Perioperative fluid management for major elective surgery

Abstract

Background Adequate fluid balance before, during and after surgery may reduce morbidity. This review examines current concepts surrounding fluid management in major elective surgery. Method A narrative review was undertaken following a PubMed search for English language reports published before July 2019 using the terms ‘surgery’, ‘fluids’, ‘fluid therapy’, ‘colloids’, ‘crystalloids’, ‘albumin’, ‘starch’, ‘saline’, ‘gelatin’ and ‘goal directed therapy’. Additional reports were identified by examining the reference lists of selected articles. Results Fluid therapy is a cornerstone of the haemodynamic management of patients undergoing major elective surgery. Both fluid overload and hypovolaemia are deleterious during the perioperative phase. Zero‐balance fluid therapy should be aimed for. In high‐risk patients, individualized haemodynamic management should be titrated through the use of goal‐directed therapy. The optimal type of fluid to be administered during major surgery remains to be determined. Conclusion Perioperative fluid management is a key challenge during major surgery. Individualized volume optimization by means of goal‐directed therapy is warranted during high‐risk surgery. In most patients, balanced crystalloids are the first choice of fluids to be used in the operating theatre. Additional research on the optimal type of fluid for use during major surgery is needed.

Therapeutic Effect and Cost-Benefit Analysis of Three Different Nutritional Schemes for Esophageal Cancer Patients in the Early Post-operative Period

“…Therefore, goaloriented fluid replacement is advocated in the concept of fasttrack rehabilitation surgery. Many studies have also confirmed that goal-oriented fluid replacement can alleviate inflammatory responses, facilitate the recovery of intestinal function and reduce the risk of post-operative complications (23)(24)(25)(26). Fluid intake of all patients in this study was relatively high (median: 60-61 mL/kg/d).…”

Perioperative liberal versus restrictive fluid strategies and postoperative outcomes: a systematic review and metanalysis on randomised-controlled trials in major abdominal elective surgery

“…In the field of perioperative fluid administration, summarising the evidence available in the literature into straightforward clinical suggestions for daily clinical practice is rather complicated, and our updated results basically indicate an equivalence between the two perioperative fluid policies, suggesting a “third way”. The overall amount of fluid (perioperative target) should be integrated into an individualised goal-directed fluid replacement strategy (perioperative policy), to prevent fluid overload and fluid shortage by closely monitoring the effects of each bolus administered, as long as the individual plateau of the impact on predefined flow or pressure variables is achieved [ 12 , 44 ]. Interestingly, this approach was incorporated into the intraoperative protocol of 5 studies [ 16 , 25 , 27 – 29 ], including the study of Myles et al who assessed central venous pressure and stroke volume variation in case of intraoperative hypotension to guide resuscitation (supplementary appendix of the trial [ 16 ]).…”

“…Among them, perioperative fluid therapy is a core concept. The ideal perioperative approach has been debated for decades, having the crucial role of balancing oxygen supply and demand, maintaining fluid and electrolyte homeostasis and avoiding inadequate tissue perfusion and fluid overload [ 5 – 12 ].…”

Effect of Goal-directed Haemodynamic Therapy Guided by Non-invasive Monitoring on Perioperative Complications in Elderly Hip Fracture Patients Within an Enhanced Recovery Pathway.

“…The results of this study suggest that not only haemodynamic strategy we perform on our patients will in uence their outcomes. The type of uid used during major surgery may affect postoperative results (Heming et al 2020). The results of the uid infusion strategy used cannot be evaluated without considering the type of drug used.…”