State-of-the-art fluid management in the operating room.
Abstract
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.
Type
Journal articleSubject
colloidcrystalloid
fluids
goal-directed fluid therapy
Fluid Therapy
Humans
Isotonic Solutions
Operating Rooms
Perioperative Care
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https://hdl.handle.net/10161/14001Published Version (Please cite this version)
10.1016/j.bpa.2014.07.003Publication Info
Gan, Tong Joo; Miller, Timothy Ellis; & Raghunathan, Karthik (2014). State-of-the-art fluid management in the operating room. Best Pract Res Clin Anaesthesiol, 28(3). pp. 261-273. 10.1016/j.bpa.2014.07.003. Retrieved from https://hdl.handle.net/10161/14001.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Tong Joo Gan
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.
Timothy Ellis Miller
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.
Karthik Raghunathan
Associate Professor of Anesthesiology
Dr. Karthik Raghunathan, MD is a board certified anesthesiologist affiliated with Duke University
and with the Durham Veterans Affairs Healthcare System in Durham, North Carolina.
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