Dataset Information

Impact of Intraoperative Fluid Management on Electrolyte and Acid-Base Variables During Posterior Spinal Fusion in Adolescents.

ABSTRACT: Introduction:Various isotonic fluids may be used to maintain intravascular homeostasis during major surgical procedures. Variations in the electrolyte and buffer concentrations between these solutions may result in differential changes in electrolyte and acid-base status during fluid resuscitation. This study evaluates these changes during posterior spinal fusion in adolescents. Methods:Patients were randomized to receive lactated Ringers (LR), normal saline (NS) or Normosol-R® (NR) during posterior spinal fusion (N=19, 20, and 20, respectively). The specific fluid was used for maintenance fluids as well as fluid replacement of deficits, third space losses, and blood loss. Results:Patients who received NS had a greater base deficit (NS: -2.0 ± 2.2 vs NR -0.6 ± 1.8, p=0.031 or LR: -0.2 ± 1.7, p=0.007) and were more likely to have a ?2 point change in the base deficit (60% with NS compared to 30% with NR and 47% with LR). Patients receiving NS also had a lower pH (NS: 7.37 ± 0.03 vs NR: 7.39 ± 0.04, p=0.013) and a greater change in pH (NS: -0.03 ± 0.04 vs NR: 0.01 ± 0.06). Conclusion:The use of NS for intraoperative resuscitation during posterior spinal fusion in adolescents resulted in a greater base deficit and a lower pH than the use of LR or NR. Although these changes had limited clinical significance in our patient population, future studies are indicated to further investigate the potential clinical impact of these changes.

SUBMITTER: King M

PROVIDER: S-EPMC7419639 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Impact of Intraoperative Fluid Management on Electrolyte and Acid-Base Variables During Posterior Spinal Fusion in Adolescents.

King Meagan M Martin David D Miketic Renata R Beebe Allan A Samora Walter W Klamar Jan J Tumin Dmitry D Tobias Joseph D JD

Orthopedic research and reviews 20200727

<h4>Introduction</h4>Various isotonic fluids may be used to maintain intravascular homeostasis during major surgical procedures. Variations in the electrolyte and buffer concentrations between these solutions may result in differential changes in electrolyte and acid-base status during fluid resuscitation. This study evaluates these changes during posterior spinal fusion in adolescents.<h4>Methods</h4>Patients were randomized to receive lactated Ringers (LR), normal saline (NS) or Normosol-R® (N ...[more]

PMID: 32821177

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Project description:OBJECTIVES:Controlled hypotension is one means to limit or avoid the need for allogeneic blood products. Clevidipine is a short-acting, intravenous calcium channel antagonist with a half-life of 1 to 3 minutes due to rapid metabolism by non-specific blood and tissue esterases. To date, there are no prospective evaluations with clevidipine in the pediatric population. We prospectively evaluated the dosing requirements, efficacy, and safety of clevidipine for ontrolled hypotension during spinal surgery for neuromuscular scoliosis in the pediatric population. METHODS:Patients undergoing posterior spinal fusion for neuromuscular scoliosis were eligible for inclusion. The study was an open label, observational study. Maintenance anesthesia included desflurane titrated to maintain a bispectral index at 40 to 60 and a remifentanil infusion. Motor and somatosensory evoked potentials were monitored intraoperatively. When the mean arterial pressure (MAP) was ? 65 mmHg despite remifentanil at 0.3 mcg/kg/min, clevidipine was added to maintain the MAP at 55 to 65 mmHg. Clevidipine was initiated at 0.25 to 1 mcg/kg/min and titrated up in increments of 0.25 to 1 mcg/kg/min every 3 to 5 minutes to achieve the desired MAP. RESULTS:The study cohort included 45 patients. Fifteen patients (33.3%) did not require a clevidipine infusion to maintain the desired MAP range, leaving 30 patients including 13 males and 17 females for analysis. These patients ranged in age from 7.9 to 17.4 years (mean ± SD: 13.7 ± 2.2 years) and in weight from 18.9 to 78.1 kg (mean ± SD: 43.4 ± 14.2 kg). Intraoperatively, the clevidipine infusion was stopped in 6 patients as the surgeon expressed concerns regarding spinal cord perfusion and requested a higher MAP than the study protocol allowed. The data until that point were included for analysis. The target MAP was initially achieved at a mean time of 8.9 minutes. Sixteen of the 30 patients (53.3%) achieved the target MAP within 5 minutes. Heart rate (HR) increased from a baseline of 83 ± 16 to 86 ± 15 beats per minute (mean ± SD) (p=0.04) with the administration of clevidipine. No patient had a HR increase ? 20 beats per minute or required the administration of a ?-adrenergic antagonist. The duration of the clevidipine administration varied from 8 to 527 minutes (mean ± SD: 160 ± 123 minutes). The maintenance infusion rate of clevidipine varied from 0.25 to 5.0 mcg/kg/min (mean ± SD: 1.4 ± 1.1 mcg/kg/min). Clevidipine was paused a total of 43 times in the 30 cases. In 18 of the 30 patients (60%), the clevidipine infusion was temporarily paused more than once due to a MAP < 55 mmHg. A fluid bolus was administered to only 1 patient to treat the low MAP. No patient required the administration of a vasoactive agent for hypotension. When the clevidipine infusion was discontinued as controlled hypotension was no longer required, the MAP returned to baseline or ? 65 mmHg within 10 minutes in 12 of the 30 patients (40%). CONCLUSIONS:Clevidipine can be used to provide controlled hypotension during posterior spinal fusion. The response of the MAP, both the onset and duration of action, were rapid. Although titration of the infusion with occasional pauses of administration may be needed, excessive hypotension was not noted.

Dataset Information

Impact of Intraoperative Fluid Management on Electrolyte and Acid-Base Variables During Posterior Spinal Fusion in Adolescents.

Publications

Impact of Intraoperative Fluid Management on Electrolyte and Acid-Base Variables During Posterior Spinal Fusion in Adolescents.

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