Drug Des Devel Ther. 2026 Oct 9;20:646669. doi: 10.2147/DDDT.S646669. eCollection 2026.
ABSTRACT
BACKGROUND: In neuroanesthesia, a prompt emergence from anesthesia is essential for postoperative neurologic assessment. Intraoperative infusion of sodium bicarbonate Ringer’s solution (BRS) and lactated Ringer’s solution (LRS) have different effects on internal environment, potentially contributing to discrepant recovery profiles. Therefore, this study aimed to compare the recovery of BRS and LRS in patients undergoing craniotomy for supratentorial tumors.
METHODS: This randomized controlled trial enrolled patients undergoing elective supratentorial tumor resection. Patients were randomized to receive BRS or LRS for intraoperative fluid therapy. The primary outcome was emergence time. Secondary outcomes included extubation times, short Orientation Memory Concentration Test (SOMCT) at 15 min after extubation and postoperative complications. Parameters including lactic acid (Lac), pH, base excess (BE), and serum Mg2+ levels were measured at several time points and compared between the two groups. Total length of hospital stay was also recorded and compared between the two groups. Primary analysis followed the intention-to-treat (ITT) principle. A per-protocol (PP) sensitivity analysis was also performed for the primary outcome.
RESULTS: The ITT analysis included 100 patients (BRS group: n = 50; LRS group: n = 50). Following exclusions for short surgery or massive intraoperative blood loss, the PP set included 48 BRS and 47 LRS patients. In the ITT analysis, Patients assigned to the BRS group had shorter emergence (13min vs 16min; median difference, 3; 95% CI, 1 to 4; P=0.003) and extubation times (15min vs 18min; median difference, 2; 95% CI, 1 to 4; P=0.01), and lower lactate levels at the end of surgery and 0.5 hour after extubation (P < 0.05). SOMCT scores at 15 min after extubation, postoperative complications and total hospitalization days were comparable between the groups (P > 0.05). Additionally, no significant group-by-time interactions were found for pH, BE and Mg2⁺ levels, indicating similar temporal changes between groups (P > 0.05).
CONCLUSION: Patients receiving BRS during supratentorial tumor resection had faster emergence and shorter extubation times, but similar SOMCT scores at 15 min after extubation and complication rates compared to those receiving LRS.
TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2500105691, registered on July 9, 2025.
PMID:42872260 | PMC:PMC13660727 | DOI:10.2147/DDDT.S646669
