Ocena wpływu roztworu Plasma-Lyte 148 i 0,9% NaCl na równowagę kwasowo-zasadową u pacjentów poddawanych neurochirurgii: randomizowane badanie kliniczne

OBJECTIVE: The choice of crystalloid solution considerably affects perioperative outcomes in neurosurgery. This study aimed to evaluate the effects of Plasma-Lyte 148 and 0.9% saline on acid-base and hydroelectrolyte balance in adults undergoing elective neurosurgical procedures. METHODS: A double-blind randomized controlled trial was conducted at Botucatu Medical School from November 2019 to May 2020. Patients received either Plasma-Lyte 148 or 0.9% saline at a maintenance rate of 2mL/kg/h, with additional bolus guided by mean arterial pressure and pulse pressure variation. The primary endpoint was arterial pH at the end of surgery. RESULTS: Sixty-eight patients (33 in the Plasma-Lyte 148 group and 35 in the saline group) completed the study. The total median volumes administered (1st-3rd quartiles) were 2,227 (1,416-3,000) and 3,000 (2,000-4,000) mL in the Plasma-Lyte 148 and saline groups, respectively (p=0.107). At procedure completion, Plasma-Lyte 148 demonstrated superior acid-base homeostasis with significantly higher pH (7.39±0.04 versus 7.35±0.05, p<0.001), bicarbonate (22.5±1.8 versus 20.6±2.2mmol/L, p<0.001), and base excess (-1.6±2.3 versus -3.9±2.6, p<0.001), while preventing hyperchloremia (109.1±6.6 versus 113.9±4.5 mmol/L, p=0.001). CONCLUSION: Plasma-Lyte 148 provides superior acid-base homeostasis compared to 0.9% saline in patients undergoing neurosurgery, with significantly better pH, bicarbonate, and base excess profiles while avoiding hyperchloremia. These findings support the preferential use of balanced crystalloids in neurosurgical practice, aligning with current evidence favoring Plasma-Lyte 148 for optimal perioperative fluid management. ReBEC platform registration number: RBR-2592-hd.