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perioperative fluid management

Management: - fluid restriction if any cardiopulmonary compromise, especially heart failure Clinical trials: Trial [1] One of the few (if only) randomized trial 141 patients, median age 66 years patients undergoing elective colorectal resection median IV fluid volume on day of surgery: - standard group: 5388 mL - fluid restriction: 2740 mL post operative day 1 - standard group: 1500 mL - fluid restriction: 500 mL complications less common in fluid-restricted group (33% vs 51%) difference due to lower cardiopulmonary & wound-healing complications in the restricted group. four patients in the standard group & none in the restricted group died from pulmonary complications: - pulmonary edema (2) - pneumonia (1) - pulmonary embolism (1) Trial [2] - balanced crystalloid (10 mL/kg body weight) during induction of anesthesia, & fluid rates of 8 mL/kg/hour until the end of surgery & 1.5 mL/kg/hour for 1 day postoperatively - restrictive-fluid group received fluids at roughly half those rates - 24 hours after surgery, median fluid received was 6.1 L in the liberal group & 3.6 L in the restrictive group - disability-free survival at 1 year = 82% in both groups - acute kidney injury was less common in the liberal group (5.0% vs 8.6%) - surgical site infections less common in the liberal group (13.6% vs 16.5%)

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perioperative management

References

  1. Journal Watch 23(23):181, 2003 Brandstrup B et al, Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 238:641, 2003 PMID: 14578723
  2. Brett AS Liberal vs. Restrictive Fluid Administration in Major Surgery. NEJM Journal Watch. May 10, 2018 Massachusetts Medical Society (subscription needed) http://www.jwatch.org - Myles PS, Bellomo R, Corcoran T et al. Restrictive versus liberal fluid therapy for major abdominal surgery. N Engl J Med 2018 May 10 PMID: 29742967 Free Article https://www.nejm.org/doi/10.1056/NEJMoa1801601