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Current concepts of fluid management in enhanced recovery pathways.
Br J Anaesth. 2018 Feb; 120(2):376-383.BJ

Abstract

Perioperative fluid management impacts outcomes and plays a pivotal role in enhanced recovery pathways (ERPs). There have been major advances in understanding the effects of fluid therapy and administration during the perioperative period. Improving fluid management during this period leads to a decrease in complications, decrease in length of stay (LOS), and enhanced patient outcomes. It is important to consider preoperative and postoperative fluid management to be just as critical as intraoperative management given multiple associated benefits to the patients. Preoperative hydration with (complex) carbohydrate drinks up until 2 h before surgery is safe and should be encouraged, as this helps improve metabolism, decrease insulin resistance, reduce anxiety, and reduce nausea and vomiting. During the intraoperative period, the goals of fluid management are to maintain euvolemia using an individualized plan for fluid and haemodynamic management, matching the needs for monitoring with patient and surgical risk through goal-directed therapy (GDT). By combining the use of fluids and inotropes, GDT uses measurements and indicators of cardiac output and stroke volume to improve blood flow intraoperatively, and ultimately reduce LOS and complications. In the postoperative period, an early transition to oral hydration helps to enhance the conditions for healing and recovery from surgery. I.V. fluid therapy should be kept at a minimum, and urine output should not be the driving force for fluid administration. The optimization of perioperative fluid management is critical to ERPs as it helps improve pulmonary function, tissue oxygenation, gastrointestinal motility, and wound healing.

Authors+Show Affiliations

Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA.Division of General, Vascular and Transplant Anesthesia, Duke University Medical Center, Durham, NC, USA.Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA. Electronic address: tong.gan@stonybrookmedicine.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

29406186

Citation

Makaryus, R, et al. "Current Concepts of Fluid Management in Enhanced Recovery Pathways." British Journal of Anaesthesia, vol. 120, no. 2, 2018, pp. 376-383.
Makaryus R, Miller TE, Gan TJ. Current concepts of fluid management in enhanced recovery pathways. Br J Anaesth. 2018;120(2):376-383.
Makaryus, R., Miller, T. E., & Gan, T. J. (2018). Current concepts of fluid management in enhanced recovery pathways. British Journal of Anaesthesia, 120(2), 376-383. https://doi.org/10.1016/j.bja.2017.10.011
Makaryus R, Miller TE, Gan TJ. Current Concepts of Fluid Management in Enhanced Recovery Pathways. Br J Anaesth. 2018;120(2):376-383. PubMed PMID: 29406186.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Current concepts of fluid management in enhanced recovery pathways. AU - Makaryus,R, AU - Miller,T E, AU - Gan,T J, Y1 - 2017/11/24/ PY - 2017/09/25/received PY - 2017/10/12/revised PY - 2017/10/19/accepted PY - 2018/2/7/entrez PY - 2018/2/7/pubmed PY - 2018/12/24/medline KW - fluid therapy KW - perioperative care KW - perioperative period SP - 376 EP - 383 JF - British journal of anaesthesia JO - Br J Anaesth VL - 120 IS - 2 N2 - Perioperative fluid management impacts outcomes and plays a pivotal role in enhanced recovery pathways (ERPs). There have been major advances in understanding the effects of fluid therapy and administration during the perioperative period. Improving fluid management during this period leads to a decrease in complications, decrease in length of stay (LOS), and enhanced patient outcomes. It is important to consider preoperative and postoperative fluid management to be just as critical as intraoperative management given multiple associated benefits to the patients. Preoperative hydration with (complex) carbohydrate drinks up until 2 h before surgery is safe and should be encouraged, as this helps improve metabolism, decrease insulin resistance, reduce anxiety, and reduce nausea and vomiting. During the intraoperative period, the goals of fluid management are to maintain euvolemia using an individualized plan for fluid and haemodynamic management, matching the needs for monitoring with patient and surgical risk through goal-directed therapy (GDT). By combining the use of fluids and inotropes, GDT uses measurements and indicators of cardiac output and stroke volume to improve blood flow intraoperatively, and ultimately reduce LOS and complications. In the postoperative period, an early transition to oral hydration helps to enhance the conditions for healing and recovery from surgery. I.V. fluid therapy should be kept at a minimum, and urine output should not be the driving force for fluid administration. The optimization of perioperative fluid management is critical to ERPs as it helps improve pulmonary function, tissue oxygenation, gastrointestinal motility, and wound healing. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/29406186/Current_concepts_of_fluid_management_in_enhanced_recovery_pathways_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)53976-8 DB - PRIME DP - Unbound Medicine ER -