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Fluid management of patients undergoing abdominal surgery – more questions than answers

Published online by Cambridge University Press:  24 May 2006

J. Boldt
J. Boldt
Affiliation:
Klinikum der Stadt Ludwigshafen, Department of Anesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
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Extract

Summary

The ‘wet vs. dry’ philosophy in patients undergoing abdominal surgery is a subject of substantial debate. It has been suggested that restricting fluid input would significantly reduce complications and improve outcome following abdominal surgery. Keeping the patients dry may be a two-edged sword because the resulting hypovolaemia may result in compromised organ perfusion and poor tissue oxygenation. A review of the literature from 1990 to 2004 revealed that only very few studies on this subject have been published. Unfortunately, most of the ‘dry’-supporting studies used fixed amounts of volume instead of a fluid concept adapted to the patients' need (‘goal-directed’) and there is no generally accepted definition of ‘restricted’, ‘dry’ or ‘overload’. Not only the amount but also the kind of administered fluid appears to be important. Current evidence indicates that using crystalloids exclusively may cause overloading of the interstitial compartment with considerable negative sequelae, whereas using colloids may improve microperfusion and tissue oxygenation. This review shows that the meagre literature on a restricted volume replacement strategy in abdominal surgery patients cannot clearly support the ‘dry’ approach. Further well-performed studies are necessary to elucidate the ideal amount and type of fluid replacement and determine how to guide fluid therapy.

Keywords

INFUSIONS INTRAVENOUSWATER-ELECTROLYTE BALANCESURGERY ABDOMINALCELL RESPIRATIONPERFUSION, TISSUES
Type
Review
Information
European Journal of Anaesthesiology , Volume 23 , Issue 8 , August 2006 , pp. 631 - 640
Copyright
© 2006 European Society of Anaesthesiology

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Footnotes

This paper was not supported by a pharmaceutical company.

References

Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth 2002; 89: 622–632.Google Scholar
Shires T, Williams J, Brown F. Acute change in extracellular fluids associated with major surgical procedures. Ann Surg 1961; 154: 803–810.Google Scholar
Brandstrup B, Tonnesen H, Beier-Holgersen R, the Danish Study Group on Perioperative Fluid Therapy. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 2003; 238: 641–448.Google Scholar
Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. 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
Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I. Effect of Intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology 2005; 103: 25–32.Google Scholar
Kudsk KA. Evidence for conservative fluid administration following elective surgery. Ann Surg 2003; 238: 649–650.Google Scholar
Deane SA, Gaudry PL, Woods P et al. The managment of injuries – a review of death in hospital. Aust NZJ Surg 1988; 58: 463–469.Google Scholar
Desborough JP. The stress response to trauma and surgery. Br J Anaesth 2000; 85: 109–117.Google Scholar
Sibbald WJ. Blood substitutes – effects of microcirculation. In: Sibbald WJ, Messmer K, Fink MP, eds. Tissue Oxygenation in Acute Medicine. Berlin, Heidelberg: Springer, 1998: P318–P331.
Vincent JL, De Backer D. Microvascular dysfunction as a cause of organ dysfunction in severe sepsis. Crit Care 2005; 9 (Suppl 4): S9–S12.Google Scholar
Verdant C, De Backer D. How monitoring of the microcirculation may help us at the bedside. Curr Opin Crit Care 2005; 11: 240–244.Google Scholar
Corso CO, Okamoto S, Leiderer R, Messmer K. Resuscitation with hypertonic saline dextran reduces endothelial cell swelling and improves hepatic microvascular perfusion and function after hemorrhagic shock. J Surg Res 1998; 80: 210–220.Google Scholar
Intaglietta M. Objectives for the treatment of the microcirculation in ischemia, shock, and reperfusion. In: Vincent JL, ed. Update in Intensive Care and Emergency Medicine. Berlin, Heidelberg, New York: Springer, 1989: 293–298.
Wang P, Hauptman JG, Chaudry IH. Hemorrhage produces depression in microvascular blood flow which persist despite fluid resuscitation. Circ Shock 1990; 32: 307–318.Google Scholar
Allen DB, Maguire JJ, Mahdavian M et al. Wound hypoxia and acidosis limit neutrophil bacterial killing mechanisms. Arch Surg 1997; 132: 991–966.Google Scholar
Sakr Y, Dubois MJ, De Backer D, Creteur J, Vincent JL. Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med 2004; 32: 1825–1831.Google Scholar
Ellis CG, Jagger J, Sharpe M. The microcirculation as a functional system. Crit Care 2005; 9 (Suppl 4): S3–S8.Google Scholar
Ernest D, Belzberg AS, Dodek PM. Distribution of normal saline and 5% albumin infusions in cardiac surgical patients. Crit Care Med 2001; 29: 2299–2302.Google Scholar
Gottschalk A, Standl TG, Freitag M et al. Effects of isovolaemic haemodilution on oxygenation of liver and skeletal muscle. Eur J Anaesthesiol 2005; 22: 181–188.Google Scholar
Rex S, Scholz M, Weyland A, Busch T, Schorn B, Buhre W. Intra- and extravascular volume status in patients undergoing mitral valve replacement: crystalloid vs. colloid priming of cardiopulmonary bypass. Eur J Anaesthesiol 2006; 23: 1–9.Google Scholar
Norberg A, Brauer KI, Prough DS et al. Volume turnover kinetics of fluid shifts after hemorrhage, fluid infusion, and the combination of hemorrhage and fluid infusion in sheep. Anesthesiology 2005; 2: 985–994.Google Scholar
Kellum JA. Saline-induced hyperchloremic metabolicacidosis. Crit Care Med 2002; 30: 259.Google Scholar
Wilkes NJ, Woolf R, Mutch M et al. The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid–base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anesth Analg 2001; 93: 811–816.Google Scholar
Kita T, Mammoto T, Kishi Y. Fluid management and postoperative respiratory disturbances in patients with transthoracic esophagectomy for carcinoma. J Clin Anesth 2002; 14: 252–256.Google Scholar
Campbell IT, Baxter JN, Tweedie IE, Taylor GT, Keens SJ. IV fluids during surgery. Brit J Anaesth 1990; 65: 726–729.Google Scholar
Arkilic CF, Taguchi A, Sharma N et al. Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery 2003; 133: 49–55.Google Scholar
Bilkovski RN, Rivers EP, Horst HM. Targeted resuscitation strategies after injury. Curr Opin Crit Care 2004; 10: 529–538.Google Scholar
De Backer D, Creteur J, Dubois MJ, Sakr Y, Vincent JL. Microvascular alterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J 2004; 147: 91–99.Google Scholar
Lowell JA, Schifferdecker C, Driscoll DF, Benotti PN, Bistrian BR. Postoperative fluid overload: not a benign problem. Crit Care Med 1990; 18: 728–733.Google Scholar
Prien T, Backhaus N, Pelster F, Pircher W, Bunte H, Lawin P. Effect of intraoperative fluid administration and colloid osmotic pressure on the formation of intestinal oedema during gastrointestinal surgery. J Clin Anesth 1990; 2: 317–323.Google Scholar
Lang K, Boldt J, Suttner S, Haisch G. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery. Anesth Analg 2001; 93: 405–409.Google Scholar
Lang K, Suttner S, Boldt J, Kumle B, Nagel D. Volume replacement with HES 130/0.4 may reduce the inflammatory response in patients undergoing major abdominal surgery. Can J Anaesth 2003; 50: 1009–1016.Google Scholar
Boldt J, Ducke M, Kumle B, Papsdorf M, Zurmeyer EL. Influence of different volume replacement strategies on inflammation and endothelial activation in the elderly undergoing major abdominal surgery. Intensive Care Med 2004; 30: 416–422.Google Scholar
Moretti EW, Robertson KM, El-Moalem H, Gan TJ. Intraoperative colloid administration reduces postoperative nausea and vomiting and improves postoperative outcomes compared with crystalloid administration. Anesth Analg 2003; 96: 611–617.Google Scholar
Hwang G, Marota JA. Anesthesia for abdominal surgery. In: Hurford WE, Bailin MT, Dawison JK, Haspel KL, Rosow C, eds. Clinical Anesthesia Procedures of the Massachusetts General Hospital. Philadelphia: Lippincott-Raven, 1997: 330–346.
Tonnesen AS. Crystalloids and colloids. In: Miller RD, ed. Anesthesia, 3rd edn. New York: Churchill Livingstone, 1990: 1439–1465.
Greif R, Akca O, Horn EP, Kurz A, Sessler DI. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. Outcomes Research Group. N Engl J Med 2000; 342: 161–167.Google Scholar
Jonsson K, Jensen JA, Goodson III WH et al. Tissue oxygenation, anemia, and perfusion in relation to wound healing in surgical patients. Ann Surg 1991; 214: 605–613.Google Scholar
Gan TJ, Soppitt A, Maroof M et al. Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 2002; 97: 820–826.Google Scholar
Conway DH, Mayall R, Abdul-Latif MS, Gilligan S, Tackaberry C. Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery. Anaesthesia 2002; 57: 845–849.Google Scholar
Schroeder RA, Collins BH, Tuttle-Newhall E et al. Intraoperative fluid management during orthotopic liver transplantation. J Cardiothorac Vasc Anesth 2004; 18: 438–341.Google Scholar
Holte K, Kehlet H. Compensatory fluid administration for preoperative dehydration – does it improve outcome? Acta Anaesthesiol Scand 2002; 46: 1089–1093.Google Scholar
Lobo DN, Dube MG, Neal KR, Allison SP, Rowlands BJ. Perioperative fluid and electrolyte management: a survey of consultant surgeons in the UK. Ann R Coll Surg Engl 2002; 84: 156–160.Google Scholar