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Neville MFL. Perioperative use of a balanced crystalloid solution versus saline in children undergoing brain tumor resection: a randomized clinical trial [thesis]. São Paulo: “Faculdade de Medicina, Universidade de São Paulo”; 2018. Objective: The aim of this study was to determine if the use of a balanced crystalloid induces less metabolic derangements than 0.9% saline solution in children undergoing brain tumor resection. Design: Phase II, single center, superiority, randomized and controlled trial performed at Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo, São Paulo, Brazil. Population: Pediatric patients (age range, 6 months to 12 years) undergoing brain tumor resection. Intervention: Use of a balanced crystalloid solution during and after (for 24 h) brain tumor resection was compared to saline 0.9%. Serum electrolyte and arterial blood gas analyses were performed before surgery (baseline), after surgery, and at postoperative day 1. Primary outcome: The primary trial outcome was the preoperative to postoperative variation in serum chloride (post-preopΔCl) measured as the absolute difference between “after surgery” and baseline plasma concentrations. Secondary outcomes: As secondary outcomes, we measured the post-preopΔ of other electrolytes and base excess (BE); hyperchloremic acidosis incidence; and the brain relaxation score, a four-point scale evaluated by the surgeon for assessing brain edema. Results: Fifty-three patients were included in the study; twenty-seven were randomized to receive a balanced crystalloid (balanced group) and twenty-six were randomized to receive 0.9% saline solution (saline group). The median post-preopΔCl (mmol l) was significantly lower in the balanced [0 (-1.0; 3.0)] than in the saline group [6 (3.5;8.5); p < .01]. Median post-preopBE (mmol l) was lower [-0.4 (-2.7; -1.3) versus -4.4 (5.0; -2.3); p < .01] and hyperchloremic acidosis less frequent (4% versus 67%; p < .01) in the balanced group than in the saline group. Brain relaxation score was comparable between groups. Conclusions: In children undergoing brain tumor resection, balanced crystalloid solution infusion reduced variation in serum chloride. These findings support the use of balanced crystalloid solutions in children undergoing brain tumor resection. Descriptors: acidosis; infusion, intravenous; brain neoplasms; chlorine; sodium chloride; neurosurgery

Uso perioperatório de solução cristaloide balanceada comparado ao de cloreto de sódio 0,9% em crianças submetidas à ressecção de tumor cerebral: ensaio clínico randomizado