Perioperative fluid management for major elective surgery

Authors: Heming, N., Moine, P., Coscas, R., and Annane, D.

Published: Br.J Surg.; 107,2:e56-e62. January 2020

Affiliations: General Intensive Care Unit, Raymond Poincare Hospital, GHU APHP University Paris-Saclay, Garches, France ; U1173 Laboratory of Inflammation and Infection, University of Versailles Saint-Quentin-en-Yvelines (UVSQ) and University Paris-Saclay – Institut National de la Sante et de la Recherche Medicale (INSERM), Montigny-le-Bretonneux, France .

Abstract: BACKGROUND: Adequate fluid balance before, during and after surgery may reduce morbidity. This review examines current concepts surrounding fluid management in major elective surgery. METHOD: A narrative review was undertaken following a PubMed search for English language reports published before July 2019 using the terms ‘surgery’, ‘fluids’, ‘fluid therapy’, ‘colloids’, ‘crystalloids’, ‘albumin’, ‘starch’, ‘saline’, ‘gelatin’ and ‘goal directed therapy’. Additional reports were identified by examining the reference lists of selected articles. RESULTS: Fluid therapy is a cornerstone of the haemodynamic management of patients undergoing major elective surgery. Both fluid overload and hypovolaemia are deleterious during the perioperative phase. Zero-balance fluid therapy should be aimed for. In high-risk patients, individualized haemodynamic management should be titrated through the use of goal-directed therapy. The optimal type of fluid to be administered during major surgery remains to be determined. CONCLUSION: Perioperative fluid management is a key challenge during major surgery. Individualized volume optimization by means of goal-directed therapy is warranted during high-risk surgery. In most patients, balanced crystalloids are the first choice of fluids to be used in the operating theatre. Additional research on the optimal type of fluid for use during major surgery is needed.