PERI-OPERATIVE FLUID THERAPY - LIBERAL OR RESTRICTIVE

Abstract

Proper perioperative fluid management is the most important aspect governing haemo dynamic function in a surgical patient. Maintenance of sufficient intravascular volume is of paramount importance. There is a large variability in the fluid regimens in daily practice and their implications for outcome in elective surgery are controversial. Recent randomised trials in major abdominal surgery suggest liberal fluid administration would affect cardio respiratory function, reduce gut motility, reduce tissue oxygenation thereby affecting would healing and lead to increased morbidity and hospital stay. It is well established with evidence in thoracic surgical circles of liberal fluid regimens contributing to poor outcomes after lung surgery. There is growing support for this view in the general surgical population with growing literature -comparing liberal with restrictive fluid management many of which show better outcomes in fluid restricted patients. Opponents of both regimens argue that our aim should be not liberal, not restrictive, based on volumes but "goal directed" towards monitored parameters.