What is it about?
Fluid Therapy in Gastrointestinal Surgeries
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Why is it important?
Gastrointestinal surgery is a major physiological insult to the body accounting for significant fluid and electrolyte disturbances. Therefore a judicious peri-operative fluid therapy needs to be considered in such cases to overcome the risks associated with organ hypo- or hyperperfusion. By large, two main fluid therapy regimens- liberal and restricted-have been proposed for gastrointestinal surgeries by various study groups, each having merits and demerits of its own. Goal directed therapy (GDT), a new term coined, emphasises on use of fluid therapy only when clearly indicated and also recommends that functional haemodynamic parameters should be assessed to judge fluid responsiveness and avoid unnecessary fluid loading. Several trials such as the Albios, the Cristal and the Cochrane meta-analyses were taken up in varied clinical scenarios as to conclude which of the two, crystalloid or colloid, have shown beneficial effect on the outcome of the patient. Monitoring of the hemodynamic parameters plays a vital role in assuring adequate global perfusion without any inadvertent fluid overload. However a perioperative fluid plan should be personalised for each case based on patient status, surgical risk, selection of hemodynamic monitoring based upon patient and surgical risk, and anaesthesiologists’ needs. The contents of this article is largely taken from websites such as google scholar and pubmed, and related scholarly journals and research articles. Textbooks such as Miller’s Anaesthesia, Current Diagnosis and Treatment of Paediatrics (McGraw Hill) and Textbook of Paediatric Surgery (Elsevier Saunders) were also referred to.
Perspectives
Gastrointestinal surgery is a major physiological insult to the body accounting for significant fluid and electrolyte disturbances. Therefore a judicious peri-operative fluid therapy needs to be considered in such cases to overcome the risks associated with organ hypo- or hyperperfusion. By large, two main fluid therapy regimens- liberal and restricted-have been proposed for gastrointestinal surgeries by various study groups, each having merits and demerits of its own. Goal directed therapy (GDT), a new term coined, emphasises on use of fluid therapy only when clearly indicated and also recommends that functional haemodynamic parameters should be assessed to judge fluid responsiveness and avoid unnecessary fluid loading. Several trials such as the Albios, the Cristal and the Cochrane meta-analyses were taken up in varied clinical scenarios as to conclude which of the two, crystalloid or colloid, have shown beneficial effect on the outcome of the patient. Monitoring of the hemodynamic parameters plays a vital role in assuring adequate global perfusion without any inadvertent fluid overload. However a perioperative fluid plan should be personalised for each case based on patient status, surgical risk, selection of hemodynamic monitoring based upon patient and surgical risk, and anaesthesiologists’ needs. The contents of this article is largely taken from websites such as google scholar and pubmed, and related scholarly journals and research articles. Textbooks such as Miller’s Anaesthesia, Current Diagnosis and Treatment of Paediatrics (McGraw Hill) and Textbook of Paediatric Surgery (Elsevier Saunders) were also referred to.
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Read the Original
This page is a summary of: Fluid Therapy in Gastrointestinal Surgeries, Indian Journal of Anaesthesia and Analgesia, January 2018, Red Flower Publication Private, Ltd.,
DOI: 10.21088/ijaa.2349.8471.5118.20.
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