These are fluid recommendations for suregry in man. With no evidence of the existence of a non-anatomical third space loss and no effect of fluid preloading of neuroaxial blockade, the ‘restricted intravenous fluid therapy’ is not at all ‘restricted’, but based on current evidence. The principle is that loss should be replaced, but fluid overload (recognized as a postoperative body weight gain) should be avoided. This principle should be continued postoperatively (in the recovery room and in the surgical ward), with replacement of the daily requirements for nutrition, electrolytes, glucose, and water. The patients should be fed. Body weight measurements are the most reliable tool for estimation of fluid balance in surgical patients and should consequently guide the quantity of perioperative fluid administration. Registration of fluid losses on the fluid chart should guide the quality of fluid replacements. However, clinical judgement is indispensable: bodyweight changes do not recognize internal loss of vascular volume. Careful examination of patients with hypotension or low diuresis should be performed and the cause treated. If the cause is loss of volume, intravenous fluids should be supplemented; if the cause is vasodilatation (e.g. due to large doses of epidural analgesia or habitual anti-hypertensive medication), the treatment is not fluid but dose adjustment of the provoking factor or vasoconstricting agents (e.g. ephedrine). If the cause is development of a surgical complication (e.g. anastomotic leakage with sepsis), action should be taken to treat the complication, etc. Best Practice & Research Clinical Anaesthesiology Vol. 20, No. 2, pp. 265–283, 2006
Posted on: Mon, 02 Sep 2013 05:00:00 +0000
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