender and physical status were also comparable. Conclusion: we conclude that the intraoperative use of Sterofundin is comparable or even better than Ringer’s Lactate in terms of preservation of acid-base and electrolyte balance, avoidance of hypo/hyperglycaemia and cardiovascular stability in patients undergoing moderate to major surgery.