Effect of Perioperative Fluids on Serum Osmolality and Serum Sodium in Patients Undergoing Transcranial Excision of Craniopharyngioma: A Prospective Randomized Controlled Trial

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 2(nd) h (P = 0.04), 3(rd) 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 3(rd) 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.