Postoperative fluid management

Abstract

Postoperative care units are run by an anesthesiologist or a surgeon, or a team formed of both. Management of postoperative fluid therapy should be done considering both patients' status and intraoperative events. Types of the fluids, amount of the fluid given and timing of the administration are the main topics that determine the fluid management strategy. The main goal of fluid resuscitation is to provide adequate tissue perfusion without harming the patient. The endothelial glycocalyx dysfunction and fluid shift to extracellular compartment should be considered wisely. Fluid management must be done based on patient's body fluid status. Patients who are responsive to fluids can benefit from fluid resuscitation, whereas patients who are not fluid responsive are more likely to suffer complications of over-hydration. Therefore, common use of central venous pressure measurement, which is proved to be inefficient to predict fluid responsiveness, should be avoided. Goal directed strategy is the most rational approach to assess the patient and maintain optimum fluid balance. However, accessible and applicable monitoring tools for determining patient's actual fluid need should be further studied and universalized. The debate around colloids and crystalloids should also be considered with goal directed therapies. Advantages and disadvantages of each solution must be evaluated with the patient's specific condition.

Crystalloid agents used in perioperative infusion therapy in children

“…В интенсивной терапии чаще используются изотонические и гипертонические растворы, чем гипотонические растворы [29,30]. Среди изотонических выделяют небуферные (несбалансированные) растворы и буферные (сбалансированные) растворы, т. е. наиболее близкие по составу к плазме крови [31,32].…”

“…Одним из представителей сбалансированных кристаллоидных растворов является раствор «Стерофундин изотонический», инфузия которого даже в больших объемах не вызывает дилюционного и гиперхлоремического ацидоза. Однако, при явных преимуществах использования сбалансированных растворов перед несбалансированными однозначного ответа в выборе препарата в конкретных ситуациях нет [4,5,30,36,37,38].…”

Ameliyat Sürecinde Uygulanan Sıvı Tedavisi Yöntemleri

“…1,2 Cerrahi girişim nedeniyle gelişen sıvı kaybını önlemek ya da en aza indirebilmek için, ameliyat olacak hastalara ameliyat öncesi, ameliyat sırası ve ameliyat sonrası dönemi kapsayan cerrahi süreç boyunca sıvı tedavisi uygulanmaktadır. Sıvı uygulamasının amacı, sıvı yüklenmesine ve dehidratasyona neden olmadan sıvı kayıpları-nın karşılanması, dokulara yeterli besin ve oksijenin sağlanması için gerekli kan basıncının sürdü-rülmesidir.…”

Utility of Fractional Flow Reserve Testing for Assessment of Coronary Artery Disease

“…Gross oedema in the elderly population within the post-operative period often points to benign fluid overload stemming from difficulties in fluid titration. 1 Within such complex postoperative oedema cases in the elderly, consideration of heart failure is expected. 2 Rarely, a sufficiently large liver cyst, malignancy or thrombus may compress the inferior vena cava (IVC) but is usually detected preoperatively.…”

“…In response to increasing outpatient waiting-times, electronic consults (eConsults) have been successfully used internationally to provide GPs with a means of accessing specialist physician advice within 72 hours. 1,2 The aim of this study was to determine the perceptions of current Royal Australasian College of Physicians (RACP) adult medicine Fellows towards establishing eConsults in their own clinical practice.…”