Efficacy of sodium bicarbonate Ringer's solution for perioperative fluid management in infants with biliary atresia: a prospective multicenter study.

Purpose: To evaluate the efficacy and safety of perioperative sodium bicarbonate Ringer's solution (BRS) in biliary atresia (BA) infants undergoing Kasai portoenterostomy (KPE).

Methods: This study was conducted in 11 pediatric medical centers across China from 2020 to 2022. Infants were randomly assigned to either the BRS group (n = 64) or the control crystalloids group (n = 56) for perioperative fluid management. Anesthesia and fluid management were standardized. Primary outcomes were arterial blood pH, bicarbonate, and base excess; secondary outcomes included changes in other blood parameters and adverse events.

Results: The baseline characteristics of the two groups were similar. During KPE, BRS more effectively maintained arterial blood pH, bicarbonate, and base excess during KPE with no electrolyte abnormalities. Three days after KPE, the BRS group had lower potassium levels. Drug safety evaluation showed no significant differences, and the incidence of adverse events was comparable.

Conclusion: BRS effectively maintained the acid-base status of BA infants during KPE. With no significant safety concerns, it is suggested that BRS is a suitable option for perioperative fluid management.