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Fluid Therapy
Published in Michele Barletta, Jane Quandt, Rachel Reed, Equine Anesthesia and Pain Management, 2023
Jarred Williams, Elizabeth Hodge
This chapter describes catheter placement as well as different types of intravenous fluids available for administration to anesthetized patients, including crystalloids, colloids, and blood products. Fluid selection and indications for fluid therapy in a variety of clinical conditions will be discussed.
Septic shock
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Bryan E. Freeman, Michael R. Foley
Fluid therapy should include administration of either colloids or crystalloids. The SAFE study demonstrated no difference in efficacy between these two types (13). Goals of fluid resuscitation are initially to achieve a central venous pressure of ‡8 mmHg (or 12 mmHg if the patient is mechanically ventilated). Fluid challenges should be administered in the form of either at least 1000 mL of crystalloids or 300 to 500 mL of colloids over 30 minutes. As long as the patient responds to fluid challenges, they should continue. However, if central venous pressures or pulmonary artery pressures increase without simultaneous hemodynamic improvement, the rate of fluid administration should be substantially reduced (12).
Circulation
Published in Kelvin Yan, Surgical and Anaesthetic Instruments for OSCEs, 2021
It is an absolute contraindication in patients with hypersensitivity to the contents of Plasma-Lyte. Given the relatively high potassium content, patients with hyperkalaemia and renal failure should not be given Plasma-Lyte. IV fluid therapy should always be used cautiously especially in patients with heart failure, renal failure and pulmonary oedema.
Goal-directed fluid therapy compared to liberal fluid therapy in patients subjected to colorectal surgery
Published in Egyptian Journal of Anaesthesia, 2023
Mona Gad Mostafa Elebieby, Mohamed Abdelkhalek, Zenat Eldadamony Mohamed Eldadamony, Mohammed Nashaat Mohammed
Between the studied groups, there were no appreciable differences in the patients’ demographics, type of surgery, or procedure length (Table 1). Also, the studied groups’ intraoperative and postoperative measurements for H.R., MAP, CVP, and S.V. were comparable (Table 2). Readings taken intraoperatively for SVV, COP, CI, and TFC were also comparable (Table 3). The serum lactate and creatinine levels of the GDFT group were slightly elevated compared to those of the LFT group, although this difference did not reach statistical significance (Figures 2, 3). Concerning the administration of fluids during surgery, it was observed that patients with liberal fluid therapy (LFT) required significantly higher amounts of crystalloid fluids, with a median volume of 2915 mL (range: 1736–4189 mL), compared to patients undergoing goal-directed fluid therapy (GDFT), who had a median volume of 2272 mL (range: 1352–2964 mL). This difference was found to be significant (P < 0.001).
Should minimally invasive approaches in rectal surgery be regarded as a key element of modern enhanced recovery perioperative care?
Published in Acta Chirurgica Belgica, 2023
Petr Kocián, Filip Pazdírek, Petr Přikryl, Tomáš Vymazal, Jiří Hoch, Adam Whitley
The ERAS protocol consisted of 16 items. A list of all these items with the adherence is shown in Table 1. A more detailed description of our ERAS protocol can be found in our previous study [11]. A brief description of the main items is given here. Preoperative counselling and nutritional screening were provided. Patients were given carbohydrate rich drinks two hours before the surgery. All patients apart from those with stenotic tumours received mechanical bowel preparation. Intraoperatively patients were actively heated by a convective air warming system and by warming intravenous fluids. Intravenous fluids were administered according to the principles of goal-directed fluid therapy. Epidural catheters were used only in open procedures. Early feeding and early mobilization after surgery were implemented. We aimed for patients to return to a full solid diet by the fourth postoperative day. Multimodal opioid-sparing analgesia consisted of a combination of paracetamol with metamizole and nonsteroidal anti-inflammatory drugs; this item was considered fulfilled when patients received no more than one dose of opioids per day.
Avoiding the night terrors: the effect of circadian rhythm on post-operative urine output and blood pressure in free flap patients
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Bara El-khayat, Deborah Foong, James Baden, Robert Warner, George Filobbos
Favourable perioperative systemic haemodynamics are important for minimising free flap anastomotic and perfusion-related complications [1]. Urine output (UO), arterial blood pressure (BP) and pulse rate (PR) are recognised surrogate markers of systemic blood flow and overall tissue perfusion [2–4]. In order to maintain adequate levels of UO and BP standard free flap post-operative care regimes in many units have incorporated intravenous fluid therapy and fluid monitoring along with flap monitoring. More recently it has been recognised that post-operative fluid overload leads to increased flap and patient oedema and may even predispose to anastomotic thrombosis in free flap patients [5–8]. This is in addition to increasing patient hospital stay and risk of other medical complications. Goal-directed fluid therapy has been developed as a means of tightly controlling fluid therapy in these patients to maintain adequate systemic circulation while avoiding complications of excessive fluids in the post-operative period [9–13].