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Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS).

Publication ,  Journal Article
Miller, TE; Roche, AM; Mythen, M
Published in: Can J Anaesth
February 2015

Optimal perioperative fluid management is an important component of Enhanced Recovery After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a continuum through the preoperative, intraoperative, and postoperative phases. Each phase is important for improving patient outcomes, and suboptimal care in one phase can undermine best practice within the rest of the ERAS pathway. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state. To achieve this, prolonged fasting is not recommended, and routine mechanical bowel preparation should be avoided. Patients should be encouraged to ingest a clear carbohydrate drink two to three hours before surgery. The goals of intraoperative fluid management are to maintain central euvolemia and to avoid excess salt and water. To achieve this, patients undergoing surgery within an enhanced recovery protocol should have an individualized fluid management plan. As part of this plan, excess crystalloid should be avoided in all patients. For low-risk patients undergoing low-risk surgery, a "zero-balance" approach might be sufficient. In addition, for most patients undergoing major surgery, individualized goal-directed fluid therapy (GDFT) is recommended. Ultimately, however, the additional benefit of GDFT should be determined based on surgical and patient risk factors. Postoperatively, once fluid intake is established, intravenous fluid administration can be discontinued and restarted only if clinically indicated. In the absence of other concerns, detrimental postoperative fluid overload is not justified and "permissive oliguria" could be tolerated.

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Published In

Can J Anaesth

DOI

EISSN

1496-8975

Publication Date

February 2015

Volume

62

Issue

2

Start / End Page

158 / 168

Location

United States

Related Subject Headings

  • Recovery of Function
  • Perioperative Care
  • Length of Stay
  • Humans
  • Fluid Therapy
  • Central Venous Pressure
  • Cardiac Output
  • Anesthesiology
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

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Miller, T. E., Roche, A. M., & Mythen, M. (2015). Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS). Can J Anaesth, 62(2), 158–168. https://doi.org/10.1007/s12630-014-0266-y
Miller, Timothy E., Anthony M. Roche, and Michael Mythen. “Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS).Can J Anaesth 62, no. 2 (February 2015): 158–68. https://doi.org/10.1007/s12630-014-0266-y.
Miller TE, Roche AM, Mythen M. Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS). Can J Anaesth. 2015 Feb;62(2):158–68.
Miller, Timothy E., et al. “Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS).Can J Anaesth, vol. 62, no. 2, Feb. 2015, pp. 158–68. Pubmed, doi:10.1007/s12630-014-0266-y.
Miller TE, Roche AM, Mythen M. Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS). Can J Anaesth. 2015 Feb;62(2):158–168.
Journal cover image

Published In

Can J Anaesth

DOI

EISSN

1496-8975

Publication Date

February 2015

Volume

62

Issue

2

Start / End Page

158 / 168

Location

United States

Related Subject Headings

  • Recovery of Function
  • Perioperative Care
  • Length of Stay
  • Humans
  • Fluid Therapy
  • Central Venous Pressure
  • Cardiac Output
  • Anesthesiology
  • 3202 Clinical sciences
  • 1103 Clinical Sciences