Battle of the Crystalloids in the Operating Room: A Literature Review

Alejandra Salinero, Greta Mitzova-Vladinov

Research output: Contribution to journalArticlepeer-review


Purpose: The purpose of this article is to synthesize the evidence regarding the commonalities and differences between the three most common crystalloid solutions used in the operating room (normal saline [NS], lactated Ringer's [LR], and Plasmalyte [PL]) in order to determine best practice. Design: This study is an integrative review of literature. Methods: A review of the literature was conducted using the PubMed, CINAHL Plus, and Cochrane Library databases. The inclusion criteria included adult patients undergoing surgery who received either NS, LR, and/or PL (or similar solutions) for fluid maintenance therapy. Findings: A total of 15 articles from 2008 to 2020 conducted in a surgical setting were selected for the review; eleven randomized controlled studies, three observational studies, and one cohort-controlled trial. Conclusions: The findings suggest balanced crystalloid solutions are superior to NS in the operating room in terms of maintaining a stable acid-base balance. PL is preferable to LR because it most closely resembles plasma concentration. Future research is needed to determine the cost-effectiveness of the solutions.

Original languageEnglish (US)
Pages (from-to)629-637
Number of pages9
JournalJournal of Perianesthesia Nursing
Issue number6
StatePublished - Dec 2021


  • anesthesia
  • crystalloids
  • fluid administration, intraoperative
  • fluids
  • surgery

ASJC Scopus subject areas

  • Medical–Surgical


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