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Contemporary Approaches to Perioperative IV Fluid Therapy.
World J Surg. 2017 10; 41(10):2457-2463.WJ

Abstract

BACKGROUND

Intravenous fluid therapy is required for most surgical patients, but inappropriate regimens are commonly prescribed. The aim of this narrative review was to provide evidence-based guidance on appropriate perioperative fluid management.

METHOD

We did a systematic literature search of the literature to identify relevant studies and meta-analyses to develop recommendations.

RESULTS

Of 275 retrieved articles, we identified 25 articles to inform this review. "Normal" saline (0.9% sodium chloride) is not physiological and can result in sodium overload and hyperchloremic acidosis. Starch colloid solutions are not recommended in surgical patients at-risk of sepsis or renal failure. Most surgical patients can have clear fluids and/or administration of carbohydrate-rich drinks up to 2 h before surgery. An intraoperative goal-directed fluid strategy may reduce postoperative complications and reduce hospital length of stay. Regular postoperative assessment of the patient's fluid status and requirements should include looking for physical signs of dehydration or hypovolemia, or fluid overload. Both hypovolemia and salt and water overload lead to adverse events, complications and prolonged hospital stay. Urine output can be an unreliable indicator of hydration status in the postoperative surgical patient. Excess fluid administration has been linked to acute kidney injury, gastrointestinal dysfunction, and cardiac and pulmonary complications.

CONCLUSION

There is good evidence supporting the avoidance of unnecessary fasting and the value of an individualized perioperative IV fluid regimen, with transition to oral fluids as soon as possible, to help patients recover from major surgery.

Authors+Show Affiliations

Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Commercial Road, Melbourne, VIC, 3004, Australia. p.myles@alfred.org.au.Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, VIC, Australia.Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, VIC, Australia.Nottingham Digestive Diseases Centre, National Institute of Health Research (NIHR) Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK.Smiths Medical Professor of Anaesthesia and Critical Care, National Institute of Health Research Biomedical Research Centre, University College London Hospitals, London, UK.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

28484814

Citation

Myles, Paul S., et al. "Contemporary Approaches to Perioperative IV Fluid Therapy." World Journal of Surgery, vol. 41, no. 10, 2017, pp. 2457-2463.
Myles PS, Andrews S, Nicholson J, et al. Contemporary Approaches to Perioperative IV Fluid Therapy. World J Surg. 2017;41(10):2457-2463.
Myles, P. S., Andrews, S., Nicholson, J., Lobo, D. N., & Mythen, M. (2017). Contemporary Approaches to Perioperative IV Fluid Therapy. World Journal of Surgery, 41(10), 2457-2463. https://doi.org/10.1007/s00268-017-4055-y
Myles PS, et al. Contemporary Approaches to Perioperative IV Fluid Therapy. World J Surg. 2017;41(10):2457-2463. PubMed PMID: 28484814.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Contemporary Approaches to Perioperative IV Fluid Therapy. AU - Myles,Paul S, AU - Andrews,Sam, AU - Nicholson,Jonathan, AU - Lobo,Dileep N, AU - Mythen,Monty, PY - 2017/5/10/pubmed PY - 2018/6/12/medline PY - 2017/5/10/entrez KW - Acute Kidney Injury KW - Enhance Recovery After Surgery KW - Fluid Administration KW - Fluid Therapy KW - Oral Fluid SP - 2457 EP - 2463 JF - World journal of surgery JO - World J Surg VL - 41 IS - 10 N2 - BACKGROUND: Intravenous fluid therapy is required for most surgical patients, but inappropriate regimens are commonly prescribed. The aim of this narrative review was to provide evidence-based guidance on appropriate perioperative fluid management. METHOD: We did a systematic literature search of the literature to identify relevant studies and meta-analyses to develop recommendations. RESULTS: Of 275 retrieved articles, we identified 25 articles to inform this review. "Normal" saline (0.9% sodium chloride) is not physiological and can result in sodium overload and hyperchloremic acidosis. Starch colloid solutions are not recommended in surgical patients at-risk of sepsis or renal failure. Most surgical patients can have clear fluids and/or administration of carbohydrate-rich drinks up to 2 h before surgery. An intraoperative goal-directed fluid strategy may reduce postoperative complications and reduce hospital length of stay. Regular postoperative assessment of the patient's fluid status and requirements should include looking for physical signs of dehydration or hypovolemia, or fluid overload. Both hypovolemia and salt and water overload lead to adverse events, complications and prolonged hospital stay. Urine output can be an unreliable indicator of hydration status in the postoperative surgical patient. Excess fluid administration has been linked to acute kidney injury, gastrointestinal dysfunction, and cardiac and pulmonary complications. CONCLUSION: There is good evidence supporting the avoidance of unnecessary fasting and the value of an individualized perioperative IV fluid regimen, with transition to oral fluids as soon as possible, to help patients recover from major surgery. SN - 1432-2323 UR - https://www.unboundmedicine.com/medline/citation/28484814/Contemporary_Approaches_to_Perioperative_IV_Fluid_Therapy_ L2 - https://dx.doi.org/10.1007/s00268-017-4055-y DB - PRIME DP - Unbound Medicine ER -