From the Guidelines
Hartman solution should be used cautiously before surgery, with the goal of maintaining near zero fluid balance, as recommended by the most recent guidelines 1. The use of Hartman solution, also known as Ringer's lactate, is a common practice in perioperative care to maintain fluid balance and electrolyte levels. However, the key aim is to maintain intravascular volume and avoid electrolyte imbalances, with a narrow range of optimal fluid therapy to prevent complications from over or under hydration.
Key Considerations
- The solution contains sodium, potassium, calcium, chloride, and lactate, making it similar to plasma composition.
- Administration should be individualized based on the patient's hydration status, expected blood loss, and duration of the procedure.
- Intraoperative fluid administration should aim to restore and maintain adequate organ and tissue perfusion, while avoiding fluid overload 1.
- Patients with congestive heart failure, chronic kidney disease, and acute and chronic lung disease have lower fluid tolerance and are at higher risk of fluid accumulation.
Recommendations
- Near zero fluid balance is recommended, with the use of balanced crystalloids such as Ringer's lactate 1.
- Avoidance of 0.9% saline due to the risk of salt and fluid overload.
- Oliguria should not trigger fluid therapy, but rather be investigated to establish the cause.
- Postoperative IVF should be discontinued at the latest during day 1, with patients encouraged to drink when fully recovered and offered an oral diet within 4 hours after abdominal/pelvic surgery.
- The use of Hartman solution should be guided by monitoring to avoid excessive fluid therapy and maintain optimal fluid balance 1.
From the Research
Hartman Solution Before Surgery
- The use of Hartman solution, also known as lactated Ringer's solution, before surgery is a common practice to maintain fluid and electrolyte balance in patients 2.
- A study published in 1995 compared the effects of amnioinfusion with normal saline and lactated Ringer's solution on fetal electrolyte and acid-base balance, and found that lactated Ringer's solution resulted in minimal changes in fetal electrolytes and acid-base balance 3.
- Another study published in 2002 investigated the effects of isotonic and hypotonic lactated Ringer's solutions with dextrose on dehydrated heifers, and found that rapid infusion of hypotonic lactated Ringer's solution was safe and effective in increasing plasma volume without increasing central venous pressure 4.
- These studies suggest that Hartman solution can be used before surgery to maintain fluid and electrolyte balance, and to prevent dehydration and metabolic acidosis.
- However, it is essential to note that the specific composition and dosage of Hartman solution may vary depending on the individual patient's needs and the type of surgery being performed.
- Further research is needed to fully understand the effects of Hartman solution on patients before surgery, and to determine the optimal composition and dosage for different clinical scenarios.