Podcast
Questions and Answers
What are the different fluid requirements encountered in the perioperative journey influenced by?
What are the different fluid requirements encountered in the perioperative journey influenced by?
- Comorbidity and preoperative hydration
- Intraoperative complications and patient age
- Patient weight and surgical factors (correct)
- Postoperative care and anesthesia type
In major surgery, what is one focus of fluid administration?
In major surgery, what is one focus of fluid administration?
- Postoperative morbidity (correct)
- Decreasing surgical time
- Preventing preoperative complications
- Enhancing anesthesia effects
What is one goal of fluid therapy for major surgery?
What is one goal of fluid therapy for major surgery?
- Supporting cellular O2 delivery (correct)
- Promoting neurohumoral side effects
- Increasing inflammatory responses
- Inducing hypoperfusion
Which iatrogenic side effect of fluid administration should be avoided?
Which iatrogenic side effect of fluid administration should be avoided?
Apart from fluid volume, what else may need to be manipulated in major surgery according to the text?
Apart from fluid volume, what else may need to be manipulated in major surgery according to the text?
Which of the following is a potential toxicity related to fluid administration according to the text?
Which of the following is a potential toxicity related to fluid administration according to the text?
What is the primary focus of fluid therapy for major surgery according to the text?
What is the primary focus of fluid therapy for major surgery according to the text?
Apart from edema, what is another iatrogenic side effect of fluid administration mentioned in the text?
Apart from edema, what is another iatrogenic side effect of fluid administration mentioned in the text?
In the RELIEF trial, what was the median IV fluid intake in the restrictive group?
In the RELIEF trial, what was the median IV fluid intake in the restrictive group?
What is a common consequence of excessive postoperative fluid?
What is a common consequence of excessive postoperative fluid?
What does one study show regarding postoperative infusions with limited water and sodium levels?
What does one study show regarding postoperative infusions with limited water and sodium levels?
What is the goal of Goal-Directed Therapy (GDT) in fluid administration?
What is the goal of Goal-Directed Therapy (GDT) in fluid administration?
Which tool is considered the gold standard hemodynamic monitor but is declining in use due to various reasons?
Which tool is considered the gold standard hemodynamic monitor but is declining in use due to various reasons?
Why is the use of Pulmonary artery catheter (PAC) declining?
Why is the use of Pulmonary artery catheter (PAC) declining?
Which measurement is derived by integrating transesophageal ultrasound measurement of descending aorta blood velocity with estimated aortic cross-sectional area?
Which measurement is derived by integrating transesophageal ultrasound measurement of descending aorta blood velocity with estimated aortic cross-sectional area?
Which measurement is derived using the Esophageal Doppler monitor (EDM) according to the text?
Which measurement is derived using the Esophageal Doppler monitor (EDM) according to the text?
Which measurement is derived by integrating Arterial pressure and waveform analysis?
Which measurement is derived by integrating Arterial pressure and waveform analysis?
Which method is poorly predictive of IV blood volume & fluid responsiveness
Which method is poorly predictive of IV blood volume & fluid responsiveness
Echocardiography: used for guiding fluid therapy and yielding information on cardiac performance & filling. what is the disadvantages?
Echocardiography: used for guiding fluid therapy and yielding information on cardiac performance & filling. what is the disadvantages?
Lactate concentration used intraoperatively
Lactate concentration used intraoperatively
Inadequate tissue O2 delivery may be reflected by
Inadequate tissue O2 delivery may be reflected by
Low mixed or central venous O2 is associated with
Low mixed or central venous O2 is associated with
What is the primary goal of administering 250 mL boluses of colloid or crystalloid in Goal-Directed Therapy (GDT)?
What is the primary goal of administering 250 mL boluses of colloid or crystalloid in Goal-Directed Therapy (GDT)?
In the context of GDT, what indicates that ventricular filling has reached the flatter part of the Starling curve?
In the context of GDT, what indicates that ventricular filling has reached the flatter part of the Starling curve?
What is a highlighted benefit of Goal-Directed Therapy (GDT) according to recent meta-analyses?
What is a highlighted benefit of Goal-Directed Therapy (GDT) according to recent meta-analyses?
What outcome was found to be reduced by Goal-Directed Therapy (GDT) as revealed by a Cochrane systematic review?
What outcome was found to be reduced by Goal-Directed Therapy (GDT) as revealed by a Cochrane systematic review?
Which type of fluid is the most rational choice for replacement of evaporative losses and maintenance fluid requirements?
Which type of fluid is the most rational choice for replacement of evaporative losses and maintenance fluid requirements?
Why does crystalloid administration typically require 40% to 50% more fluid than colloid for the same clinical volume effect?
Why does crystalloid administration typically require 40% to 50% more fluid than colloid for the same clinical volume effect?
What is one disadvantage of crystalloids compared to colloids in terms of volume expansion?
What is one disadvantage of crystalloids compared to colloids in terms of volume expansion?
In studies specific to patients with sepsis, what adverse events were associated with starch-based colloids?
In studies specific to patients with sepsis, what adverse events were associated with starch-based colloids?
What did the Cochrane review find regarding the use of colloids for intravascular volume expansion in unselected critical care populations?
What did the Cochrane review find regarding the use of colloids for intravascular volume expansion in unselected critical care populations?
Why is it recommended to avoid starch colloids in perioperative patients with severe sepsis or at risk of renal failure?
Why is it recommended to avoid starch colloids in perioperative patients with severe sepsis or at risk of renal failure?
What aspect of fluid administration may crystalloids specifically lead to in comparison to colloids?
What aspect of fluid administration may crystalloids specifically lead to in comparison to colloids?
What type of fluid should be used to replace upper gastrointestinal losses?
What type of fluid should be used to replace upper gastrointestinal losses?
In emergency surgery patients, what should fluid resuscitation be guided by?
In emergency surgery patients, what should fluid resuscitation be guided by?
Why is it more rational to treat hypotension caused by anesthesia with vasopressors and/or inotropes?
Why is it more rational to treat hypotension caused by anesthesia with vasopressors and/or inotropes?
For patients at higher risk in major surgery, what monitoring is suggested for fluid therapy?
For patients at higher risk in major surgery, what monitoring is suggested for fluid therapy?
What is the goal regarding achieving euvolemia by the end of surgery or early postoperative period?
What is the goal regarding achieving euvolemia by the end of surgery or early postoperative period?
What should be optimized by titrating boluses of colloid or balanced crystalloid during certain orthopedic and intraabdominal operations?
What should be optimized by titrating boluses of colloid or balanced crystalloid during certain orthopedic and intraabdominal operations?
What is a key theme in prescribing fluids for moderate-to-major surgery according to the text?
What is a key theme in prescribing fluids for moderate-to-major surgery according to the text?
What does the text recommend regarding oral clear fluid intake before elective surgery?
What does the text recommend regarding oral clear fluid intake before elective surgery?
How should fluids be individualized in perioperative fluid management?
How should fluids be individualized in perioperative fluid management?
What is recommended regarding the approach to fluid management in moderate-to-major surgery?
What is recommended regarding the approach to fluid management in moderate-to-major surgery?
How should fluid requirements be addressed during perioperative fluid management?
How should fluid requirements be addressed during perioperative fluid management?
What should be given special consideration when prescribing fluids in moderate-to-major surgery?
What should be given special consideration when prescribing fluids in moderate-to-major surgery?
What type of fluid should be used to replace lower gastrointestinal losses?
What type of fluid should be used to replace lower gastrointestinal losses?
in moderate-to-major surgery, Pure “maintenance” fluid should be given at
in moderate-to-major surgery, Pure “maintenance” fluid should be given at
The use of preoperative bowel preparation should be
The use of preoperative bowel preparation should be
some patients have electrolytes abnormality due to The use of preoperative bowel preparation in preoperative period, how they should be prepared for the surgery?
some patients have electrolytes abnormality due to The use of preoperative bowel preparation in preoperative period, how they should be prepared for the surgery?
at which infusion rate crystalloids should be used for maintenance requirements during surgery.
at which infusion rate crystalloids should be used for maintenance requirements during surgery.
Blood loss should be replaced with
Blood loss should be replaced with
What treatment is advised for losses to third spaces like reaccumulation of ascites?
What treatment is advised for losses to third spaces like reaccumulation of ascites?
Which of the following is NOT mentioned as a supporting physiologic measurement for assessing fluid status after major surgery?
Which of the following is NOT mentioned as a supporting physiologic measurement for assessing fluid status after major surgery?
What should be considered the best approach to avoid the iatrogenic effects of postoperative fluid administration?
What should be considered the best approach to avoid the iatrogenic effects of postoperative fluid administration?
which of the following may reduce the incidence of postoperative complications.
which of the following may reduce the incidence of postoperative complications.
For patients requiring ongoing IV therapy, what should be checked daily ?
For patients requiring ongoing IV therapy, what should be checked daily ?
What volume range is recommended for 'Pure' maintenance requirements in fluid infusions postoperatively?
What volume range is recommended for 'Pure' maintenance requirements in fluid infusions postoperatively?
What infusion rate is recommended for 'Pure' maintenance requirements in fluid infusions postoperatively?
What infusion rate is recommended for 'Pure' maintenance requirements in fluid infusions postoperatively?
postoperative “Pure” maintenance requirements dosing in obesity is based on ?
postoperative “Pure” maintenance requirements dosing in obesity is based on ?
What volume of Na+ should be given in 24 hours for maintenance intravascular fluid volume postoperative ?
What volume of Na+ should be given in 24 hours for maintenance intravascular fluid volume postoperative ?
What volume of K+ should be given in 24 hours for maintenance intravascular fluid volume postoperative ?
What volume of K+ should be given in 24 hours for maintenance intravascular fluid volume postoperative ?
When should the maintenance intravascular fluid volume not be increased in postoperative period?
When should the maintenance intravascular fluid volume not be increased in postoperative period?
How should new requirements in fluid replacement be addressed postoperatively?
How should new requirements in fluid replacement be addressed postoperatively?
during Replacement of ongoing losses. which assessment of the following should be made?
during Replacement of ongoing losses. which assessment of the following should be made?
What is the focus of fluid assessment for all patients after major surgery ?
What is the focus of fluid assessment for all patients after major surgery ?
How should losses from the GI tract such as vomiting be replaced?
How should losses from the GI tract such as vomiting be replaced?
What should be used to replace blood loss in the context of fluid management during major surgery?
What should be used to replace blood loss in the context of fluid management during major surgery?
when the Postoperative oliguria should be interpreted cautiously?
when the Postoperative oliguria should be interpreted cautiously?
Postoperative oliguria, what shouldn't be done In the absence of markers indicating hypovolemia and inadequate tissue perfusion?
Postoperative oliguria, what shouldn't be done In the absence of markers indicating hypovolemia and inadequate tissue perfusion?
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.
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Description
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.
