Comparative study of two balanced salt solutions on electrolyte balance and acid base status in patients undergoing emergency exploratory laparotomy for blunt abdomen trauma under general anaesthesia A prospective randomised double blind study

Fluid therapy plays a important role in the management of patients undergoing major surgery for trauma. Most of the fluid given perioperative are comprises of maintenance fluid, replacement of on-going losses and correction of hypovolemia. Therefore, the hydrating solution should ideally have a composition of electrolytes as similar to plasma. Surprisingly, no such fluid is available. Controversy still exists regarding use of various type of fluids intraoperatively. Crystalloid is the most commonly used intraoperative fluid due to less expensive, readily available, compatible with other medicines and reaction free. Although data on clinical outcomes associated with crystalloid infusion are heterogeneous,whereas advantages of balanced salt solutions might include a lower need of blood products, lower incidence of renal replacement therapy, hyperkalemia and postoperative infections. Taken together, a critical appraisal of the data suggests that balanced salt solutions  deserve consideration as infusates of first choice. Ringer Lactate (RL) solution is the most commonly used balanced salt solution intraoperatively since long time, However Ringer Lactate is slightly hypotonic due to lower sodium level (Na=130mmol/l) than plasma (Na= 140 mmol/l) and also having lactate which has been associated with hyperlactemia, calcium interface with coagulation profile of patients if used extensively. But Sterofundin have sodium of 140mmol/L which is isotonic to plasma and seems to remain intravascular more in comparison to fluid containing serum sodium of 130mmol/L(RL), subsequently causing less hemodynamic instability.

Recent critical care review has brought lactated solution into question with its hepatic mediated metabolism and increased aerobic demand making it not a good choice for patient with liver injury. Unlike lactated solution, acetated solution has acetate which is more rapidly metabolised extrahepatically and with less oxygen demand and can reduce liver metabolic burden for patients with damaged liver.In blunt abdomen trauma cases electrolyte imbalance and acid base changes already exist in majority of patients. To prevent further de-arrangement type of fluid using in the intraoperative period as maintanence plays an important role. So we plan this study to compare lactated solution with acetated solution on electrolyte balance and acid-base status in blunt abdomen trauma cases undergoing emergency laparotomy under general anaesthesia.