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Modern fluid management in thoracic surgery.

Timothy J P Batchelor¹

¹Department of Thoracic Surgery, Barts Thorax Centre, St. Bartholomew's Hospital, West Smithfield, London, UK.

Current Opinion in Anaesthesiology

|December 12, 2023

Summary

Perioperative fluid management for lung resection patients can achieve euvolemia by focusing on pre- and postoperative hydration. A pragmatic intraoperative approach, guided by enhanced recovery after surgery (ERAS) principles, often negates the need for goal-directed fluid therapy.

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Area of Science:

Thoracic surgery
Anesthesiology
Critical care medicine

Background:

Intraoperative fluid management in lung resection is critical, as both under- and overhydration are linked to adverse outcomes.
Enhanced Recovery After Surgery (ERAS) programs for thoracic surgery have not prioritized intraoperative fluid management, potentially due to the impact of other ERAS elements.
Preoperative carbohydrate loading and allowing water intake until just before anesthesia induction optimize patient hydration and metabolic status.

Approach:

This review provides an approach to perioperative fluid management for lung resection patients, integrating the entire patient pathway within international ERAS guidelines.
The approach emphasizes optimizing pre- and postoperative fluid balance.
It advocates for a pragmatic strategy for intraoperative fluid management.

Key Points:

Preoperative carbohydrate loading and allowing oral fluid intake until induction ensure patients are well-hydrated and metabolically stable entering the operating room.
Maintaining a euvolemic state during anesthesia can be achieved without goal-directed fluid therapy in many cases, despite some guideline recommendations.
Intravenous fluid administration can be safely discontinued in the immediate postoperative period.

Conclusions:

The overarching goal of perioperative euvolemia in lung resection patients is attainable through the continuous development and application of ERAS principles.
A strategic focus on the pre- and postoperative phases of fluid management, coupled with a practical intraoperative approach, typically eliminates the necessity for goal-directed fluid therapy.