Modulation of physiological hemostasis by irrigation solution: comparison of various irrigation solutions using a mouse brain surface bleeding model

Laboratory investigation

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Intraoperative bleeding often obscures the surgical field and may cause neurological damage. The irrigation fluids used during surgery might affect physiological hemostasis because they modulate the extracellular fluid composition of the bleeding area directly. The authors therefore investigated the influence of irrigation fluid on hemostasis in a mouse brain surface bleeding model.


The cerebral cortices of ddY strain mice were exposed under irrigation with normal saline, lactated Ringer (LR) solution, or artificial CSF (ACF-95). To investigate the influence of electrolytes, calcium, potassium, or both were also added to the saline. After 10 minutes of irrigation at 100 ml/hour, sequential photographs of the surgical area were taken with a microscope, and the number of bleeding points was counted visually. Irrigation and counting were performed in a masked manner.


There were significantly more bleeding points after irrigation with normal saline than with ACF-95; LR solution had a similar effect on physiological hemostasis as ACF-95. Saline augmented with calcium or potassium and calcium was superior to normal saline in terms of hemostasis.


The authors demonstrated that the irrigation fluid used in neurosurgery affects bleeding at the surgical site. To avoid surgical site bleeding, ACF-95 and LR solution should be used as irrigation fluids instead of normal saline. The calcium and potassium content of irrigation solutions seems to be important in hemostasis.

Abbreviations used in this paper: AL = group irrigated with ACF-95 and then lactated Ringer solution; AS = group irrigated with ACF-95 and then normal saline; LA = group irrigated with lactated Ringer solution and then ACF-95; LR = lactated Ringer; MABP = mean arterial blood pressure; SA = group irrigated with saline and then ACF-95.

Article Information

Address correspondence to: Kazuhisa Doi, M.S., Research and Development Center, Otsuka Pharmaceutical Factory, Inc., 115 Tateiwa Naruto, Tokushima 7728601, Japan. email:

Please include this information when citing this paper: published online August 7, 2009; DOI: 10.3171/2009.7.JNS09561.

© AANS, except where prohibited by US copyright law.



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    Photographs showing the bleeding points after irrigation for 10 minutes with each test solution (the area shown is equivalent to 2.2 × 2.9 mm). Twenty-eight sequential photographs were taken at each time point over a 10-second period, and bleeding points were counted in these photographs. A: First image obtained in the AS group at Time Point 1 (ACF-95). B: First image obtained in the AS group at Time Point 2 (normal saline). C: First image obtained in the SA group at Time Point 1 (normal saline). D: First image obtained in the SA group at Time Point 2 (ACF-95). Original magnification × 3.


  • 1

    Davson H: Physiology of the Cerebrospinal Fluid LondonJA Churchill1967. 3354

  • 2

    Doi KKawano TMorioka YFujita YNishimura M: Various irrigation fluids affect postoperative brain edema and cellular damage during experimental neurosurgery in rats. Surg Neurol 66:5655722006

  • 3

    Elliott KACJasper HH: Physiological salt solutions for brain surgery. J Neurosurg 6:1401521949

  • 4

    Enomoto RTatsuoka HKomai TSugahara CTakemura KYamauchi A: Involvement of histone phosphorylation in apoptosis of human astrocytes after exposure to saline solution. Neurochem Int 44:4594672004

  • 5

    Kamikawa SInui AAsakawa AKasuga MTamaki NKobayashi N: Histologic diagnosis and management of hypothalamic tumors in children by the use of newly developed flexible neuroendoscopes. Int J Oncol 22:2692722003

  • 6

    Mahdy AMWebster NR: Perioperative systemic haemostatic agents. Br J Anaesth 93:8428582004

  • 7

    Milhorat TH: Hydrocephalus and the Cerebrospinal Fluid BaltimoreWilliams & Wilkins1972. 141

  • 8

    Oka KYamamoto MNonaka TTomonaga M: The significance of artificial cerebrospinal fluid as perfusate and endoneurosurgery. Neurosurgery 38:7337361996

  • 9

    Uchida KYamada MHayashi TMine YKawase T: Possible harmful effects on central nervous system cells in the use of physiological saline as an irrigant during neurosurgical procedures. Surg Neurol 62:961052004




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