Perioperative Fluid Management 2002

Although most aspects of perioperative fluid management have remained relatively constant for more than two decades, new concepts and practices are currently evolving. Until the mid-to-late 1960s, the prevailing strategy of perioperative fluid management was rigid restriction (1). After Shires et al. (2,3) convincingly demonstrated that major surgery and trauma were associated with fluid requirements that substantially exceeded usual maintenance fluid rates, perioperative volume replacement became much less restrictive. However, recent evidence suggests that excessive perioperative fluid infusion may be a frequent problem. Arieff (4) estimated, based on a 1-yr retrospective review of patients undergoing major surgery at two university medical centers in the US, an annual incidence of 8000 to 74,000 cases of postoperative pulmonary edema, including a frequency of 2.6% in patients without important comorbidities. Currently, investigators are applying kinetic analysis, using principles similar to those of pharmacokinetics, to better define responses to perioperative fluid administration, especially in situations involving pharmacologic or physiologic perturbations (5). In the 1970s, considerable controversy revolved around the question of whether crystalloids or colloids were preferable for perioperative management. Although apparently resolved in favor of crystalloids, the controversy has arisen again as current investigators have performed meta-analyses of previous comparisons. Development of new colloid solutions, in terms of the characteristics of both the colloids and their diluents, promises to reduce problems associated with existing formulations. Research into the components of conventional crystalloid solutions may even prompt revisions in the composition of these common anesthetic tools. This review will focus on several areas of research that are changing clinical practice, including the following: