J.Jpn. Surg. Soc.. 58(11): 1718-1742, 1958

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WATER AND ELECTROLYTE BALANCE DURING AND AFTER SURGICAL INTERVENTION WITH ENDOTRACHEAL ANESTHESIA

This paper is a report of studies concering to certain aspects of the water and electrolyte response to operation in patients. An attempt has been made to evaluate some of the factors present in the response to operative and anesthetic procedures by determination of serum electrolytes levels and blood sugar, urinary output and its content of electrolytes for every 30 minutes during and after operation.
RESULTS:
In hypoproteinemic or dehydrated patients rapid infusion of fluid caused forced excretion of pottasium resulting hypokalemia and edema. They also showed electrolyte instability during and after operation.
Deleterious effect of unskillfulness of anesthesia was reflected upon the electrolyte metabolism. Slow intubation accompanied by prolonged apnea caused immediate decrease of urine output or even anuria and increase of urinary concentration of pottasium and chloride.
During operative procedure output of urine, urinary pottasium and chloride were very small without correlation to the volume of administered fluid or duration of operation. Excess fluid caused pulmonary edema or edema of traumatized area. On the other hand increase of urinary pottasium, preceded by a rise of blood sugar, suggests the glycolysis of the liver glycogen.
In thoracic surgery pressing or pulling of lung tissue was followed by sudden increase of urinary chloride output as high as Cl/Na ratio of 3.0-4.0. After the completion of pulmonary procedure this ratio came back to near 1.0. In abdominal operations such fluctuation of chloride could not be seen.
Postoperative output of water and electrolytes in the first 24 hours was rather largeregarding the scantiness of that collected during operation. After the second day they decreased gradually until the 5-7th day when considerable amount was excreted irrespective of intake (diuretic phase). Recovery was slower in abdominal patients than in thoracic cases.
It must be, therefore.noted that mid-and post-operative fluid therapy should be carried out very carefully. Small amount of Ringer's solution plus 10% glucose solution was satisfactory for mid-operative infusion, and following operation the same solution added by KCl was preferable.
(author's abstract)

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