[Impact of intraoperative fluid therapy and transfusion on the postoperative outcome].
Recent clinical studies suggest that intraoperative liberal crystalloid infusion causes postoperative edema and various systemic and local complications. Weight gain may be a promising predictor for postoperative complications. "No intravenous infusion should be continued simply because it is a 'routine' component of clinical care." as GIFTASUSP (British consensus of guidelines on intravenous fluid therapy for adult surgical patients) has suggested. Optimal titration of fluid infusion should be considered on the individual basis. Clinical studies may have suggested that approximately 2000-3000 ml shift of extracellular fluid would be the acceptable level not worsening postoperative outcome. Although the safety of transfusion itself has improved, rare complications such as TRALI are still to be aware of. Immediate transfusion for rapid and massive bleeding should salvage life and reduce complication after resuscitation. It is still under research and debate whether transfusion would promote cancer. Unnecessary transfusion should be avoided and any effort to reduce transfusion should be recommended. Too-much or too-low infusion and transfusion causes adverse outcome. Optimizing the volume may be the key for ideal postoperative outcome.
Department of Anesthesiology, Showa University, School of Dentistry, Tokyo 145-8515.
Takehiko
T
Iijima
D000328:Adult; D001803:Blood Transfusion; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007432:Intraoperative Period; D007668:Kidney / Q000502:physiology; D011184:Postoperative Period; D065227:Transfusion Reaction; D016896:Treatment Outcome