Management of perioperative volume therapy – monitoring and pitfalls

Abstract

Anesthesiologists play an important role in the perioperative process by assessing the overall risk of surgery, including the risk factors of the surgical procedure and those of the patient. There have been substantial developments over the last few decades regarding the risk of anesthesia. In the early days of anesthesia, the risk of the anesthetic procedure itself was high and led to a number of fatalities [1,2]. This has changed dramatically, and these days anesthesia-related deaths are extremely low. Such advances are likely related to drug advancements, an improved understanding of physiology, and better monitoring and management. However, death after surgery, including the whole perioperative process, has not substantially declined. The risk of death during the 30 days following surgery is 1,000 times more likely than during surgery itself [3]. According to recent data, death within 30 days of surgery is the third leading cause of death in the United States of America, behind cardiac diseases and malignancy [4]. Some recent studies have assessed this risk in detail. According to Weiser et al. [5], it is estimated that more than 310 million surgical procedures are performed worldwide. The exact complication rate and risk of death after these procedures are largely unknown. However, it is estimated that depending on the type of surgery and patient's comorbidities that about 30-40% of patients develop complications, of which up to 20% are severe and possibly life-threatening [6-8]. Besides, the mortality risk of surgery is not precisely known. It has been estimated that between 3 and 12 million patients die worldwide after surgery. The European Surgical Outcome study evaluated this in detail in a seven-day cohort study that included 46,539 patients from 498 European centers. Patients were followed for up to 60 days after their surgical procedure. Of this cohort, 1,855 patients died while in hospital, giving an in-hospital mortality rate of 4.7%. Additionally, the study Over 300 million surgical procedures are performed every year worldwide. Anesthesiologists play an important role in the perioperative process by assessing the overall risk of surgery and aim to reduce the risk of complications. Perioperative hemodynamic and volume management can help to improve outcomes in perioperative patients. There has been ongoing discussion about goal-directed therapy. However, there is a consensus that fluid overload and severe fluid depletion in the perioperative period are harmful and can lead to adverse outcomes. This article provides an overview of how to evaluate the fluid responsiveness of patients, details which parameters could be used, and what limitations should be noted.

Intravenous iron and erythropoietin therapy for postoperative anemia among orthopedic surgery patients

“…Hemodilution due to volume overload represents a potential cause for low hemoglobin levels. Hb concentration alone is therefore insufficient for a diagnosis of postoperative anemia, given its influence by plasma volume derangements, which may result in overdiagnosis [ 19 ]. In cases of uncomplicated recovery from surgery, a nadir in Hb concentration is mostly observed within the first 3–4 days [ 1 ].…”

Combination of Static Echocardiographic Indices for the Prediction of Fluid Responsiveness in Patients Undergoing Coronary Surgery: A Pilot Study

“…In that context, echocardiographic dynamic indices, such as peak flow, velocity-time integral of the ascending aorta or carotid artery and diameter of the inferior or superior vena cava, have also emerged as useful predictors of fluid responsiveness [ 12 , 14 ]. However, these indices are also subject to the same inherent limitations related to heart–lung interaction [ 15 ]. By contrast, static preload indices, such as invasive filling pressures and non-invasive echocardiographic variables, can be readily and reliably assessed at end-expiration atmospheric pressure, regardless of the ventilatory status or heart rhythm of the patients.…”