Why crystalloids will do the job in the operating room

Area of Science:

• Anesthesiology
• Fluid Management
• Intraoperative Care

Background:

• Current anesthesia trends favor crystalloid over colloid fluids for intraoperative volume replacement.
• Recent studies offer new insights into managing crystalloid infusions based on outcomes and kinetics.

Purpose of the Study:

• To analyze the efficacy and management of crystalloid fluids in anesthesia.
• To compare crystalloid and colloid fluid properties during surgery.

Main Methods:

• Review of outcome-oriented studies and kinetic analyses of fluid infusions.
• Evaluation of fluid efficiency, elimination rates, and effects of bleeding and inflammation.

Main Results:

• Crystalloid fluids demonstrate 50-80% plasma volume expansion efficiency during infusion, increasing to 100% when arterial pressure drops.
• Fluid elimination during surgery is significantly slower (10% of conscious volunteers).
• Infusing over 3L of crystalloids may prolong gastrointestinal recovery time.

Conclusions:

• Four key factors limit the need for large crystalloid volumes during surgery.
• Selective use of colloids is an option to prevent prolonged hospital stays, but their therapeutic window is narrow.
• Inflammation may reduce colloid fluid efficiency and potentially accelerate crystalloid turnover.