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World Journal of Surgery
Published in: World Journal of Surgery 10/2017

01-10-2017 | Scientific Review

Contemporary Approaches to Perioperative IV Fluid Therapy

Authors: Paul S. Myles, Sam Andrews, Jonathan Nicholson, Dileep N. Lobo, Monty Mythen

Published in: World Journal of Surgery | Issue 10/2017

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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.
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Metadata
Title
Contemporary Approaches to Perioperative IV Fluid Therapy
Authors
Paul S. Myles
Sam Andrews
Jonathan Nicholson
Dileep N. Lobo
Monty Mythen
Publication date
01-10-2017
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 10/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-017-4055-y

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