Fluid Management in Gastrointestinal Surgery
Major gastrointestinal (GI) surgery is high risk, producing significant physiological disturbance in patients who are often frail prior to surgery. It is associated with considerable morbidity and mortality [1, 2]. Fluid therapy is a fundamental part of the management of the high-risk surgical patient . Detailed knowledge of the pharmacology of the available intravenous solutions should guide their use. It is now clear that differentiation between the properties of the carrier solution and the dissolved colloid is of fundamental importance. Preoperative risk assessment should lead to institution of adequate perioperative monitoring to guide fluid therapy and allocation of an appropriate level of postoperative care, which in many cases will be in a dedicated critical care facility. Fluid therapy should be titrated to rational, physiological endpoints and not dictated by a recipe. Pro-active “optimization” of intravascular volume and organ blood flow has been shown to improve outcome. A “big picture” look at the available literature suggests that the “when” and “how much” of fluid therapy are far more important than the “what”.
KeywordsFluid Therapy Fluid Management Colloid Osmotic Pressure Plasma Volume Expansion Organ Blood Flow
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