Effects of Sodium Bicarbonate Ringer's Solution Combined with Positive End-Expiratory Pressure on the Internal Environment of Patients Undergoing Bariatric Surgery: A Randomized 2 × 2 Factorial Design Pilot.

BACKGROUND: To evaluate the influence of sodium bicarbonate Ringer's solution (BRS) combined with positive end-expiratory pressure (PEEP) on the internal environment in patients who have undergone laparoscopic bariatric surgery.

METHODS: A total of 128 patients undergoing laparoscopic bariatric surgery were randomly divided into the control group (group C), the PEEP group (group P), the BRS group (group B), and the BRS combined with the PEEP group (group BP). The results of arterial blood gas analysis, including pH value, base excess (BE), concentrations of electrolyte, and lactate (Lac) were documented before intravenous infusion (T0) and 5 min after the surgery (T1). Additional metrics included tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) and were quantified before intravenous infusion and at 30 min post-surgery. The quality of recovery-15 questionnaire (QoR-15) scores were documented preoperatively (D0) and on the first (D1) and third (D3) days, postoperatively.

RESULTS: There was no significant interaction effect between the two factors of BRS and PEEP (p = 0.659). After the infusion of BRS, the pH level increased significantly at T2 (p < 0.05). Using PEEP during operation can increase PaO2 in patients with obesity (p < 0.05). The level of pH value is increased, and the concentrations of inflammatory factors are reduced due to the combination of BRS and PEEP (p < 0.05). Compared with group C, group BP exhibited an augmentation in QoR-15 (p < 0.05), and the recovery time of group BP was significantly shortened (p < 0.05).

CONCLUSIONS: BRS combined with PEEP has been demonstrated to improve acid-base balance, reduce the inflammatory response, shorten the recovery time, and substantially enhance the quality of early postoperative recovery.