Perioperative fluid restriction reduces complications after major gastrointestinal surgery

Risk of death after emergency repair of abdominal wall hernias. Still waiting for improvement

“…Also, a restrictive policy for intraoperative volume infusion [27] and a selective use of nasogastric decompression after surgery [28] seems advisable. Patients with high-risk score for postoperative death (Table 4) may benefit from strict monitoring and systematic application of similar guidelines as designed for fast-track surgery and to prevent postoperative pneumonia [29].…”

The Acute Stress Reaction to Major Thoracic Surgery

“…The natural final goal is the retention of water and sodium; if the body is going to conserve water and sodium as a response to the surgical trauma, that would imply that smaller quantities of these elements should suffice to maintain homeostasis [6].…”

“…Walsh et al in an interesting manuscript "Perioperative fluid restriction reduces complications after major gastrointestinal surgery" [6]. They reported that the body's fluid and electrolyte balance is maintained within a tightly defined range and this is achieved mainly by the kidney, under the influence of antidiuretic hormone and the renin--angiotensin-aldosterone axis, which influence sodium and water excretion and retention as necessary to maintain the volume and osmolality of the extracellular fluid.…”

“…The resulting accumulation of albumin increases the oncotic pressure of the interstitium, serving to draw further water and sodium from the intravascular space. [6] A new insight in the mechanism liable for the fluid's transendothelial permeability came from the comprehension of the endothelial surface layer (ESL) and the role of endothelial glycocalyx as reported by Strunden [13]. Every healthy vascular endothelium is coated by transmembrane syndecans and membrane-bound glypicans containing heparan sulphate and chondroitin sulfate side chains, which together constitute the endothelial glycocalyx [14,15].…”

Anthropometric, Hemodynamic, Metabolic, and Renal Responses during 5 Days of Food and Water Deprivation

“…Increased fluid intake was reported to decrease glomerular filtration rate (GFR) [6]. Fluid restriction was found to be beneficial: (a) in surgery, since it reduced complications after partial colectomy [7], (b) in nephrology, since it improved the prognosis of chronic kidney disease (CKD) [8,9], and (c) in intensive care medicine, since it improved the treatment of lung injury and acute respiratory distress syndrome (ARDS) [10]. …”