Skip Navigation LinksHome > February 2009 - Volume 22 - Issue 1 > Current aspects of perioperative fluid handling in vascular...
Current Opinion in Anaesthesiology:
doi: 10.1097/ACO.0b013e32831f1c65
Cardiovascular anesthesia: Edited By Stefan De Hert

Current aspects of perioperative fluid handling in vascular surgery

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

Collapse Box


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.

© 2009 Lippincott Williams & Wilkins, Inc.


Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.