The maintenance and monitoring of perioperative blood volume

Abstract

The assessment and maintenance of perioperative blood volume is important because fluid therapy is a routine part of intraoperative care. In the past, patients undergoing major surgery were given large amounts of fluids because health-care providers were concerned about preoperative dehydration and intraoperative losses to a third space. In the last decade it has become clear that fluid therapy has to be more individualized. Because the exact determination of blood volume is not clinically possible at every timepoint, there have been different approaches to assess fluid requirements, such as goal-directed protocols guided by invasive and less invasive devices.This article focuses on laboratory volume determination, capillary dynamics, aspects of different fluids and how to clinically assess and monitor perioperative blood volume.

Perbandingan Pemberian Cairan Liberal dan Restriktif terhadap Mean Arterial Pressure, Laju Nadi, dan Capaian Nilai Post Anesthetic Discharge Scoring System Usia 1–3 Tahun di Bedah Rawat Jalan

“…Komplikasi akibat pemberian cairan liberal yang berlebihan dapat dihindari dengan pemberian cairan secara restriktif, yaitu pemberian cairan rumatan sebanyak 1−3 mL/kgBB/jam serta tidak lagi memberikan cairan pengganti puasa karena pemendekan waktu puasa sesuai American Society of Anesthesiology (ASA) dan tidak memberikan cairan pengganti akibat kehilangan cairan 'ruang ketiga'. [1][2][3][4][5][6][7][8] Pemendekan waktu puasa tidak akan menyebabkan kondisi dehidrasi atau hipoglikemia, memberikan respons hemodinamik yang stabil, mengurangi kejadian mual muntah pascaoperasi, serta capaian postanesthetic discharge scoring system (PADSS) yang cepat pada bedah rawat jalan sehingga pemberian cairan yang berlebihan tidak diperlukan. 1,8−14 Penelitian ataupun literatur sebelumnya tentang pemberian cairan secara restriktif masih banyak dilakukan pada pasien dewasa dengan lama operasi lebih dari dua jam dan penelitian tentang pemberian cairan secara restriktif pada pediatrik dengan lama operasi yang singkat (kurang dari dua jam) masih belum ada.…”

Controversies in the use of hydroxyethyl starch solutions in small animal emergency and critical care

“…The interstitial COP (πt), which contributes to fluid filtration out of the vessel, varies between tissues depending on interstitial albumin content, with higher πt in the lungs compared to skeletal muscle or subcutaneous tissue . Based on the Starling equation, a constant outward movement of fluid occurs on the arterial side of the capillary while a slight inward movement occurs on the venous side due to differences in hydrostatic pressure . Excess interstitial fluid, which is not resorbed on the venous side, returns to the circulation via lymphatic vessels.…”

“…Vasodilation and hypotension due to anesthetic agents, ongoing insensible losses, as well as procedure‐related fluid losses justify the use of perioperative fluid therapy . Conventional perioperative fluid therapy in people consisted of large volumes of crystalloids, often associated with postoperative fluid overload and gain in body weight . The sequela of perioperative fluid overload include cardiopulmonary dysfunction, reduced intestinal motility, dehiscence of small bowel anastomoses, abdominal compartment syndrome, increased extravascular lung water, decreased pulmonary function, impaired wound healing, and impaired hemostasis .…”

Perioperative sequential monitoring of hemodynamic parameters in patients with pheochromocytoma using the Non-Invasive Cardiac System (NICaS)

“…A semi-automated blood volume analyzer, the BVA-100, also uses indicator dilution principles to measure plasma volume using radioactive iodinated human serum albumin. Although the BVA-100 system improves accuracy and eliminates the many time-consuming and difficult steps required for on-site standard testing, it is expensive, and is not suitable for repeated measurement of CBV [5,6].…”