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Restricted or Liberal Fluid Therapy

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Book cover Perioperative Fluid Management

Abstract

While fluid deprivation and fluid overdose resulting from negligence or misinformed prescription are surely harmful, observations and experiments do not point to fluid therapy as a significant determinant of patient outcomes from major surgery. We can take steps to regulate (a) the extracellular fluid volume and (b) the intravascular—extravascular distribution of the extracellular fluid. On point (a), maintaining a positive input—output fluid balance of 1 to 2 liters on the day of surgery seems to be optimal for modern minimally-invasive surgery. On point (b) there are two interdependent extracellular fluid circulations, of blood and of interstitial fluid. The determinant of the equilibrium between plasma volume and interstitial volume are the transendothelial filtration rate (Jv) of fluid from the blood circulation to the interstitial circulation and the pre-nodal lymph flow rate (Qlymph). Both are affected by anesthesia and by vasoactive agents. We can minimise post-operative edema (harmful interstitial fluid accumulation) and optimize intravascular fluid volume by taking steps to balance fluid input, fluid output, Jv and Qlymph.

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  1. FluidPhysiology.org. Previously Department of Critical Care, University Hospital Southampton, Southampton, UK

    Thomas E. Woodcock

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Editors and Affiliations

  1. Anesthesiology Institute, Cleveland Clinic and Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA

    Ehab Farag

  2. Anesthesiology Institute, Cleveland Clinic and Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA

    Andrea Kurz

  3. Anesthesiology Institute, Cleveland Clinic and Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA

    Christopher Troianos

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Woodcock, T.E. (2020). Restricted or Liberal Fluid Therapy. In: Farag, E., Kurz, A., Troianos, C. (eds) Perioperative Fluid Management. Springer, Cham. https://doi.org/10.1007/978-3-030-48374-6_9

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  • DOI: https://doi.org/10.1007/978-3-030-48374-6_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-48373-9

  • Online ISBN: 978-3-030-48374-6

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