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CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(01): 126-131
DOI: 10.4103/ajns.AJNS_324_19
Original Article

Effect of perioperative fluids on serum osmolality and serum sodium in patients undergoing transcranial excision of craniopharyngioma: A prospective randomized controlled trial

Pranshuta Sabharwal
Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh
,
Nidhi Panda
Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh
,
Neeru Sahni
Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh
,
Ashish Sahoo
Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh
,
Ankur Luthra
Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh
,
Rajeev Chauhan
Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh
,
Hemant Bhagat
Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh
,
Pinaki Dutta
1   Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh
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Background: Electrolyte imbalance and acute diabetes insipidus (DI) are the most common complications in patients undergoing craniopharyngioma excision. Data are sparse regarding the choice of fluid in these patients. We compared the effects of balanced salt solution and 0.45% saline infused perioperatively on serum osmolality and serum sodium levels in these patients. Methodology: A prospective randomized double-blinded study was conducted in 30 patients undergoing transcranial excision of craniopharyngioma. The patients received either balanced salt solution or 0.45% sodium chloride solution perioperatively till they were allowed orally. Serum and urine osmolality, serum and urine sodium, urine specific gravity, and total dose of desmopressin required to treat DI were measured in the perioperative period. Results: Demographic data were comparable. We observed that there was significantly higher serum osmolality in the intraoperative period at 2nd h (P = 0.04), 3rd h (P = 0.01), at end of the surgery (P = 0.034) and on postoperative day 0 (POD 0) with P = 0.03 in patients receiving balanced salt solution. We also observed that the difference in serum sodium levels were significantly higher in patients receiving balanced salt solution as compared to those receiving 0.45% sodium chloride solution intraoperatively, at 3rd h (P = 0.02) and at the end of surgery (P = 0.04) although the values were comparable in both the groups as measured on POD 0, 1 and 2. Conclusion: 0.45% sodium chloride solution has better effect on serum osmolality than balanced salt solution in patients undergoing transcranial resection of craniopharyngioma.

Key-words:

0.45% sodium chloride solution - balanced salt solution - craniopharyngioma - diabetes insipidus - hypernatremia

Financial support and sponsorship

Nil.




Publication History

Received: 31 October 2019

Accepted: 23 November 2020

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Crandell WB. Parenteral fluid therapy. Surg Clin North Am 1968;48:707-21.
  • 2 Desborough JP, Hall GM. Endocrine response to surgery. In: Kaufman L, editor. Anaesthesia Review. Vol. 10. Edinburgh: Churchill Livingstone; 1993. p. 131-48.
  • 3 Hutchin P, Terzi RG, Hollandsworth LC, Johnson G Jr, Peters RM. The influence of intravenous fluid administration on postoperative urinary water and electrolyte excretion in thoracic surgical patients. Ann Surg 1969;170:813-23.
  • 4 Tommasino C. Fluids and the neurosurgical patient. Anesthesiol Clin North Am 2002;20:329-46, vi.
  • 5 Mukherjee KK, Dutta P, Singh A, Gupta P, Srinivasan A, Bhagat H, et al. Choice of fluid therapy in patients of craniopharyngioma in the perioperative period: A hospital-based preliminary study. Surg Neurol Int 2014;5:105.
  • 6 Williams EL, Hildebrand KL, McCormick SA, Bedel MJ. The effect of intravenous lactated Ringer's solution versus 0.9% sodium chloride solution on serum osmolality in human volunteers. Anesth Analg. 1999;88:999-1003.
  • 7 Duggal AK, Yadav P, Agarwal AK, Rewari BB. Clinical approach to altered serum sodium levels. J Indian Acad Clin Med 2006;7:91-103.
  • 8 Pratheesh R, Swallow DM, Joseph M, Natesan D, Rajaratnam S, Jacob KS, et al. Evaluation of a protocol-based treatment strategy for postoperative diabetes insipidus in craniopharyngioma. Neurol India 2015;63:712-7.
  • 9 Lehrnbecher T, Müller-Scholden J, Danhauser-Leistner I, Sörensen N, von Stockhausen HB. Perioperative fluid and electrolyte management in children undergoing surgery for craniopharyngioma. A 10-year experience in a single institution. Childs Nerv Syst 1998;14:276-9.
  • 10 Verbalis JG, Robinson AG, Moses AM. Postoperative and post traumatic diabetes insipidus. Front Horm Res 1985;13:247-65.
  • 11 Bucci MN, Chin LS, Hoff JT. Perioperative morbidity associated with operative resection of craniopharyngioma: A review of ten years experience. Neurochirurgia (Stuttg) 1987;30:135-8.
  • 12 Ghirardello S, Hopper N, Albanese A, Maghnie M. Diabetes insipidus in craniopharyngioma: postoperative management of water and electrolyte disorders. J Pediatr Endocrinol Metab. 2006;19:413-21.