Perioperative fluid management and clinical outcomes in adults.

Centre for Anaesthesia, University College London, United Kingdom.
Anesthesia & Analgesia (Impact Factor: 3.42). 05/2005; 100(4):1093-106. DOI: 10.1213/01.ANE.0000148691.33690.AC
Source: PubMed

ABSTRACT The administration of IV fluid to avoid dehydration, maintain an effective circulating volume, and prevent inadequate tissue perfusion should be considered, along with the maintenance of sleep, pain relief, and muscular relaxation, a core element of the perioperative practice of anesthesia. Knowledge of the effects of different fluids has increased in recent years, and the choice of fluid type in a variety of clinical situations can now be rationally guided by an understanding of the physicochemical and biological properties of the various crystalloid and colloid solutions available. However, there are few useful clinical outcome data to guide this decision. Deciding how much fluid to give has historically been more controversial than choosing which fluid to use. A number of clinical studies support the notion that an approach based on administering fluids to achieve maximal left ventricular stroke volume (while avoiding excess fluid administration and consequent impairment of left ventricular performance) may improve outcomes. In this article, we review the available fluid types and strategies of fluid administration and discuss their relationship to clinical outcomes in adults.

  • [Show abstract] [Hide abstract]
    ABSTRACT: The scientific knowledge base that supports clinical decisions about perioperative fluid management continues to evolve. However, despite these advancements in the understanding of the physiology of fluid replacement, the definition of ‘‘optimal’’ perioperative fluid management remains a matter of clinical judgment. With an appreciation of the many factors, both sensible and insensible, that contribute to changes in blood and extracellular fluid volume during surgery, clinicians have tried to create reproducible and generally applicable formulas for replacement of fluid during surgery. These formulas have been challenged recently by the introduction of new tools for monitoring cardiopulmonary function, by the implementation of monitor-guided protocols for fluid management, and, more recently, by clinical data suggesting that fluid restriction may improve surgical outcomes in some clinical settings. The relative ease of pre-identified fluid replacement protocols is being slowly replaced by data-guided interventions that take into account a variety of factors. Clinicians are therefore required to tailor their fluid replacement strategies based on preoperative patient characteristics, the type of surgery and even the type of anesthetic that is utilized. Some of the benefits of this new approach range from relatively ‘‘minor’’ outcomes such as diminished nausea after surgery to preventing postoperative complications such as wound breakdown and cardiopulmonary failure.
    Seminars in Dialysis 11/2006; 19(6). · 2.25 Impact Factor
  • Source
    Journal of Cardiothoracic and Vascular Anesthesia 10/2014; · 1.48 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Die korrekte perioperative Flüssigkeitsbilanz ist Grundlage einer zielgerichteten Infusionspraxis. Weder Ausgangsstatus noch perioperative Veränderungen der Flüssigkeitsräume lassen sich jedoch in der täglichen Routine verlässlich bestimmen. Insbesondere die insensiblen Verluste werden nach wie vor nicht einheitlich beurteilt, und deren Substitution erfolgt daher zum großen Teil empirisch. Die vorliegende Arbeit soll die wissenschaftliche Datenlage zu diesem Thema vermitteln.Präoperative Nüchternheit (10 h) erzeugt per se keine relevante Hypovolämie. Die Gesamtevaporation über Haut, Atemwege und Wundfläche während großer abdominaler Eingriffe beträgt beim Erwachsenen weniger als 1 ml/kg/h. Ein perioperativ inkonstant auftretender Flüssigkeits- und Proteinshift in das Interstitium scheint hypervolämieassoziiert und somit vermeidbar zu sein. Die entscheidende Rolle spielt hierbei die Zerstörung der endothelialen Glykokalyx, deren weitere pathophysiologische Bedeutung bislang nur ansatzweise bekannt ist. Klinische Studien konnten den Zusammenhang zwischen Flüssigkeitsrestriktion und verbessertem Outcome nach großen abdominalen Eingriffen demonstrieren.
    Der Anaesthesist 01/2007; 56(8). · 0.74 Impact Factor

Full-text (2 Sources)

Available from
Jun 2, 2014