Perioperative Fluid Therapy PDF

Preface

Intravenous fluid therapy is an essential component of perioperative management. Virtually all surgical patients, ranging from those having brief, minimally invasive outpatient procedures to those having major intracavitary surgery, receive at least preoperative and intraoperative fluids; the majority of surgical inpatients receive postoperative fluids for varying intervals. Perioperative fluid management has historically generated controversy, with little compelling data to address the conflict between the extreme approaches of ‘‘keep them dry'' and ‘‘aggressively hydrate them.'' The limited data until now have driven a gradual change toward more liberal fluid administration in recent decades, but, in general, clinicians have used coarse, empirical approaches based on weakly supported rules of thumb. Many clinicians have no doubt concluded that their version of current practice is entirely satisfactory and perhaps have devoted little attention to recent clinical and technological advances in perioperative fluid management.

The scientific literature addressing perioperative fluid therapy is extensive, if somewhat dated and poorly suited to evidence-based management. Within the past 15 years, however, the basic and clinical science of perioperative fluid management has become a vibrant, rapidly advancing discipline. Application of pharmacokinetic principles has clarified the responses to fluid administration of blood volume and fluid excretion in both healthy volunteers and surgical patients. Related studies in experimental animals have explored pharmacologic influences on the kinetics of fluid administration. Well-designed clinical trials have provided important insights into the fluid requirements of patients undergoing specific types of outpatient and inpatient surgery, suggesting that perioperative fluid therapy must be individualized and specifically modified based on the type of surgery.

 As the dynamic discipline of perioperative fluid management evolves in the years to come, clinicians can anticipate both rapid growth in knowledge and the application of that knowledge to practice. The purpose of this book is to assemble the current knowledge and expertise of international experts on perioperative fluid management. Towards that goal, we have divided the book into seven parts: (I) Basic Science; (II) Methods of Assessing Fluid Balance; (III) Intravenous Fluids; (IV) Intravenous Fluid Therapy in Special Situations; (V) Intravenous Fluid Therapy in Daily Practice; (VI) Adverse Effects of Fluids; and (VII) The Future of Intravenous Fluid Therapy. The chapters within these sections provide a synthesis of fundamental pharmacologic and physiologic issues and an overview of the application of those principles across a broad spectrum of perioperative clinical challenges. We hope to bridge the gap between conventional, crude rules of thumb and current knowledge. To some extent, as this discipline rapidly changes, we must rely on expert opinion. However, the goal of this book is to balance expert opinion with evidence-based recommendations—to emphasize not only what to do but, more importantly, why to do it.