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Perioperative Fluid Administration: Historical Highlights and Implications for Practice

Srinivasa, Sanket MBChB,; Hill, Andrew G. MD (Thesis) FRACS FACS

doi: 10.1097/SLA.0b013e31825a2f22
Surgical Retrospection

Perioperative fluid administration is an important aspect of surgical care but is often poorly understood. Surgeons have historically made a considerable contribution to the evidence base governing current practice. This review provides an overview of the history of perioperative fluid therapy and its relevance to modern practice.

Intravenous fluids (IVF) first gained therapeutic importance in the treatment of cholera in the 1830s. From the 1880s, IVF began to be administered perioperatively to compensate for the “injurious” effects of anaesthesia. Clinical improvements were consequently noted, though the adverse effects of saline were observed. The work of Ringer, Hartmann, and others emphasized the importance of the composition of IVF and laid the foundations for the balanced solutions in use today.

The intravenous “drip” was introduced by Rudolph Matas in 1924. As the metabolic response to injury was increasingly investigated in the 1940s and 1950s, the cause of post-operative oliguria was debated widely with the most prominent surgeons being Moore and Shires. These differences in opinion, coupled with reports of injured soldiers from the Korean War receiving large IVF infusions and surviving, dictated the surgical practice of liberal IVF administration until very recently.

Newer work in fluid therapy has explored the concept of fluid restriction. Shoemaker and colleagues also pioneered the concept of fluid administration to achieve supranormal indices of cardiorespiratory function, which has led to the advent of goal-directed fluid therapy. Alongside the development of balanced solutions, the renewed focus on perioperative fluid therapy has led to IVF administration being guided by physiological principles with a new consideration of the lessons gleaned from history.

Surgeons have made a notable contribution to the important field of perioperative fluid therapy. Fluid management, however, remains a poorly understood area in clinical practice. This review provides a historical perspective on perioperative fluid therapy and its influence on modern practice.

Department of Surgery, South Auckland Clinical School, Middlemore Hospital, University of Auckland, Auckland, New Zealand.

Reprints: Sanket Srinivasa, MBChB, Department of Surgery, South Auckland Clinical School, Middlemore Hospital, University of Auckland, Auckland, New Zealand. E-mail:

Disclosure: Sanket Srinivasa is a recipient of the Auckland Medical Research Foundation Ruth Spencer Medical Research Fellowship.

© 2012 Lippincott Williams & Wilkins, Inc.