Wet or Dry? A Review of Intravenous Fluid Administration in Anesthesia Practice

Fluid therapy has dramatically changed since its early inception nearly 200 years ago. Administration of intravenous fluid (IVF) has evolved from a "drip" technique to the algorithmic approach of the anesthetic fluid plan, and is now moving toward Goal-Directed Fluid Therapy. As the science and culture of fluid management evolves, anesthetists must remain focused on "why" anesthetic fluid matters. The purpose of IVF administration is to support tissue perfusion and maintain euvolemia. As the evidence underlying perioperative practice matures and the science of anesthesia races to meet the evolving demands of surgery, anesthetists must align knowledge generation with the individualized needs of the patient. The future of perioperative IVF therapy will be patient centric. In the near future, anesthetists will know the patient's blood volume before, during, and after the surgery. They will no longer depend on inaccurate surrogates to estimate, but have the knowledge to titrate fluids to maintain a zero balance. Practice will move away from algorithms and toward individualized fluid administration based on reproducible end points. Decisions about fluid selection, timing, and volume will be driven by patient- and case-specific requirements as specific as when a patient is typed and crossed for blood transfusion. The greatest challenge for the anesthetist in perioperative fluid therapy is to move beyond the dogmatic practices of the past and toward fluid therapy guided by patient centric evidence.