title: State-of-the-art fluid management in the operating room.
abstract: The underlying principles guiding fluid management in any setting are very simple: maintain central euvolemia, and avoid salt and water excess. However, these principles are frequently easier to state than to achieve. Evidence from recent literature suggests that avoidance of fluid excess is important, with excessive crystalloid use leading to perioperative weight gain and an increase in complications. A zero-balance approach aimed at avoiding fluid excess is recommended for all patients. For major surgery, there is a sizeable body of evidence that an individualized goal-directed fluid therapy (GDFT) improves outcomes. However, within an Enhanced Recovery program only a few studies have been published, yet so far GDFT has not achieved the same benefit. Balanced crystalloids are recommended for most patients. The use of colloids remains controversial; however, current evidence suggests they can be beneficial in intraoperative patients with objective evidence of hypovolemia.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. Electronic address: timothy.miller2@duke.edu.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Miller
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA; Durham VAMC, Durham, NC 27710, USA. Electronic address: Karthik.Raghunathan@duke.edu.
authors.forename: Karthik
authors.initials: K
authors.lastname: Raghunathan
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. Electronic address: tjgan@duke.edu.
authors.forename: Tong J
authors.initials: TJ
authors.lastname: Gan
mesh_terms: D000077324:Crystalloid Solutions; D005440:Fluid Therapy / Q000379:methods* / Q000639:trends; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage; D009873:Operating Rooms / Q000379:methods* / Q000639:trends; D019990:Perioperative Care / Q000379:methods* / Q000639:trends
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions
keywords: colloid; crystalloid; fluids; goal-directed fluid therapy