92 B . Ali et al .: J Extra Corpor Technol 2024 , 56 , 84 – 93
Recommendation
Lactated Ringer ’ s solution should be avoided in patients with hypercalcemia , hypokalemia , kidney stones , or a history of metabolic acidosis . Compared to normal saline , it has a lower risk of causing metabolic acidosis due to its lactate content . However , Ringer ’ s solution may interact negatively with certain medications . Research suggests that intraoperative blood sugar levels increase significantly when Ringer ’ s lactate is used , especially when combined with dextrose . While Ringer ’ s lactate is considered superior to normal saline , some clinicians avoid it due to concerns that lactate contributes to hyperglycemia , particularly in diabetic surgical patients . However , lactate in Ringer ’ s lactate is generally only problematic for patients with liver dysfunction , especially in cases of liver failure .
We recommend a study with a larger sample size and more parameters for primary outcomes to find the best alternative for Plasma Lyte A by keeping the original del Nido cardioplegia as the control standard .
Conclusion
There were no significant differences in CK-MB , Troponin T , Troponin I , and Lactate levels between using normal salinebased , Ringer lactate-based , or plain Ringer-based modified del Nido cardioplegia , along with other intraoperative and postoperative factors including ; bypass time , clamp time , cardioplegia volume , cardioplegia doses , post clamp removal VF , AFL , AF , Ventilation support time , ICU stay and mortality . Therefore , we concluded that all three solutions , including normal saline , Ringer lactate , and plain Ringer , can serve as a baseline solution for modified del Nido cardioplegia in isolated CABG surgery as there was no difference in myocardial protection among them .
Acknowledgements
We express our gratitude to the Department of Anesthesiology and Critical Care Research Center of the Shiraz University of Medical Science , Shiraz , Iran for their invaluable legal assistance . We extend our thanks to the perfusion department of Shahid Faghihi Hospital , Shiraz for their exceptional support during the intervention and follow-up period . Additionally , we appreciate the efforts of the clinical laboratory and ICU staff for providing us with the necessary data .
Funding
This project was funded by the Research Committee of Shiraz University of Medical Sciences ( Grant No : 1401-26912 ).
Conflicts of interest The authors declare no conflict of interest .
Data availability statement The research data is available on request from the authors .
Author contribution statement
Babar Ali : Lead conceptualization , Lead visualization , Lead writing original draft , Lead methodology .
Salman Pervaiz Butt : Lead supervision , Lead validation , Equal writing original draft and revision , Equal project administration , supporting data analysis .
Mohammad Ghazi Nour : Lead data curation , Lead project administration .
Mohammad Bagher Khosravi : Supporting visualization , Supporting project administration . Naeimehossadat Asmarian : Lead data analysis . Ali Raza Shoul : Equal data curation . Arun Kumar : Supporting supervision . Umer Darr : Supporting supervision . Gopal Bhatnagar : Supporting supervision .
Ethics approval
This study was approved by the Research Ethical Committee of the School of Medicine – Shiraz University of Medical Science ( Id : IR . SUMS . MED . REC . 1401.534 ) and was registered in the Iranian Registry of Clinical Trials ( Code : IRCT20230719058845N1 ). References
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