Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS).
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Optimal perioperative fluid management is an important component of Enhanced Recovery After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a continuum through the preoperative, intraoperative, and postoperative phases. Each phase is important for improving patient outcomes, and suboptimal care in one phase can undermine best practice within the rest of the ERAS pathway. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state. To achieve this, prolonged fasting is not recommended, and routine mechanical bowel preparation should be avoided. Patients should be encouraged to ingest a clear carbohydrate drink two to three hours before surgery. The goals of intraoperative fluid management are to maintain central euvolemia and to avoid excess salt and water. To achieve this, patients undergoing surgery within an enhanced recovery protocol should have an individualized fluid management plan. As part of this plan, excess crystalloid should be avoided in all patients. For low-risk patients undergoing low-risk surgery, a "zero-balance" approach might be sufficient. In addition, for most patients undergoing major surgery, individualized goal-directed fluid therapy (GDFT) is recommended. Ultimately, however, the additional benefit of GDFT should be determined based on surgical and patient risk factors. Postoperatively, once fluid intake is established, intravenous fluid administration can be discontinued and restarted only if clinically indicated. In the absence of other concerns, detrimental postoperative fluid overload is not justified and "permissive oliguria" could be tolerated.
Central Venous Pressure
Length of Stay
Recovery of Function
Published Version (Please cite this version)10.1007/s12630-014-0266-y
Publication InfoMiller, Timothy Ellis; Roche, Anthony Michael; & Mythen, Michael Gerard (2015). Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS). Can J Anaesth, 62(2). pp. 158-168. 10.1007/s12630-014-0266-y. Retrieved from http://hdl.handle.net/10161/13966.
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Associate Professor of Anesthesiology
Clinical and research interests are Enhanced Recovery and Perioperative Medicine; with particular interests in fluid management, and perioperative optimization of the high-risk non-cardiac surgery patient.
Adjunct Professor in the Department of Anesthesiology
Main area of research interest is the role of gut mucosal hypoperfusion in the pathogenesis of post-operative organ dysfunction. On-going projects include: i) the effects of temperature on gut perfusion during cardiopulmonary by-pass, ii) the relationship between cerebral and splanchnic hypoperfusion during cardiac surgery, iii) the relationship between gut mucosal hypoperfusion and outcome in patients admitted for surgical intensive care, iv) the effects of enteral feeding on gut perfusion and
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