69 Questions
What are the different fluid requirements encountered in the perioperative journey influenced by?
Patient weight and surgical factors
In major surgery, what is one focus of fluid administration?
Postoperative morbidity
What is one goal of fluid therapy for major surgery?
Supporting cellular O2 delivery
Which iatrogenic side effect of fluid administration should be avoided?
Excessive intravascular volume
Apart from fluid volume, what else may need to be manipulated in major surgery according to the text?
Cardiac output and vascular resistance
Which of the following is a potential toxicity related to fluid administration according to the text?
nonphysiologic quantities of anions (lactate, acetate, gluconate).
What is the primary focus of fluid therapy for major surgery according to the text?
To ensure adequate cellular O2 delivery
Apart from edema, what is another iatrogenic side effect of fluid administration mentioned in the text?
Excess Na+ or Cl− load
In the RELIEF trial, what was the median IV fluid intake in the restrictive group?
3.7 liters
What is a common consequence of excessive postoperative fluid?
Increased hospital length of stay
What does one study show regarding postoperative infusions with limited water and sodium levels?
Earlier return to gut function
What is the goal of Goal-Directed Therapy (GDT) in fluid administration?
To target defined physiologic end-points
Which tool is considered the gold standard hemodynamic monitor but is declining in use due to various reasons?
Pulmonary artery catheter (PAC)
Why is the use of Pulmonary artery catheter (PAC) declining?
Concerns about catheter-associated morbidity
Which measurement is derived by integrating transesophageal ultrasound measurement of descending aorta blood velocity with estimated aortic cross-sectional area?
Stroke volume
Which measurement is derived using the Esophageal Doppler monitor (EDM) according to the text?
Peak velocity as an indicator of ventricular contractility
Which measurement is derived by integrating Arterial pressure and waveform analysis?
stroke volume variation
Which method is poorly predictive of IV blood volume & fluid responsiveness
CVP readings
Echocardiography: used for guiding fluid therapy and yielding information on cardiac performance & filling. what is the disadvantages?
requires operator expertise
Lactate concentration used intraoperatively
reduction in lactate concentrations is used as a marker of successful resuscitation.
Inadequate tissue O2 delivery may be reflected by
increased O2 extraction and mixed or central venous O2 desaturation.
Low mixed or central venous O2 is associated with
poor outcomes after high-risk surgery
What is the primary goal of administering 250 mL boluses of colloid or crystalloid in Goal-Directed Therapy (GDT)?
To increase stroke volume by 10% or more
In the context of GDT, what indicates that ventricular filling has reached the flatter part of the Starling curve?
A plateau in stroke volume despite fluid administration
What is a highlighted benefit of Goal-Directed Therapy (GDT) according to recent meta-analyses?
Reduced number of patients with postoperative complications
What outcome was found to be reduced by Goal-Directed Therapy (GDT) as revealed by a Cochrane systematic review?
Postoperative mortality
Which type of fluid is the most rational choice for replacement of evaporative losses and maintenance fluid requirements?
Crystalloids
Why does crystalloid administration typically require 40% to 50% more fluid than colloid for the same clinical volume effect?
Increased propensity of crystalloids to filter across capillary membrane
What is one disadvantage of crystalloids compared to colloids in terms of volume expansion?
Greater GI mucosal edema
In studies specific to patients with sepsis, what adverse events were associated with starch-based colloids?
Increased renal replacement therapy requirement
What did the Cochrane review find regarding the use of colloids for intravascular volume expansion in unselected critical care populations?
No improvement in all-cause mortality
Why is it recommended to avoid starch colloids in perioperative patients with severe sepsis or at risk of renal failure?
To decrease the need for renal replacement therapy
What aspect of fluid administration may crystalloids specifically lead to in comparison to colloids?
Increased extravascular volume expansion
What type of fluid should be used to replace upper gastrointestinal losses?
Isotonic saline
In emergency surgery patients, what should fluid resuscitation be guided by?
Rational physiologic endpoints (BP & HR, lactate, urine output)
Why is it more rational to treat hypotension caused by anesthesia with vasopressors and/or inotropes?
Primarily related to vasodilation and reduced inotropy
For patients at higher risk in major surgery, what monitoring is suggested for fluid therapy?
Invasive pressure monitoring
What is the goal regarding achieving euvolemia by the end of surgery or early postoperative period?
Optimize cardiac output
What should be optimized by titrating boluses of colloid or balanced crystalloid during certain orthopedic and intraabdominal operations?
Cardiac output
What is a key theme in prescribing fluids for moderate-to-major surgery according to the text?
Constant reassessment of fluid status
What does the text recommend regarding oral clear fluid intake before elective surgery?
Extending up to 2 hours preoperatively
How should fluids be individualized in perioperative fluid management?
Tailored based on physiologic variables and losses
What is recommended regarding the approach to fluid management in moderate-to-major surgery?
Adapting to patient and surgical variables
How should fluid requirements be addressed during perioperative fluid management?
By individualizing based on varying needs
What should be given special consideration when prescribing fluids in moderate-to-major surgery?
The indication for giving a specific fluid
What type of fluid should be used to replace lower gastrointestinal losses?
balanced solutions
in moderate-to-major surgery, Pure “maintenance” fluid should be given at
low fixed rate
The use of preoperative bowel preparation should be
restricted to carefully selected cases
some patients have electrolytes abnormality due to The use of preoperative bowel preparation in preoperative period, how they should be prepared for the surgery?
infusion of 1 to 2 L of balanced crystalloid with K+ supplementation should be given
at which infusion rate crystalloids should be used for maintenance requirements during surgery.
1-1.5 mL/kg/h
Blood loss should be replaced with
colloid or blood products
What treatment is advised for losses to third spaces like reaccumulation of ascites?
Treated with a mixture of colloid and crystalloid
Which of the following is NOT mentioned as a supporting physiologic measurement for assessing fluid status after major surgery?
Respiratory rate
What should be considered the best approach to avoid the iatrogenic effects of postoperative fluid administration?
Early oral intake
which of the following may reduce the incidence of postoperative complications.
early oral nutrition
For patients requiring ongoing IV therapy, what should be checked daily ?
hyponatremia and other electrolyte derangements.
What volume range is recommended for 'Pure' maintenance requirements in fluid infusions postoperatively?
$1500-2500$ mL in 24 hours
What infusion rate is recommended for 'Pure' maintenance requirements in fluid infusions postoperatively?
1 to 1.2 mL/kg/h
postoperative “Pure” maintenance requirements dosing in obesity is based on ?
ideal body weight
What volume of Na+ should be given in 24 hours for maintenance intravascular fluid volume postoperative ?
50 to 100 mEq
What volume of K+ should be given in 24 hours for maintenance intravascular fluid volume postoperative ?
40 to 80 mEq
When should the maintenance intravascular fluid volume not be increased in postoperative period?
When suspicion for hypovolemia exists
How should new requirements in fluid replacement be addressed postoperatively?
By titrating replacement fluids appropriately
during Replacement of ongoing losses. which assessment of the following should be made?
intravascular volume status and adequacy of organ perfusion
What is the focus of fluid assessment for all patients after major surgery ?
Fluid status based on clinical examination and physiologic measurements
How should losses from the GI tract such as vomiting be replaced?
With isotonic saline or balanced crystalloid with K+
What should be used to replace blood loss in the context of fluid management during major surgery?
Blood, colloid, or blood products
when the Postoperative oliguria should be interpreted cautiously?
first postoperative day
Postoperative oliguria, what shouldn't be done In the absence of markers indicating hypovolemia and inadequate tissue perfusion?
large volumes of fluid challenge
Study Notes
- Maintenance intravascular fluid volume should not be increased postoperatively if hypovolemia is suspected. Ongoing losses should be identified and treated separately.
- Oral fluid intake increase should lead to proportionate reduction in maintenance fluid. Replacement of losses should be based on measured amounts and assessment of volume status.
- High-risk surgical patients may benefit from goal-directed therapy targeting oxygen delivery postoperatively. Other patients should have fluid status assessed based on clinical examination and physiologic measurements.
- Electrolytes should be checked daily for monitoring. Fluid requirements should be divided into categories for assessment and treatment.
- "Pure" maintenance fluid should be salt-poor and contain free water based on weight. Fluid dosing in obesity should consider ideal body weight.
- Administration of more than 3500 to 5000 mL of crystalloid solution postoperatively may lead to increased morbidity, weight gain, and delayed healing.
- A restrictive vs. liberal IV fluid regimen study showed no difference in disability-free survival at 1 year but increased surgical site infections and need for renal-replacement therapy in the restrictive group.
Learn about the practical management of perioperative fluid therapy, including different fluid requirements in the preoperative, intraoperative, and postoperative phases. Understand how patient and surgical factors influence fluid therapy goals.
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