Contemporary perspectives on perioperative fluid therapy

Area of Science:

• Anesthesiology
• Physiology
• Pharmacology

Background:

• Perioperative intravenous (IV) fluid administration aims to maintain tissue perfusion by supporting intravascular volume.
• Anesthetic agents and general anesthesia induce physiological changes impacting fluid balance and hemodynamics.
• Understanding fluid compartments, balance, and drug kinetics is essential for appropriate IV fluid dosing.

Approach:

• This narrative review synthesizes current knowledge on anesthesia-related physiological and fluid kinetic alterations.
• It examines how these changes affect IV fluid efficacy during surgery.
• A framework for intraoperative fluid dosing is presented, considering hypotension, blood loss, and overload risks.

Key Points:

• Anesthesia modulates the body's response to IV fluids, potentially leading to interstitial fluid accumulation and overload.
• Intraoperative fluid management requires careful consideration of anesthetic effects on hemodynamics.
• Dynamic, goal-directed methods are recommended for monitoring fluid responsiveness.

Conclusions:

• Individualized intraoperative IV fluid administration is critical.
• Monitoring fluid responsiveness using dynamic methods helps optimize tissue perfusion.
• This approach mitigates risks associated with fluid overload and inadequate resuscitation.