Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-27T08:55:26.700Z Has data issue: false hasContentIssue false

Chapter 29 - Fundamentals of Fluid and Electrolyte Balance during Surgery

Published online by Cambridge University Press:  18 August 2022

By
Chris Wood  and
Rebecca Parker
Edited by
Daniel Rodger ,
Kevin Henshaw ,
Paul Rawling  and
Scott Miller
Daniel Rodger
Affiliation:
Senior Lecturer in Perioperative Practice, London South Bank University
Kevin Henshaw
Affiliation:
Associate Head of Allied Health Professions, Edge Hill University, Ormskirk
Paul Rawling
Affiliation:
Senior Lecturer in Perioperative Practice, Edge Hill University, Ormskirk
Scott Miller
Affiliation:
Consultant Anaesthetist, St Helens and Knowsley Hospitals NHS Trust
Get access

Summary

Intravenous fluids are solutions containing various quantities of water, electrolytes, salts, and sugar. They are used to maintain haemostasis when the enteral route is insufficient to meet physiological demand. Fluid therapy maintains hydration, oxygen delivery, and thus organ function. Poor perioperative fluid control is associated with impaired physiological function, resulting in patient harm and increasing healthcare costs. Perioperative fluid management is based upon three distinct but related factors: patient (age and comorbidities), surgical (urgency, indication and duration) and anaesthetic. This chapter is an introduction to intravenous fluids, highlighting the physiological control mechanisms, the composition of intravenous fluids, and important clinical assessment principles.

Keywords

ColloidCrystalloidFluid balanceUrineBloodPhysiologyIntravenous fluidOptimisation
Type
Chapter
Information
Fundamentals of Operating Department Practice , pp. 322 - 333
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Silva, J. M. Jr, de Oliveira, A. M. R. R., Nogueira, F. A. M., et al. The effect of excess fluid balance on the mortality rate of surgical patients: a multicenter prospective study. Critical Care 2013; 17: R288.CrossRefGoogle ScholarPubMed
Aukland, K. and Reed, R. K.. Interstitial-lymphatic mechanisms in the control of extracellular fluid volume. Physiological Reviews 1993; 73: 1–78.Google Scholar
Haggerty, A. and Nirmalan, M.. Capillary dynamics, interstitial fluid and the lymphatic system. Anaesthesia and Intensive Care Medicine 2019; 20: 182–189.Google Scholar
Yang, N. J. and Hinner, M. J.. Getting across the cell membrane: an overview for small molecules, peptides, and proteins. In Gautier, A and Hinnerda, M. J (eds.), Site-Specific Protein Labeling: Methods and Protocols. New York: Springer, 2015, pp. 29–53.Google Scholar
Lozić, M., Šarenac, O., Murphy, D., and Japundžić-Žigon, N.. Vasopressin, central autonomic control and blood pressure regulation. Current Hypertension Reports 2018; 20: 11.CrossRefGoogle ScholarPubMed
Boone, M. and Deen, P. M. T.. Physiology and pathophysiology of the vasopressin-regulated renal water reabsorption. Pflügers Archiv European Journal of Physiology 2008; 456: 1005–1024.CrossRefGoogle ScholarPubMed
Yang, T. and Xu, C.. Physiology and pathophysiology of the intrarenal renin–angiotensin system: an update. Journal of the American Society of Nephrology 2017; 28: 1040–1049.CrossRefGoogle ScholarPubMed
Varrier, M. and Ostermann, M.. Fluid composition and clinical effects. Critical Care Clinics 2015; 31: 823–837.CrossRefGoogle ScholarPubMed
Mitra, S. and Khandelwal, P.. Are all colloids the same? How to select the right colloid? Indian Journal of Anaesthesia 2009; 53: 592–607.Google Scholar
Boer, C., Bossers, S. M., and Koning, N. J.. Choice of fluid type: physiological concepts and perioperative indications. British Journal of Anaesthesia 2018; 120: 384–396.CrossRefGoogle ScholarPubMed
Lewis, S. R., Pritchard, M. W., Evans, D. J., et al. Colloids versus crystalloids for fluid resuscitation in critically ill people. Cochrane Database of Systematic Reviews 2018; 8: CD000567.Google Scholar
Elmi, M., Mahar, A., Kagedan, D., et al. The impact of blood transfusion on perioperative outcomes following gastric cancer resection: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database. Canadian Journal of Surgery 2016; 59: 322–329.Google Scholar
Finfer, S., Myburgh, J., and Bellomo, R.. Intravenous fluid therapy in critically ill adults. Nature Reviews Nephrology 2018; 14: 541–557.Google Scholar
Jacob, M., Chappell, D., and Rehm, M.. The ‘third space’: fact or fiction? Best Practice and Research: Clinical Anaesthesiology 2009; 23: 145–157.Google Scholar
Lamke, L. O., Nilsson, G. E., and Reithner, H. L.. Water loss by evaporation from the abdominal cavity during surgery. Survey of Anesthesiology 1979; 23: 222.Google Scholar
Russell, G. and Lightman, S.. The human stress response. Nature Reviews Endocrinology 2019; 15: 525–534.CrossRefGoogle ScholarPubMed
Khan, K. S., Hayes, I., and Buggy, D. J.. Pharmacology of anaesthetic agents I: intravenous anaesthetic agents. Continuing Education in Anaesthesia, Critical Care and Pain 2014; 14: 100–105.CrossRefGoogle Scholar
Tsui, P. Y. and Chu, M. C.. Ketamine: an old drug revitalized in pain medicine. BJA Education 2017; 17: 84–87.Google Scholar
Al-Ghamdi, A. A.. Intraoperative fluid management: past and future, where is the evidence? Saudi Journal of Anaesthesia 2018; 12: 311–317.Google Scholar
Mackenzie, D. C. and Noble, V. E.. Assessing volume status and fluid responsiveness in the emergency department. Clinical and Experimental Emergency Medicine 2014; 1: 67–77.Google Scholar
Herzog, N., Dablin, J-B, Giacardi, C., et al. Goal-directed therapy in the perioperative management: is a complete hemodynamics bundle of care better? Critical Care 2021; 25: 105.Google Scholar
Messina, A., Robba, C., Calabrò, L., et al. Association between perioperative fluid administration and postoperative outcomes: a 20-year systematic review and a meta-analysis of randomized goal-directed trials in major visceral/noncardiac surgery. Critical Care 2021; 25: 43.Google Scholar
Jin, J., Min, S., Liu, D., et al. Clinical and economic impact of goal-directed fluid therapy during elective gastrointestinal surgery. Perioperative Medicine 2018; 7: 1–8.Google Scholar
Rollins, K. E. and Lobo, D. N.. Intraoperative goal-directed fluid therapy in elective major abdominal surgery. Annals of Surgery 2016; 263: 465–76.Google Scholar
Rajagopalan, S., Mascha, E., Na, J., et al. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology 2008; 108: 71–77.Google Scholar
Kurz, A., Sessler, D. I., and Lenhardt, R.. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. New England Journal of Medicine 1996; 334: 1209–1215.Google Scholar
Lenhardt, R., Marker, E., Goll, V., et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology 1997; 87: 1318–1323.Google Scholar
Frank, S. M., Fleisher, L. E., Breslow, M. J., et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: a randomized clinical trial. American Journal of Rhinology 1997; 277: 1127–1134.Google Scholar
Belletti, A., Castro, M. L., Silvetti, S., et al. The effect of inotropes and vasopressors on mortality: a meta-analysis of randomized clinical trials. British Journal of Anaesthesia 2015; 115: 656–675.Google Scholar
DesJardin, J. T. and Teerlink, J. R.. Inotropic therapies in heart failure and cardiogenic shock: an educational review. European Heart Journal: Acute Cardiovascular Care 2021; 10: 676–686.Google Scholar
Thiele, R. H., Raghunathan, K., Brudney, C. S., et al. American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery. Perioperative Medicine 2016; 5: 24.Google Scholar
Jonsson, K., Jensen, J. A., Goodson, W. H. 3rd, et al. Tissue oxygenation, anemia, and perfusion in relation to wound healing in surgical patients. Annals of Surgery 1991; 214: 605–613.Google Scholar
Thiele, R. H., Rea, K. M., Turrentine, F. E., et al. Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. Journal of the American College of Surgeons 2015; 220: 430–443.CrossRefGoogle ScholarPubMed
Lobo, D. N., Bostock, K. A., Neal, K. R., et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet 2002; 359: 1812–1818.Google Scholar
Reintam Blaser, A., Preiser, J-C, Fruhwald, S., et al. Gastrointestinal dysfunction in the critically ill: a systematic scoping review and research agenda proposed by the Section of Metabolism, Endocrinology and Nutrition of the European Society of Intensive Care Medicine. Critical Care 2020; 24: 224.Google Scholar
Sarkar, M., Niranjan, N., Banyal, P. K.. Mechanisms of hypoxemia. Lung India 2017; 34: 47–60.Google Scholar
Farina, J. A., Rosique, M. J., and Rosique, R. G.. Curbing inflammation in burn patients. International Journal of Inflammation 2013; 2013: 715645.Google Scholar
Guilabert, P., Usúa, G., Martín, N., et al. Fluid resuscitation management in patients with burns: update. British Journal of Anaesthesia 2016; 117: 284–296.Google Scholar
National Network for Burn Care. National Burn Care Referral Guidance Available from: www.britishburnassociation.org/wp-content/uploads/2018/02/National-Burn-Care-Referral-Guidance-2012.pdf.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×