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?
In major surgery, what is one focus of fluid administration?
In major surgery, what is one focus of fluid administration?
What is one goal of fluid therapy for major surgery?
What is one goal of fluid therapy for major surgery?
Which iatrogenic side effect of fluid administration should be avoided?
Which iatrogenic side effect of fluid administration should be avoided?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
What is a common consequence of excessive postoperative fluid?
What is a common consequence of excessive postoperative fluid?
Signup and view all the answers
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?
Signup and view all the answers
What is the goal of Goal-Directed Therapy (GDT) in fluid administration?
What is the goal of Goal-Directed Therapy (GDT) in fluid administration?
Signup and view all the answers
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?
Signup and view all the answers
Why is the use of Pulmonary artery catheter (PAC) declining?
Why is the use of Pulmonary artery catheter (PAC) declining?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
Which measurement is derived by integrating Arterial pressure and waveform analysis?
Which measurement is derived by integrating Arterial pressure and waveform analysis?
Signup and view all the answers
Which method is poorly predictive of IV blood volume & fluid responsiveness
Which method is poorly predictive of IV blood volume & fluid responsiveness
Signup and view all the answers
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?
Signup and view all the answers
Lactate concentration used intraoperatively
Lactate concentration used intraoperatively
Signup and view all the answers
Inadequate tissue O2 delivery may be reflected by
Inadequate tissue O2 delivery may be reflected by
Signup and view all the answers
Low mixed or central venous O2 is associated with
Low mixed or central venous O2 is associated with
Signup and view all the answers
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)?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
What type of fluid should be used to replace upper gastrointestinal losses?
What type of fluid should be used to replace upper gastrointestinal losses?
Signup and view all the answers
In emergency surgery patients, what should fluid resuscitation be guided by?
In emergency surgery patients, what should fluid resuscitation be guided by?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
How should fluids be individualized in perioperative fluid management?
How should fluids be individualized in perioperative fluid management?
Signup and view all the answers
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?
Signup and view all the answers
How should fluid requirements be addressed during perioperative fluid management?
How should fluid requirements be addressed during perioperative fluid management?
Signup and view all the answers
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?
Signup and view all the answers
What type of fluid should be used to replace lower gastrointestinal losses?
What type of fluid should be used to replace lower gastrointestinal losses?
Signup and view all the answers
in moderate-to-major surgery, Pure “maintenance” fluid should be given at
in moderate-to-major surgery, Pure “maintenance” fluid should be given at
Signup and view all the answers
The use of preoperative bowel preparation should be
The use of preoperative bowel preparation should be
Signup and view all the answers
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?
Signup and view all the answers
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.
Signup and view all the answers
Blood loss should be replaced with
Blood loss should be replaced with
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
which of the following may reduce the incidence of postoperative complications.
which of the following may reduce the incidence of postoperative complications.
Signup and view all the answers
For patients requiring ongoing IV therapy, what should be checked daily ?
For patients requiring ongoing IV therapy, what should be checked daily ?
Signup and view all the answers
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?
Signup and view all the answers
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?
Signup and view all the answers
postoperative “Pure” maintenance requirements dosing in obesity is based on ?
postoperative “Pure” maintenance requirements dosing in obesity is based on ?
Signup and view all the answers
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 ?
Signup and view all the answers
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 ?
Signup and view all the answers
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?
Signup and view all the answers
How should new requirements in fluid replacement be addressed postoperatively?
How should new requirements in fluid replacement be addressed postoperatively?
Signup and view all the answers
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?
Signup and view all the answers
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 ?
Signup and view all the answers
How should losses from the GI tract such as vomiting be replaced?
How should losses from the GI tract such as vomiting be replaced?
Signup and view all the answers
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?
Signup and view all the answers
when the Postoperative oliguria should be interpreted cautiously?
when the Postoperative oliguria should be interpreted cautiously?
Signup and view all the answers
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?
Signup and view all the answers
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.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
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.