Use of a Novel Buffered Hypertonic Saline Solution for Fluid Replacement and Resuscitation During Spinal Surgery in Adolescents

Background: During major orthopedic procedures, such as posterior spinal fusion (PSF), isotonic fluids, colloids, starches, or gelatins are commonly used to replace the preoperative fluid deficit and provide ongoing fluid resuscitation. Given recent concerns regarding the potential adverse physiologic effects of albumin solutions, we have modified our intraoperative practice to include the use of a novel 2% buffered hypertonic saline solution during major orthopedic procedures. We present our preliminary clinical experience with this novel fluid for intraoperative resuscitation and its impact on limiting the use of 5% albumin. Methods: A retrospective review was performed to identify patients who received 2% buffered hypertonic saline during PSF. The intraoperative course of these patients was compared to case-matched control patients who received standard care with isotonic fluids plus 5% albumin as an adjunct for intravascular resuscitation. Results: The study cohort included 23 patients who received 2% buffered hypertonic saline and 25 in the case-matched control group. There was no difference in the volume of intraoperative isotonic crystalloid fluids, estimated blood loss, and urine output between the two groups. In the control cohort, 19 of 25 patients (76%) received 5% albumin compared to only six of 23 patients (26%, P = 0.0005) in the 2% buffered hypertonic saline group. The final pH was higher in the patients that received 2% buffered hypertonic saline than in the control group (7.40 +/- 0.03 versus 7.36 +/- 0.06, P = 0.0131). Additionally, the starting and final serum sodium values were higher in the patients that received 2% buffered hypertonic saline, although no difference was noted in the mean change from the starting value (average increase of 2 mEq/L in both groups). Conclusion: Use of a novel 2% buffered hypertonic saline solution for intraoperative resuscitation during major orthopedic procedures decreases the need for 5% albumin while avoiding the development of hyperchloremic metabolic acidosis which may occur with standard sodium chloride solutions.