Well, it’s about time I mentioned an article I didn’t particularly enjoy on here. It’s not like I think it’s a waste of paper, it’s an important topic, but it does nothing creative and does little to contribute to the understanding of the subject. The article looks at the effects of different rates of Lactated Ringers Solution administered while under isoflurane anesthesia. It uses healthy animals, discusses well documented effects in humans, and just reinforces common practice.
Lactated Ringers is the most frequently prescribed fluid for maintenance of homeostasis in surgery and pretty much any other health stress event. I know when any patient wasn’t feeling well from any situation at my clinic, we always administered LRS either through a catheter or subcutaneously for outpatients, the dosage based on weight and severity of condition. We know how to use it, and it’s gotten a proven history of effectiveness in both humans and animals. The article justifies itself by saying that fluid therapy in dogs is largely based on human evidence, and that the formulas we use to determine rates have not been thoroughly investigated. Yet throughout the article they repeatedly compare their results to similar studies, and make no conclusions that aren’t already accepted in human and animal medicine. Additionally, the gaps in the literature they identify can’t even be answered using the methods and results of this study, so you can’t use them to justify its existence.
So the big conclusions they determined were that providing LRS increased plasma volume and cardiac output, didn’t increase urine production, and appears to leave the blood volume and remain in extracellular space. These are important points, but they were accepted unanimously without the presence of this study. Further, if their goal was to confirm these assumptions, their results are pretty much irrelevant with a sample size of only 8 animals, all in perfect health, similar size (26-41 lbs isn’t a lot of variance in the world of dogs), and undergoing no medical stress other than common anesthesia and mechanical ventilation.
My impression after finishing the paper was that the people at QTest labs (associated with Ohio State University College of Veterinary Medicine) needed a study to do, needed to get a grant proposal ready, and did enough research on the subject to sell this trial. It’s well written and the authors do a great job of placing their results in context of the literature, mostly because it all agrees. But it can’t hide the fact that it does nothing revolutionary other than providing history on the subject, and giving an excellent account of the methods used in the study. With such great, specific, and controlled procedures, this facility could be solidifying other theories that have conflicting data, if they’d use a sample size large enough. I’m sure that they don’t always do milk run trials such as this one, and I look forward to seeing their name again in future articles.
William W. Muir III, Anusak Kijtawornrat, Yukie Ueyama, Steven V. Radecki, & Robert L. Hamlin (2011). Effects of intravenous administration of lactated Ringer’s solution on hematologic, serum biochemical, rheological, hemodynamic, and renal measurements in healthy isoflurane-anesthetized dogs JAVMA, 239 (5), 630-637