Fluid Management In Peri operative Setting

Fluid management in the perioperative setting remains an area of significant controversy. Poor fluid management can wreak havoc in a surgical patient’s physiological electrolyte and fluid balance and thus cause inadequate tissue oxygenation and perfusion. From a perioperative perspective, this is especially concerning in patient’s undergoing abdominal surgery because these patients must fast pre-operatively and are often not able to manage their own fluid consumption post-operatively. Therefore, the onus falls upon the perioperative clinician to administer fluid appropriately and safely to correct for any tissue hypo-perfusion. In order to do so, one must be very careful to not replace fluid excessively or insufficiently, even if the risk is relatively small in previously and otherwise healthy, low risk surgical patients. Nevertheless, it should be noted that even in these otherwise low risk patients, a tendency towards hypervolemia or hypovolemia is reasonable in the setting of recent abdominal surgery. To this end, extensive research on perioperative fluid management has been done comparing “liberal” fluid regimens with “restrictive” and “goal-directed” fluid regimens. Fluid Management In Peri operative Setting

Historically, clinicians have tended towards a more liberal fluid regimen of up to 7 litres of crystalloid on the day of abdominal surgery. This was usually done to correct for perceived fluid deficits such as preoperative fasting (although some have argued that dehydration from preoperative fasting is negligible), vasodilation secondary to anaesthetic agents, and third space losses. This has been shown to decrease nausea, drowsiness and thirst in patients undergoing minor surgery. Unfortunately, overzealous replacement has been shown to cause tissue oedema with concurrent weight gain. Furthermore, accidentally causing a hypervolemic state could increase the risk of renal failure, pulmonary oedema, impaired wound healing and even sepsis. In recent years, there has been more support for fluid restriction. Whilst there have been some smaller studies that have demonstrated decreased hospital stays and fewer post-surgical complications secondary to a restrictive fluid regimen; the overall evidence for its use in abdominal surgery remains inconclusive. Moreover, accidentally causing a hypovolemic state could increase the risk of hypotension and decreased organ tissue perfusion leading to organ failure. Fluid Management In Peri operative Setting