Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Anesthesiology Reports
Published in: Current Anesthesiology Reports 4/2019

01-12-2019 | Geriatric Anesthesia (S Akhtar, Section Editor)

The Challenge of Perioperative Fluid Management in Elderly Patients

Authors: Birgitte Brandstrup, Ann M. Møller

Published in: Current Anesthesiology Reports | Issue 4/2019

Login to get access

Abstract

Purpose of Review

The purpose of this chapter is to describe physiological changes occurring with age relevant to fluid therapy, and to discuss the influence of fluid therapy on outcome of surgery from this perspective.

Recent Findings

Dehydration, common among elderly people, is often mistaken for dementia or depression. Dehydration with dizziness increases the risk of falling, a predictor for adverse outcomes after surgery.
Young volunteers can excrete up to 300 mmol sodium per liter urine. Elderly people cannot achieve such a concentration emphasizing the importance of giving water to excrete the osmoles given with intravenous crystalloids.
Brain natriuretic peptide increases in cardiac disease and with age. Preoperative elevated levels predict adverse outcomes following surgery.

Summary

The evidence and the physiology show that elderly patients benefit from a thorough regulation of fluid therapy keeping fluid balance close to zero (no more than 2 l positive) and with sufficient glucose and water supply.
Literature
1.
2.
Lawler M, Selby P, Aaparo MS, Duffy S. Ageism in cancer care: time to change the mindset. BMJ. 2014;348:g1614.PubMed
3.
•• Montroni I, Ugolini G, Saur, et al. Personalized management of elderly patients with rectal cancer: expert recommendations of the European Society of Surgical Geriatric Oncology, and American College of Surgeons Comission on Cancer. Eur J Surg Oncol. 2018;44:1685–702 This is a paper describing the currently best treatment for elderly patients with rectal cancer in an ERAS program. PubMed
4.
Wakefield BJ, Mentes J, Holman JE, Culp K. Risk factors and outcomes associated with hospital admission for dehydration. Rehab Nurs. 2008;33(6):233–41.
5.
Marshall KA, Burson R, Gall K, Saunders MM. Hospital admission for malnutrition and dehydration in patients with dementia. Home Healthc Now. 2016;34(1):32–7.PubMed
6.
Phillips PA, Rolls BJ, Ledingham JGG, Forsling ML, Morton JJ, Crowe MJ, et al. Reduced thirst after water deprivation in healthy elderly men. New Engl J Med. 1984;311(12):753–9.PubMed
7.
Chan SP, Ip KY, Irvin MG. Perioperative optimisation of elderly and frail patients: a narrative review. Anaesthesia. 2019;74(Suppl. 1):80–9.PubMed
8.
Payton P, Shook JE. Perioperative understanding of geriatric patients. Clin Podiatr Med Surg. 2019;36:131–40.PubMed
9.
Dasgupta M, Rolfson DB, Stolee P, Borrie MJ, Speechley M. Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr. 2007;48:78–83.
10.
Li JL, Henderson MA, Revenig LM, et al. Frailty and one-year mortality in major intra-abdominal operations. J Surg Res. 2019;203:507–12.
11.
12.
Overgaard-Steensen C, Ring T. Clinical review: Practical approach to hyponatriaemia and hypernatriaemia in critically ill patients. Crit Care. 2013;17:206.PubMedPubMedCentral
13.
14.
Beck LH. Perioperative renal, fluid and electrolyte mangement. Clin Geriatr Med. 1990;6(3):557–69.PubMed
15.
Rowe JW, Shock NW, DeFonzo RA. The influence of age on the renal responce to water deprivation in man. Nephron. 1976;17(4):270–8.PubMed
16.
Drummer C, Gerzer R, Heer M, et al. Effect of an acute saline infusion on fluid and electrolyte metabolism in humans. Am J Phys. 1992;262(5):F744–54.
17.
Gamble JL. Physiological information gained from studies on the life raft ration. Harvey Lect. 1947;42:247–73.
18.
Prough IC, Baker EM. Maximum physiological concentration of sodium in human urine. J Appl Physiol. 1959;14(6):1036–8.
19.
Weaver CM, Martin BR, McCabe GP, et al. Individual variation in urinary sodium excretion among adolescent girls on a fixed intake. J Hypertens. 2016;34:1290–7.PubMed
20.
Blichert-Toft M, Christensen V, Engquist A, Fog-Moller F, Kehlet H, Madsen SN, et al. Influence of age on the endocrine-metabolic responce to surgery. Ann Surg. 1979;190(6):761–70.PubMedPubMedCentral
21.
Kudoh A, Ishihara H, Matsuki A. Renin-aldosterone system and atrial natriuretic peptide during anesthesia in orthopedic patients over 80 years of age. J Clin Anesth. 1999;11:101–7.PubMed
22.
23.
Karthikeyan G, Moncur RA, Levine O, et al. Is a pre-operative brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide measurement an independent predictor of adverse cardiovascular outcomes within 30 days of noncardiac surgery? J Am Coll Cardiol. 2009;54(17):1599–606.PubMed
24.
Rodseth RN, Biccard BM, Manach YL, et al. The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery. B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: a systematic review and individual patient data meta-analysis. J Am Coll Cardiol. 2014;63(2):170–80.PubMed
25.
Cai GL, Chen J, Hu CB, Yan ML, Xu QH, Yan J. Value of plasma brain natriuretic peptide levels for predicting postoperative atrial fibrillation: a systemic review and meta-analysis. World J Surg. 2014;38:51–9.PubMed
26.
Ryding ADS, Kumar S, Worthington AM, Burgess D. Prognostic value of brain natriuretic peptide in noncardiac surgery. A meta-analysis. Aneshsiology. 2009;111:311–9.
27.
Yang JH, Choi JH, Ki YW, Kim DI, Kim DK, Park JR, et al. Plasma N-terminal pro-B-type natriuretic peptide is predictive of perioperative cardiac events in patients undergoing vascular surgery. Korean J Intern Med. 2012;27:301–10.PubMedPubMedCentral
28.
Rajagopalan S, Croal BL, Reeve J, Bachoo P, Brittenden J. N-terminal pro-B-type natriuretic peptide is an independant predictor of all-cause mortality and MACE after major vascular surgery in medium-term follow-up. Eur J Vasc Endovasc Surg. 2011;41:657–62.PubMed
29.
Goei D, van Kuijk JP, Flu WJ, Hoeks SE, Chonchol M, Verhagen HJ, et al. Usefulness of repeated N-terminal pro-B-type natriuretic peptide measurements as incremental predictor for longterm cardiovascular outcome after vascular surgery. Am J Cardiol. 2011;107(4):609–14.PubMed
30.
Scrutinio D, Guido G, Guida P, et al. Combined use of high-sensitivity C-reactive protein and N-terminal pro-B-type peptide for risk stratification of vascular surgery patients. Ann Vasc Surg. 2014;28(6):1522–9.PubMed
31.
Oscarsson A, Fredrikson M, Sörliden M, Anskär S, Eintrei C. N-terminal fragment of pro-B-type natriuretic peptide is a predictor of cardiac events in high-risk patients undergoing acute hip fracture surgery. Br J Anaesth. 2009;103(2):206–12.PubMed
32.
Chong CP, Ryan JE, Van Gaal WJ, et al. Usefulness of N-terminal Pro-brain natriuretic peptide to predict postoperative cardiac complications and long-term mortality after emergency lower limb orthopedic surgery. Am J Cardiol. 2010;106(6):865–72.PubMed
33.
Nordling P, Kiviniemi T, Strandberg M, Strandberg N, Airaksinen J. Predicting the outcome of hip fracture patients by using N-terminal fragment of pro-B-type natriuretic peptide. BMJ Open. 2016;6:e009416.PubMedPubMedCentral
34.
Cornell CN. CORR insights: does N-terminal pro-brain type natriuretic peptide predict cardiac complications after hip fracture surgery? Clin Orthop Relat Res. 2017;475:1737–9.PubMedPubMedCentral
35.
Manikandan R, Nathaniel C, Lewis P, Brough RJ, Adeyoju A, Brown SC, et al. Tropionin T and N-terminal natriuretic peptide changes in patients undergoing transurethral resection of the prostate. J Urol. 2005;174(5):1892–5.PubMed
36.
Hou JL, Gao K, Li M, Ma JY, Shi YK, Wang Y, et al. Increased N-terminal pro-brain natriuretic peptide level predicts atrial fibrillation after surgery for esophageal carcinoma. World J Gastroenterol. 2008;14(16):2582–5.PubMedPubMedCentral
37.
Yeh HM, Lau HP, Lin JM, Sun WZ, Wang MJ, Lai LP. Preoperative plasma N-terminal pro-brain natriuretic peptide as a marker of cardiac risk in patients undergoing elective non-cardiac surgery. Br J Surg. 2005;92:1041–5.PubMed
38.
Farzi S, Stojakovic T, Marko T, Sankin C, Rehak P, Gumpert R, et al. Role of N-terminal pro B-type natriuretic peptide in identifying patients at high risk for adverse outcome after emergent non-cardiac surgery. Br J Anaesth. 2013;110(4):554–60.PubMed
39.
Kim IJ, Moon JY, Ko EJ, Lim YM, Kim SH, Yang WI, et al. Prognostic value of preoperative N-terminal pro-brain natriuretic peptide in non-cardiac surgery of elderly patients with normal left ventricular systolic function. Geriatr Gerontol Int. 2016;16:1109–16.PubMed
40.
Borges FK, Furtadu MV, Rossini APW, et al. Prognostiv value of perioperative n-terminal pro-B-type natriuretic peptide in noncardiac surgery. Arq Bras Cardiol. 2013;100(6):561–70.PubMed
41.
Januzzi JL, Chen-Tournoux AA, Moe G. Amino-terminal pro-B-type natriuretic peptide testing for the diagnosis or exclusion of heart failure in patients with acute symptoms. Am J Cardiol. 2008;101(3A):29A–38A.
42.
Roberts E, Ludman AJ, Dworzynski K, et al. The diagnostic accuracy of natriuretic peptides in heart failure: systematic review and diagnostic meta-analysis in the acute care setting. BMJ. 2015;350(h910):1–16.
43.
Kumar S, Khosravi M, Massart A, Davenport A. Is there a role for N-terminal probrain-type natriuretic peptide in determining volume status in haemodialysis patients? Nephron Clin Pract. 2012;122(1-2):33–7.PubMed
44.
Haines R, Crichton S, Wilson D, Treacher D, Ostermann M. Cardiac biomarkers are associated with maximum stage of acute kidney injury in critically ill patients: a prospective analysis. Crit Care. 2017;21:88–96.PubMedPubMedCentral
45.
Velasco N, Chamney P, Wabel P, Moissl U, Imtiaz T, Spalding E, et al. Optimal fluid control can normalize cardiovascular risk markers and limit left ventricular hypertrophy in thrice weekly dialysis patients. Hemodial Int. 2012;16:465–72.PubMed
46.
47.
Chen H, Wu B, Gong D, Liu Z. Fluid overload at start of continous renal replacement therapy is associated with poorer clinical condition and outcome: a prospective observational study on the combindes use of bioimpedance vector analysis and serum N-terminal pro-B-type natriuretic peptide measurement. Crit Care. 2015;19:135–43.PubMedPubMedCentral
48.
Kawagoe C, Sato Y, Toida T, et al. N-terminal-pro-B-type-natriuretic peptide associated with 2-year mortality from both cardiovascular and non-cardiovascular origins in prevalent chronic hemodialysis patients. Ren Fail. 2019;40(1):127–34.
49.
Lang CC, Choy AM, Turner K, Tobin R, Coutie W, Struthers AD. The effect of intravenous saline loading on plasma levels of brain natriuretic peptide in man. J Hypertens. 1993;11(7):737–41.PubMed
50.
Wambach G, Koch J. BNP plasma levels during acute volume expansion and chronic sodium loading in normal men. Clin Exp Hypertens. 1995;17(4):619–29.PubMed
51.
Lobo DN, Stanga Z, Aloysius MM, et al. Effect of volume loading with 1 liter intravenous infusions of 0.9% saline, 4% succinylated gelatine (gelofusine) and 6% hydroxyethyl starch (Voluven) on blood volume and endocrine responses: a randomized, three-way crossover study in healthy volunteers. Crit Care Med. 2010;38(2):464–70.PubMed
52.
Bihari S, Wiersema UF, Schembri D, et al. Bolus intravenous 0.9% saline, but not 4% albumin or 5% glucose, causes interstitial pulmpnary edema in helathy subjects. J Appl Physiol (1985). 2015;119(7):783–92.
53.
Gillies MA, Shah ASV, Mullenheim J, et al. Perioperative myocardial injury in patients receiving cardiac output-guided haemodynamic therapy: a substudy of the OPTIMISE Trial. Br J Anaesth. 2015;115(2):227–33.PubMed
54.
Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens. A randomized assessor blinded multi centre trial. Ann Surg. 2003;238(5):641–8.PubMedPubMedCentral
55.
Brandstrup B, Beier-Holgersen R, Iversen LH et al. The influence of fluid therapy on N-terminal-pro-brain natriuretic peptide and the association with heart and lung komplications in patients undergoing colorectal surgery. Secondary results of a clinical randomized assessor-blinded multicentre trial. 2019. Submitted for publication
56.
Brandstrup B, Svendsen C, Engquist A. Hemorrhage and operation cause a contraction of the extra cellular space needing replacement — evidence and implications? A systematic review. Surgery. 2006;139(3):419–32.PubMed
57.
Warrillow SJ, Weinberg L, Parker F, Calzavacca P, Licari E, Aly A, et al. Perioperative fluid prescription, complications and outcomes in major elective open gastrointestinal surgery. Anaesth Intensive Care. 2010;38:259–65.PubMed
58.
Walsh SR, Walsh CJ. Intravenous fluid-associated morbidity in postoperative patients. Ann R Coll Surg Engl. 2005;87:126–30.PubMedPubMedCentral
59.
Kalus JS, Caron MF, White CM, Mather JF, Gallagher R, Boden WE, et al. Impact on fluid balance on incidence of atrial fibrillation after cardiothoracic surgery. Am J Cardiol. 2004;94:1423–5.PubMed
60.
Hübner M, Schäfer M, Demartines N, Müller S, Maurer K, Baulig W, et al. Impact of restrictive intravenous fluid replacement and combined epidural analgesia on perioperative volume balance and renal function within a fast track program. J Surg Res. 2012;173:68–74.PubMed
61.
Ettinger KS, Arce K, Lohse CM, et al. Higher Perioperative fluid administration is associated with increased rates of complications following head and neck microvascular recunstruction with fibular free flaps. Microsurgery. 2016;00:000–9.
62.
Bjerregaard LS, Møller-Sørensen H, Hansen KL, Ravn J, Nielsson JC. Using clinical parameters to guide fluid therapy in high-risk thoracic surgery. A retrospective, obervational study. BMC Anesthesiol. 2015;15:91–8.PubMedPubMedCentral
63.
Elofson KA, Eiferman DS, Porter K, Murphy CV. Impact on late fluid balance on clinical outcomes in the critical ill surgical and trauma population. J Crit Care. 2015;30:1338–43.PubMedPubMedCentral
64.
• Jurt J, Hübner M, Pache B, Hahnloser D, Demartines N, Grass F. Respiratory complications after colorectal surgery: avoidable or fate? World J Surg. 2018;42:2708–14 Even though this is a retrospective study, it describes risk factors for adverse outcomes in an ERAS program. PubMed
65.
• Askild D, Segelman J, Gedda C, Hjern F, Pekkari K, Gustavsson UO. The impact of perioperative fluid therapy on short-term outcomes and 5-year survival among patients undergoing colorectal cancer surgery — a prospective cohort study within an ERAS protocol. Eur J Surg Oncol. 2017;43:1433–9 In a prospective cohort design, risk factors for adverse outcomes in an ERAS-protocol are described.
66.
Nielsson L, Wodlin NB, Kjølhede P. Risk factors for postoperative complications after fast-track abdominal hystereectomy. Aust N Z J Obst Gyn. 2012;52:113–20.
67.
Duke MD, Guirdy C, Guice J, et al. Restrictive fluid resuscitation in combination with damage control resuscitation: time for adaption. J Trauma Acute Care Surg. 2012;73(3):674–8.PubMed
68.
Minambres E, Rodrigo E, Ballesteros MA, et al. Impact of restrictive fluid balance focused to increase lung procurement on renal function after kidney transplantation. Nephrol Dial Transplant. 2010;25:2352–6.PubMed
69.
Weinberg L, Wong D, Karalapilli D, et al. The impact of fluid intervention on complications and length of hospital stay after pancreaticoduodenodenectomt (Whipple's procedure). BMC Anesthesiol. 2014;14:35–43.PubMedPubMedCentral
70.
Møller AM, Pedersen T, Svendsen P-E, Engquist A. Perioperative risk factors in elective pneumonectomy: the impact of excess fluid balance. Eur J Anaesthesiol. 2002;19:57–62.PubMed
71.
Parquin F, Marchal M, Mehiri S, Herve P, Lescot B. Post-pneumonektomy pulmonary edema: analysis and risk factors. Eur J Cardiothorac Surg. 1996;10:929–33.PubMed
72.
Patel RL, Townsend ER, Fountain SW. Elective pneumonectomy: factors associated with morbidity and operative mortality. Ann Thorac Surg. 1992;54(84):88.
73.
Turnage WS, Lunn JJ. Postpneumonectomy pulmonary edema. A retrospective analysis of associated variables. Chest. 1993;103(6):1646–50.PubMed
74.
Verheijen-Breemhaar L, Bogaard JM, van den Berg B, Hilvering C. Post-pneumonectomy pulmonary edema. Thorax. 1998;43(4):323–6.
75.
Zeldin RA, Normandin D, Landtwing D, Peters RM. Postpneumonectomy pulmonary edema. J Thorac Cardiovasc Surg. 1984;87(3):359–65.PubMed
76.
Abraham-Nordling M, Hjern F, Pollack J, Prytz M, Borg T, Kressner U. Randomized clinical trial of fluid restriction in colorectal surgery. Br J Surg. 2012;99(2):186–91.PubMed
77.
Gao T, Li N, Zhang J, Xi FC, Chen QY, Zhu WM, et al. Restricted intravenous fluid regimen reduces the rate of postoperative complications and alters immunological activity of elderly patients operated for abdominal cancer: a randomized prospective clinical trial. World J Surg. 2012;36:993–1002.PubMed
78.
Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet. 2002;359:1812–8.PubMed
79.
Lobo SM, Lobo FR, Polachini CA, et al. Prospective, Randomized trial comparing fluids and doputamine optimization of oxygen delivery in high-risk surgical patients. Crit Care. 2006;10:R72.PubMedPubMedCentral
80.
Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I. Effect of intraoperative fluid management on outcome after intra-abdominal surgery. Anesthesiology. 2005;103(1):25–32.PubMed
81.
Wenkui Y, Ning L, Jianfeng G, Weiqin L, Shaoqiu T, Zhihui T, et al. Restricted peri-operative fluid administration adjusted by serum lactate level improved outcome after major elective surgery for gastrointestinal malignancy. Surgery. 2010;147(4):542–52.PubMed
82.
Wuethrich PY, Burchard FC, Thalmann GN, Stueber F, Studer UE. Restrictive deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy reduces postoperative complications and hospitalization time: a randomized clinical trial. Aneshsiology. 2014;120(2):365–77.
83.
National Heart and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Comparison of two fluid management strategies in acute lung injury. New Engl J Med. 2006;354:2564–75.
84.
Bhaskaran K, Arumugam G, Kumar PV. A prospective randomized comparison study on effect of perioperative use of chloride liberal intravenous fluids versus chloride restricted intravenous fluids on postoperative acute kidney injuri in patients undergoing off-pump coronary artery bypass grafting surgeries. Ann Card Anaesth. 2018;21:413–8.PubMedPubMedCentral
85.
McArdle GT, McAuley DF, McKinley A, Blair P, Hoper M, Harkin DW. Preliminary results of a prospective randomized trial of restrictive versus standard fluid regime in elective open abdominal aortic aneurysm repair. Ann Surg. 2009;250(1):28–34.PubMed
86.
Lobo SM, Ronchi LS, Oliveira NE, Brandão PG, Froes A, Cunrath GS, et al. Restrictive strategy of intraoperative fluid maintenance during optimization of oxygen delivery decreases major complications after high-risk surgery. Crit Care. 2011;15(5):R226.PubMedPubMedCentral
87.
Stewart RM, Park PK, Hunt JP, et al. Less is more: improved outcomes in surgical patients with conservative fluid administration and central venous catheter monitoring. J Am Coll Surg. 2009;208:725–37.PubMed
88.
Varadhan KK, Lobo DN. A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery: getting the balance right. Proc Nutr Soc. 2010;69(4):488–98.PubMed
89.
•• Myles PS, Bellomo R, Corcoran T, et al. Restrictive versus liberal fluid therapy for major abdominal surgery. New Engl J Med. 2018;378(24):2263–74 The largest randomized trial of restricted versus liberal fluid therapy. The liberal regimen is not very liberal, but the restricted regimen is too restricted.PubMed
90.
• Brandstrup B. Finding the right balance. New Engl J Med. 2018;378(24):2335–6 Goes with the Myles et al. trial [89]. PubMed
91.
Nessim C, Sideris L, Turcotte S, et al. The effect of fluid overload in the presence of an epidural on the strength of colonic anastomoses. J Surg Res. 2013;183:567–73.PubMed
92.
Kulemann B, Timme S, Sifert G, et al. Intraoperative crystalloid overload leads to substantial inflammatory infiltration of intestinal anastomosis — a histomorphological analysis. Surgery. 2013;154(3):596–603.PubMed
93.
Marjanovic G, Villain C, Juettner E, et al. Impact of different crystalloid volume fluid regimens on intestinal anastomotic stability. Ann Surg. 2009;249(2):181–5.PubMed
94.
Gonzalez-Fajardo JA, Mengibar L, Brizuela JA, Castrodeza J, Vaquero-Puerta C. Effect of postoperative restrictive fluid therapy in the recovery of patients with abdominal vascular surgery. Eur J Vasc Endovasc Surg. 2009;37:538–43.PubMed
95.
MacCay G, Fearon K, McConnachie A, Serpell MG, Molloy RG, O'Dweyer PJ. Randomized clinical trial of the effect of postoperative intravenous fliod restriction on recovery after elective colorectal surgery. Br J Surg. 2006;93(12):1469–74.
96.
Vermeulen H, Hofland J, Legemate DA, Ubbink DT. Intravenous fluid restriction after major abdominal surgery: a randomized blinded clinical trial. Trials. 2009;7:10–50.
97.
Boland MR, Noorani A, Varty K, Coffey C, Agha R, Walsh SR. Perioperative fluid restriction in major abdominal surgery: systematic review and meta-analysis of randomized clinical trials. World J Surg. 2013;37:1193–202.PubMed
98.
Brandstrup B, Svendsen PE, Rasmussen M, et al. Which goal for fluid therapy during colorectal surgery is followed by the best outcome: near maximal stroke volume or zero fluid balance? A clinical randomized double blinded multi centre trial. Eur J Anaesth. 2010;27(suppl 47):4.
99.
•• Feldheiser A, Aziz O, Baldini G, et al. Enhanged recovery after surgery (ERAS) in gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anesthesiol Scand. 2016;60(3):289–334 Describes the state of the art perioperative care including the fluid therapy in an ERAS-program.
100.
Ljungqvist O, Scott M, Fearon KC. Enhanged recovery after surgery: a review. JAMA Surg. 2017;152(3):292.PubMed
Metadata
Title
The Challenge of Perioperative Fluid Management in Elderly Patients
Authors
Birgitte Brandstrup
Ann M. Møller
Publication date
01-12-2019
Publisher
Springer US
Published in
Current Anesthesiology Reports / Issue 4/2019
Electronic ISSN: 2167-6275
DOI
https://doi.org/10.1007/s40140-019-00349-6

Other articles of this Issue 4/2019

Current Anesthesiology Reports 4/2019 Go to the issue

Correction

Correction to: Quadratus Lumborum Block: a Technical Review

Geriatric Anesthesia (S Akhtar, Section Editor)

Perioperative Acute Care of Older Patients Living with Frailty

Thoracic Anesthesia (T Schilling, Section Editor)

Pulmonary Hypertension and Thoracic Surgery: Impact and Treatment Options

Thoracic Anesthesia (T Schilling, Section Editor)

Positive End-Expiratory Pressure (PEEP), Tidal Volume, or Alveolar Recruitment: Which One Does Matter in One-Lung Ventilation?

Thoracic Anesthesia (T Schilling, Section Editor)

Experimental Data on the Pulmonary Effects of Remote Ischemic Preconditioning

Geriatric Anesthesia (S Akhtar, Section Editor)

Emergency General Surgery in Older Patients: Where Are We Now?