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Current aspects of perioperative fluid handling in vascular surgery

Jacob, Matthiasa; Chappell, Daniela; Hollmann, Markus Wb

Current Opinion in Anaesthesiology:
doi: 10.1097/ACO.0b013e32831f1c65
Cardiovascular anesthesia: Edited By Stefan De Hert
Abstract

Purpose of review: Perioperative fluid management influences patient outcome. Vascular surgery unites various surgical procedures, mainly with a high impact on patients who often have relevant preexisting illnesses. There are only scarce data on this specialty, forcing the clinician to extrapolate existing data when planning perioperative fluid management. This review aims to summarize the underlying facts.

Recent findings: Perioperative insensible perspiration does not exceed 1 ml/kg per hour. A third space shift does not exist; therefore, its primary substitution is erroneous. Rather, a crystalloid fluid excess causes a tremendous shift towards the interstitial space. Colloidal volume effects are context sensitive, that is, only their use as a substitute when blood or plasma loss occurs leads to maintenance within the circulatory space. Colloidal hypervolaemia and surgical trauma both have the potential to deteriorate the vascular barrier, leading to plasma loss into the interstitial space. Current perioperative fluid therapy should aim to maintain normovolaemia of the individual body fluid compartments as far as possible. This might be achieved by combining a protocol-based replacement of extracellular losses (urinary output plus insensible perspiration) with isotonic balanced crystalloids and blood volume optimization using isooncotic colloids.

Summary: The basis of fluid therapy in vascular surgery is a careful differential indication of the respective classes of preparations. A goal-directed approach might help to avoid hypovolaemia.

Author Information

aClinic of Anaesthesiology, Ludwig Maximilians University of Munich, Munich, Germany

bDepartment of Anaesthesiology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands

Correspondence to Dr Matthias Jacob, Clinic of Anaesthesiology, Ludwig Maximilians University of Munich, Nussbaumstrasse 20, 80336 Munich, Germany Tel: +49 89 5160 2691; fax: +49 89 5160 4446; e-mail: matthias.jacob@med.uni-muenchen.de

© 2009 Lippincott Williams & Wilkins, Inc.