Management of perioperative volume therapy - monitoring and pitfalls

Abstract

Over 300 million surgical procedures are performed every year worldwide. Anesthesiologists play an important role in the perioperative process by assessing the overall risk of surgery and aim to reduce the risk of complications. Perioperative hemodynamic and volume management can help to improve outcomes in perioperative patients. There has been ongoing discussion about goal-directed therapy. However, there is a consensus that fluid overload and severe fluid depletion in the perioperative period are harmful and can lead to adverse outcomes. This article provides an overview of how to evaluate the fluid responsiveness of patients, details which parameters could be used, and what limitations should be noted.

Keywords: Cardiac output monitoring; Colloids; Crystalloid solutions; Hemodynamic monitoring; Hypotension; Volume therapy.

Fig. 1.

Relationship between morbidity and hypo- normo- and hypervolemia. Bellamy [17] developed a theoretical framework based on their concept that there is a U-shape relationship between fluid therapy and outcome. Therefore, prevention of hypo- and hypervolemia by goal-directed fluid management is essential. SIRS: systemic inflammatory response syndrome, MOV: multiple organ failure, PONV: postoperative nausea and vomiting.