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GENERAL ARTICLES

The Volume Kinetics of Acetated Ringer’s Solution During Laparoscopic Cholecystectomy

Joel Olsson, MD, PhD^*, Christer H. Svensén, MD, PhD^*, and Robert G. Hahn, MD, PhD

*Department of Anesthesiology, University of Texas Medical Branch, Galveston; and Department of Anesthesiology, Karolinska Institute, Stockholm, Sweden

Address correspondence and reprint requests to Robert G. Hahn, MD, PhD, Department of Anesthesiology, South Hospital, S-118 83 Stockholm, Sweden. Address e-mail to Robert.hahn{at}sos.sll.se

We studied the distribution and elimination of an IV infusion of 20 mL/kg of acetated Ringer’s solution (approximately 1500 mL) over 60 min in 12 women undergoing laparoscopic cholecystectomy. A plasma dilution of 4.2% developed during the induction of general anesthesia, even though fluid was withheld. The additional plasma dilution induced by the subsequent volume expansion was slightly larger than expected from previous volunteer experiments and averaged 18%. The diuretic response to intravascular fluid administration was small, and only 20% of the infused fluid had been excreted 4 h later. Volume kinetic analysis showed that the IV fluid expanded a central body fluid space by 3.2 L. The clearance constants for distribution and elimination averaged 115 mL/min and 6.8 mL/min, respectively. These data represent a half-life of the fluid in the patients that is 17 times longer (median, 4.5 h) than the half-life of the plasma dilution (16 min), indicating a strong tendency to the formation of peripheral edema. A nomogram based on the kinetic variables suggests that infusion rates should be relatively rapid early on during surgery but slower later. This strategy creates a constant plasma dilution at any desired level without causing undue peripheral accumulation of fluid.

IMPLICATIONS: A weak diuretic effect that slightly enhanced the hemodilution occurred on infusing acetated Ringer’s solution during laparoscopic cholecystectomy. A nomogram facilitates the choice of infusion rate.

This article has been cited by other articles:

				R. G. Hahn Fluid Therapy Might Be More Difficult Than You Think Anesth. Analg., August 1, 2007; 105(2): 304 - 305. [Full Text] [PDF]

				C. H. Svensen, J. Olsson, and R. G. Hahn Intravascular fluid administration and hemodynamic performance during open abdominal surgery. Anesth. Analg., September 1, 2006; 103(3): 671 - 676. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999