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Efficacy of sodium bicarbonate Ringer's solution for perioperative fluid management in infants with biliary atresia:
Hongyi Zhang1, Pei Wang1, Ruohui Li1
1Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China.
Insights
Perioperative sodium bicarbonate Ringer's solution (BRS) effectively maintained acid-base balance in infants with biliary atresia (BA) during Kasai portoenterostomy (KPE). BRS demonstrated safety and is a suitable fluid management option.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Anesthesiology
Background:
- Biliary atresia (BA) is a severe neonatal liver disease requiring surgical intervention.
- Kasai portoenterostomy (KPE) is the primary surgical procedure for BA.
- Maintaining acid-base balance during KPE is critical for infant outcomes.
Purpose of the Study:
- To assess the efficacy of perioperative sodium bicarbonate Ringer's solution (BRS) in infants with BA undergoing KPE.
- To evaluate the safety profile of BRS in this pediatric surgical population.
- To compare BRS with standard crystalloid solutions for fluid management.
Main Methods:
- A randomized controlled trial involving 120 infants with BA across 11 centers in China (2020-2022).
- Infants were assigned to either BRS or control crystalloid groups for perioperative fluid management.
- Standardized anesthesia and fluid protocols were employed, with primary outcomes including arterial blood pH, bicarbonate, and base excess.
Main Results:
- BRS effectively maintained arterial blood pH, bicarbonate, and base excess during KPE without causing electrolyte abnormalities.
- The BRS group exhibited lower potassium levels three days post-KPE.
- No significant differences in drug safety or incidence of adverse events were observed between groups.
Conclusions:
- Perioperative BRS is effective in maintaining acid-base homeostasis in BA infants undergoing KPE.
- BRS presents a safe and suitable option for perioperative fluid management in this patient group.
- Further research may explore long-term outcomes associated with BRS use in pediatric surgery.
Purpose:
To evaluate the efficacy and safety of perioperative sodium bicarbonate Ringer's solution (BRS) in biliary atresia (BA) infants undergoing Kasai portoenterostomy (KPE).
Methods:
This study was conducted in 11 pediatric medical centers across China from 2020 to 2022. Infants were randomly assigned to either the BRS group (n = 64) or the control crystalloids group (n = 56) for perioperative fluid management. Anesthesia and fluid management were standardized. Primary outcomes were arterial blood pH, bicarbonate, and base excess; secondary outcomes included changes in other blood parameters and adverse events.
Results:
The baseline characteristics of the two groups were similar. During KPE, BRS more effectively maintained arterial blood pH, bicarbonate, and base excess during KPE with no electrolyte abnormalities. Three days after KPE, the BRS group had lower potassium levels. Drug safety evaluation showed no significant differences, and the incidence of adverse events was comparable.
Conclusion:
BRS effectively maintained the acid-base status of BA infants during KPE. With no significant safety concerns, it is suggested that BRS is a suitable option for perioperative fluid management.
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