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Fluid Management in Neurosurgical Patients

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Textbook of Neuroanesthesia and Neurocritical Care

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Abstract

Intravenous fluids should be regarded with the same consideration as other pharmacologically active agents. Perioperative fluid management is an important component of the treatment to restore and/or maintain adequate cerebral blood flow and cerebral perfusion pressure. The distribution of these infused synthetic fluids in our patients depends on their volume and composition and also the patient’s underlying physiology. Unnecessary volumes, or infusion of hypotonic fluids, results in cerebral edema, influencing the strong ion difference that may in turn affect the acid-base balance. Also, the electrolyte composition has far-reaching consequences, such as chloride rich solutions that contribute toward hyperchloremic acidosis and impaired renal blood flow. Synthetic colloid solutions and mannitol are not without their own limitations, for example, they may also contribute toward acute kidney injury. This chapter discusses treatment choices with different fluid types in specific neurosurgical situations. Perioperative fluid management in these settings should be tailored to suit a patient’s clinical condition and underlying pathophysiology. In general, hypotonic fluids should be avoided, with isotonic fluids being preferred. Personalized fluid management strategies should be guided by dynamic variables that assess fluid responsiveness.

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Competing Interests

Wojciech Dabrowski, Manu Malbrain, and Robert Wise declare that they have no competing interests.

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Authors and Affiliations

  1. Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland

    Wojciech Dabrowski

  2. Department of Anaesthetics, Critical Care and Pain Management, Pietermaritzburg Metropolitan, Pietermaritzburg, South Africa

    Robert Wise

  3. Discipline of Anaesthesiology and Critical Care, Clinical School of Medicine, University of KwaZulu-Natal, Durban, South Africa

    Robert Wise

  4. Intensive Care Unit, University Hospital Brussels (UZB), Jette, Belgium

    Manu L. N. G. Malbrain

  5. Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium

    Manu L. N. G. Malbrain

Authors
  1. Wojciech Dabrowski
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  2. Robert Wise
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  3. Manu L. N. G. Malbrain
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Editor information

Editors and Affiliations

  1. Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India

    Hemanshu Prabhakar

  2. Division of Neuroanesthesiology, Department of Anesthesiology, Sher-i-Kashmir Institute of Medical Sciences Soura, Srinagar, Jammu and Kashmir, India

    Zulfiqar Ali

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Dabrowski, W., Wise, R., Malbrain, M.L.N.G. (2019). Fluid Management in Neurosurgical Patients. In: Prabhakar, H., Ali, Z. (eds) Textbook of Neuroanesthesia and Neurocritical Care. Springer, Singapore. https://doi.org/10.1007/978-981-13-3387-3_26

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  • DOI: https://doi.org/10.1007/978-981-13-3387-3_26

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