Highlights ■ This randomized controlled trial in elective neurosurgery adds important evidence to the growing body of literature comparing Plasma-Lyte 148 with 0.9% saline in specialized surgical populations. ■ Plasma-Lyte 148 demonstrated superior acid-base homeostasis with significantly higher bicarbonate levels and base excess at surgical completion, whereas 0.9% saline induced hyperchloremia in the saline group. ■ The biochemical advantages of Plasma-Lyte 148 align with current evidence supporting balanced crystalloids as the preferred choice in perioperative fluid management. ■ These findings […]