State-of-the-art fluid management in the operating room.
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The underlying principles guiding fluid management in any setting are very simple: maintain central euvolemia, and avoid salt and water excess. However, these principles are frequently easier to state than to achieve. Evidence from recent literature suggests that avoidance of fluid excess is important, with excessive crystalloid use leading to perioperative weight gain and an increase in complications. A zero-balance approach aimed at avoiding fluid excess is recommended for all patients. For major surgery, there is a sizeable body of evidence that an individualized goal-directed fluid therapy (GDFT) improves outcomes. However, within an Enhanced Recovery program only a few studies have been published, yet so far GDFT has not achieved the same benefit. Balanced crystalloids are recommended for most patients. The use of colloids remains controversial; however, current evidence suggests they can be beneficial in intraoperative patients with objective evidence of hypovolemia.
goal-directed fluid therapy
Published Version (Please cite this version)10.1016/j.bpa.2014.07.003
Publication InfoMiller, Timothy E; Raghunathan, Karthik; & Gan, Tong J (2014). State-of-the-art fluid management in the operating room. Best Practice and Research: Clinical Anaesthesiology, 28(3). pp. 261-273. 10.1016/j.bpa.2014.07.003. Retrieved from https://hdl.handle.net/10161/14001.
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Consulting Professor in the Department of Anesthesiology
My current research interests include postoperative nausea and vomiting (PONV), acute postoperative pain, clinical pharmacology of anesthetic drugs and resuscitation fluids as well as database research in postoperative outcomes. Improving Outcome in Surgical Patients: Nausea and vomiting is regarded as one of the most unpleasant experiences in postoperative recovery. To date, there is no single antiemetic which can satisfactorily control PONV. My interests concentrate o
This author no longer has a Scholars@Duke profile, so the information shown here reflects their Duke status at the time this item was deposited.
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.
Associate Professor of Anesthesiology
Board Certified in Anesthesiology and in Critical Care Medicine, Dr. Raghunathan is an Associate Professor with Tenure at the Duke University School of Medicine and is a Staff Physician at the Durham Veterans Affairs Healthcare System in Durham, North Carolina. He is Co-Director of the Critical Care and Perioperative Population Health Research (CAPER) Unit at the Department of Anesthesiology, Duke University Medical Center.&n
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