The management of fluid in the postoperative surgical patient can vary from simple to complex. Understanding body fluid physiology and possible outcomes of different fluid management strategies is crucial for all surgeons. Dillon, in pediatric surgery seventh edition, 2012. Perioperative fluid management impacts outcomes and plays a pivotal role in enhanced recovery pathways erps. Perioperative fluid therapy for major surgery anesthesiology. This iv fluid is for maintenance and i hesitate to comply to their wishes. Perioperative and postoperative fluid management in. Abstractperioperative fluid management remains controversial. Postoperative fluid management aims to maintain a normovolemic state and continues to assess fluid responsiveness, particularly in highrisk patients. Fluid management is a major part of junior doctor prescribing.
Fasting prior to surgery is mandatory to avoid aspiration of stomach content to the lungs. Current evidence favors a flowguided approach to perioperative fluid administration, which uses variables such as stroke volume and cardiac. Postoperative fluid management baishideng publishing group. Appropriate fluid management is a cornerstone of anesthetic practice. Four typical clinical examples 41, 367, 395, 406 of over hydration as a result of intraoperative dilution of the ecfv with iv fluids of different chloride.
Optimizing perioperative fluid management is essential to reducing the risk of postoperative complications and mortality. Six hours fasting from food and 2 h from liquids is generally recommended, and the patient should be encouraged to minimize the fasting period, thus avoiding dehydration. Achieving optimal iv fluid therapy should improve perioperative outcomes and is a key component in many perioperative guidelines and pathways. However, some surgeons are insisting ringers lactate be put on as an option as well. Jun 16, 2007 in a recent randomised trial in patients, the ards clinical trials network concluded that a balanced fluid regimen conservative management over the first 7 days was beneficial in patients with acute lung injury. Blood glucose and electrolytes should be monitored closely regardless of fluid. The primary exposure variable was total intraoperative.
Intraoperative fluid management volume of intraoperative fluids. Postoperative fluid management plays a key role in providing adequate tissue perfusion, stable hemodynamics and reducing morbidities related with hemodynamics. There have been major advances in understanding the effects of fluid therapy and administration during the perioperative period. Proper administration of fluids is critical, especially in patients who undergo major surgeries such as emergency laparotomies, bowel resections and hepatectomy procedures. Perioperative and postoperative fluid management in pediatric cardiac surgery vary according to operation type, fluid needs and the condition of each patient adaptation. Effects of intraoperative fluid management on postoperative outcomes.
Carbohydrates given orally or intravenously have been shown to improve postoperative wellbeing and. Overview of fluid and electrolyte therapy in injury, illness and starvation 6. Postoperative intravenous maintenance fluid therapy ensures adequate organ perfusion, prevents catabolism, ensures electrolyte and phbalance, and may be all that is required for patients who undergo surgical procedures that do not significantly alter the hemodynamic milieu. Anesthesiologists know that too much fluid may lead to complications from side effects, including tissue edema, poor cardiac function, or pulmo.
Perioperative fluid management and postoperative hyponatremia. It is common practice to include intraoperative fluids in the fluid balance on the day of surgery. Jan 20, 20 o fluid administration depends upon clinical judgement of patients status. Perioperative fluid management and postoperative hyponatremia in children gia j. Healthy humans may live in a state of fluid responsiveness without the need for fluid supplementation. When new npo guidelines are followed, fasting fluid deficit is expected to be minimal. Standard postoperative fluid management in adults the. Perioperative fluid therapy bja education oxford academic. May 12, 2006 currently, the options for postop iv fluid are 0. Estimation of fluid and electrolyte losses can be difficult especially in conditions that predispose to third spacing such as sepsis, hypoalbuminemia, intraabdominal infection, postoperative abdominal surgery or cardiac surgery.
In a recent randomised trial in patients, the ards clinical trials network concluded that a balanced fluid regimen conservative management over the first 7 days was beneficial in patients with acute lung injury. Assuming the usual 70 kg previously healthy person, this means you should aim for. This analysis of data on file included 92,094 adult patients undergoing noncardiac surgery with endotracheal intubation between 2007 and 2014 at an academic tertiary care hospital and two affiliated community hospitals. Liberal fluid volumes highest quintile of fluid administration practice. Perioperative fluid therapy in pediatrics murat 2008. Currently taught and prac ticed methods of intraoperative volume management in which intravenous fluids are given based on a generalizable formula relying on. Recommendations for preoperative fluid management 8. Fluid management in perioperative and critically ill patients. Pdf postoperative fluid management in major elective. International audits of perioperative fluid management suggest that the availability of institutional guidelines, algorithms, audits, and the application of goal directed fluid management guided by flow monitors is rare. Ventilator support should be tailored to keep preductal sa o 2 greater than 90% and p co 2 less than 60 mm hg. Pdf postoperative care units are run by an anesthesiologist or a surgeon, or a team formed of both. Fluid therapy in the perioperative settinga clinical.
Fluid therapy to restore andor maintain tissue perfusion may affect patient outcomes in perioperative, emergency, and intensive care. Indicators that a patient may need fluid resuscitation include. Diagnosis, prevention and management of postoperative. Postoperative management for transoral robotic surgery is relatively routine with administration of iv antibiotics, pain medication, and steroids as indicated.
Would you consider ringers lactate as an appropriate postop fluid choce. Evidence is emerging that isotonic fluids are preferable in postoperative patients, due to their increased risk of free water retention and hyponatraemia. Apa consensus guideline on perioperative fluid management in children v 1. A more structured approach to fluid management is required to overcome these problems. Major surgery is associated with a number of fluid, electrolyte, and acidbase disorders, which can be ascribed to a number of different causes, including blood. Fluid management is key to preventing complications. Intraoperative fluid management and blood transfusion essentials.
Ensuring considered fluid and haemodynamic management is central to perioperative. Mar 18, 2008 intraoperative fluid management volume of intraoperative fluids. Anesthesiologists know that too much fluid may lead to complications from side effects, including tissue edema, poor cardiac function, or. Request pdf postoperative fluid management major surgery is associated with a number of fluid, electrolyte, and acidbase disorders, which can be ascribed to a number of different causes. Perioperative and postoperative fluid management in pediatric. Sutherland intravenous iv fluids are used ubiquitously when children undergo surgical procedures. To improve prognosis after esophageal surgery, intraoperative fluid optimization is important.
Effects of intraoperative fluid management on postoperative. Recommendations for intra operative fluid management 9. Most patients are less able to excrete fluid and sodium postoperatively. Guidelines on intravenous fluid therapy for surgical patients. Nonsteroidal antiinflammatory drugs nsaids, such as diclofenac 1 mgkg and ibuprofen can also be. Postoperative fever presents a diagnostic challenge to surgeons as it can be due to a number of infectious causes, as well as a noninfectious inflammatory response to the procedure itself.
An increased recognition of hospitalacquired hyponatremia and its associated morbidity has led to a critical reexamination of iv fluid management. Therefore, the administration of intravenous fluids before, during, and after surgery at the right time and in the right amounts is of great importance. Preoperative fluid management strategies aim to avoid the patient arriving in the operating room in a hypovolemic or dehydrated state. A number of factors contribute to effective postoperative pain management including a structured acute pain management team, patient education, regular staff training, use of. D r i s m a h s u r g i c a l d e p a r t m e n t iv fluids beneficial or more harm. Multiple international guidelines, including those from the american society of anesthesiologists, allow unrestricted intake of clear fluids up to 2 h before elective surgery. Postoperative management should continue the trends and goals established before the operative procedure. Current concepts of fluid management in enhanced recovery. Postoperative patients can also be at risk of hyperglycaemia if excessive glucose is administered. Postoperative fluid management most patients are less able to excrete fluid and sodium postoperatively, which they retain 4. Current concepts of fluid management in enhanced recovery pathways. Postoperative pulmonary edema is a wellknown postoperative complication with little known etiology and mortality. Major surgery is associated with a number of fluid, electrolyte, and acidbase disorders, which can be ascribed to a number of different causes, including blood loss, volume resuscitation, tissue trauma, cardiovascular instability, changes in body temperature and renal dysfunction.
The gold standart of the fluid therapy is to use the correct fluid, to maintaine the electrolyte balance, and to provide cardiovascular stability, adequate organ. Perioperative fluid management is at the heart of enhanced recovery and the use of intraoperative fluid management technology, such as oesophageal doppler, is supported by the erp in line with the national institute of clinical excellence nice guidance mtg3, the nhs operating framework 2012 and the department of health innovation. Guidelines on intravenous fluid therapy for surgical. They were developed in colonic operations 11,14e17 and are now being applied to all major operations. All consecutive adult patients who underwent elective esophageal surgery for cancer. Thirdspace losses are usually underestimated and postoperative fluid prescribing rarely takes them into account. Nevertheless, its optimization is essential to reducing the risk of postoperative complications, which have been shown to profoundly affect patients short and longterm outcomes. Postoperative fluid management europe pmc article europe pmc. Stroke volume variationguided fluid management decreased postoperative pain in patients undergoing spine surgery anaesth critic care med j stroke volume variationguided fluid management decreased postoperative pain in patients undergoing spine surgery chen 1wy,3, chia yy1,2,3 and lo y1,2,3. Mar 18, 2015 intravenous iv fluids are used ubiquitously when children undergo surgical procedures.
Evaluate the doseresponse relationship between intraoperative fluid administration and postoperative outcomes in a large cohort of surgical patients. Until recently, holliday and segars guidelines for calculating maintenance fluids dictated fluid management strategies in postoperative pediatric patients. Intraoperative fluid therapy is aimed at providing basal metabolic requirements maintenance fluids, at compensating for preoperative fasting deficit and at replacing losses from surgical field. Historically, the focus has been on the intraoperative management of. Overview of postoperative fluid therapy in adults uptodate.
Kinetic analyses and outcomeoriented studies have provided more insight into fluid management. Perioperative fluid management to enhance recovery. Perioperative hypovolemia and fluid overload have effects on both complications following surgery and on patient survival. Important injectable drugs for pain are the opiate analgesics. Postoperative oliguria significant dehydration will be covered in a separate article fluid volume. Pre and postoperative fluid management in infancy american. Management of postoperative fluid therapy should be done considering both patients status and intraoperative events. Pain management and techniques effective analgesia is an essential part of postoperative management. The eras programmes have now become a standard in perioperative management that has been adopted in many countries across several surgical specialties. Knowledge of the most common causes of fever after surgery is necessary to guide.
Careful estimation of ongoing pathogenic fluid losses is important to determine the best volume and composition of fluid replacement. Perioperative fluid stressors cont patients primary disease causes intravascular fluid excess. Effective postoperative pain management has a humanitarian role, but there are additional medical and economic benefits for rapid recovery and discharge from hospital. Eating and drinking soon after gastrointestinal resection should be encouraged, as feeding is associated with a reduced risk of infection and a decreased length of stay, without an increase in the risk of anastomotic. Similarly, perioperative fluid therapy can be divided into three components, namely, preoperative, intraoperative, and postoperative management. Types of the fluids, amount of the fluid given and timing of the administration are the main topics that determine the fluid management strategy. Nov 29, 2019 fluid therapy to restore andor maintain tissue perfusion may affect patient outcomes in perioperative, emergency, and intensive care. Many patients will require nasogastric feeding tube support during the postoperative recovery for several days, and a gastrostomy tube, although rarely required for earlystage lesions. Herein, we hypothesized that hydroxyethyl starch administration during esophagectomy reduce the total amount of fluid infused and it could have a positive effect on postoperative complication occurrence and mortality. Details of fluids administered must be clearly recorded and easily. On the contrary, many postoperative patients after aortic surgery are hypovolemic when they return from. Fluid management and goaldirected therapy as an adjunct to enhanced recovery after surgery eras. Postoperative management an overview sciencedirect topics.
424 275 1421 889 16 529 512 1489 1268 499 795 1052 48 1158 1014 1186 841 111 1047 633 1138 82 73 1084 162 916 1115 1433 537 355 891