Document Detail

A rational approach to perioperative fluid management.
MedLine Citation:
PMID:  18813052     Owner:  NLM     Status:  MEDLINE    
Replacement of assumed preoperative deficits, in addition to generous substitution of an unsubstantiated increased insensible perspiration and third space loss, plays an important role in current perioperative fluid regimens. The consequence is a positive fluid balance and weight gain of up to 10 kg, which may be related to severe complications. Because the intravascular blood volume remains unchanged and insensible perspiration is negligible, the fluid must accumulate inside the body. This concept brings into question common liberal infusion regimens. Blood volume after fasting is normal, and a fluid-consuming third space has never been reliably shown. Crystalloids physiologically load the interstitial space, whereas colloidal volume loading deteriorates a vital part of the vascular barrier. The endothelial glycocalyx plays a key role and is destroyed not only by ischemia and surgery, but also by acute hypervolemia. Therefore, undifferentiated fluid handling may increase the shift toward the interstitial space. Using the right kind of fluid in appropriate amounts at the right time might improve patient outcome.
Daniel Chappell; Matthias Jacob; Klaus Hofmann-Kiefer; Peter Conzen; Markus Rehm
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Anesthesiology     Volume:  109     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-24     Completed Date:  2008-10-07     Revised Date:  2009-04-23    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  723-40     Citation Subset:  AIM; IM    
Clinic of Anesthesiology, Ludwig-Maximilians University, Munich, Germany.
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MeSH Terms
Blood Volume
Colloids / therapeutic use
Endothelium, Vascular / metabolism
Extracellular Space / metabolism
Fluid Therapy*
Glycocalyx / metabolism
Isotonic Solutions / therapeutic use
Perioperative Care*
Postoperative Nausea and Vomiting / prevention & control
Surgical Wound Infection / prevention & control
Reg. No./Substance:
0/Colloids; 0/Isotonic Solutions; 0/crystalloid solutions
Comment In:
Anesthesiology. 2009 May;110(5):1197-8; author reply 1198   [PMID:  19387195 ]

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