Perioperative Fluid Restriction

Abstract

Perioperative fluid management of the colorectal surgical patient has evolved significantly over the last five decades. Older notions espousing aggressive hydration have been shown to be associated with increased complications. Newer data regarding fluid restriction has shown an association with improved outcomes. Management of perioperative fluid administration can be considered in three primary phases: In the preoperative phase, data suggests that avoidance of preoperative bowel preparation and avoidance of undue preoperative dehydration can improve outcomes. Although the type of intraoperative fluid given does not have a significant effect on outcome, data do suggest that a restrictive fluid regimen results in improved outcomes. Finally, in the postoperative phase of fluid management, a fluid-restrictive regimen, coupled with early enteral feeding also seems to result in improved outcomes.

Keywords

colorectal - bowel surgery - fluid restriction - mechanical bowel preparation - enhanced recovery - outcomes

• References

• 1 Srinivasa S, Hill AG. Perioperative fluid administration: historical highlights and implications for practice. Ann Surg 2012; 256 (6) 1113-1118
• 2 Choi PT, Yip G, Quinonez LG, Cook DJ. Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med 1999; 27 (1) 200-210
• 3 Shires T, Williams J, Brown F. Acute change in extracellular fluids associated with major surgical procedures. Ann Surg 1961; 154: 803-810
• 4 Doherty M, Buggy DJ. Intraoperative fluids: how much is too much?. Br J Anaesth 2012; 109 (1) 69-79
• 5 Holte K, Nielsen KG, Madsen JL, Kehlet H. Physiologic effects of bowel preparation. Dis Colon Rectum 2004; 47 (8) 1397-1402
• 6 Güenaga KF, Matos D, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2011; (9) CD001544
• 7 Eskicioglu C, Forbes SS, Fenech DS, McLeod RS ; Best Practice in General Surgery Committee. Preoperative bowel preparation for patients undergoing elective colorectal surgery: a clinical practice guideline endorsed by the Canadian Society of Colon and Rectal Surgeons. Can J Surg 2010; 53 (6) 385-395
• 8 Lassen K, Soop M, Nygren J , et al; Enhanced Recovery After Surgery (ERAS) Group. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg 2009; 144 (10) 961-969
• 9 Ren L, Zhu D, Wei Y , et al. Enhanced Recovery After Surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial. World J Surg 2012; 36 (2) 407-414
• 10 Bamboat ZM, Bordeianou L. Perioperative fluid management. Clin Colon Rectal Surg 2009; 22 (1) 28-33
• 11 Piper GL, Kaplan LJ. Fluid and electrolyte management for the surgical patient. Surg Clin North Am 2012; 92 (2) 189-205, vii vii.
• 12 Tommasino C, Picozzi V. Volume and electrolyte management. Best Pract Res Clin Anaesthesiol 2007; 21 (4) 497-516
• 13 Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2012; 6: CD000567
• 14 Brandstrup B. Fluid therapy for the surgical patient. Best Pract Res Clin Anaesthesiol 2006; 20 (2) 265-283
• 15 Brandstrup B, Tønnesen H, Beier-Holgersen R , et al; Danish Study Group on Perioperative Fluid Therapy. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 2003; 238 (5) 641-648
• 16 Bundgaard-Nielsen M, Secher NH, Kehlet H. 'Liberal' vs. 'restrictive' perioperative fluid therapy—a critical assessment of the evidence. Acta Anaesthesiol Scand 2009; 53 (7) 843-851
• 17 Gao T, Li N, Zhang JJ , et al. Restricted intravenous fluid regimen reduces the rate of postoperative complications and alters immunological activity of elderly patients operated for abdominal cancer: a randomized prospective clinical trail. World J Surg 2012; 36 (5) 993-1002
• 18 Holte K, Foss NB, Andersen J , et al. Liberal or restrictive fluid administration in fast-track colonic surgery: a randomized, double-blind study. Br J Anaesth 2007; 99 (4) 500-508
• 19 Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet 2002; 359 (9320) 1812-1818
• 20 Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology 2005; 103 (1) 25-32
• 21 Arkiliç CF, Taguchi A, Sharma N , et al. Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery 2003; 133 (1) 49-55
• 22 Kabon B, Akça O, Taguchi A , et al. Supplemental intravenous crystalloid administration does not reduce the risk of surgical wound infection. Anesth Analg 2005; 101 (5) 1546-1553
• 23 Bundgaard-Nielsen M, Holte K, Secher NH, Kehlet H. Monitoring of peri-operative fluid administration by individualized goal-directed therapy. Acta Anaesthesiol Scand 2007; 51 (3) 331-340
• 24 Abbas SM, Hill AG. Systematic review of the literature for the use of oesophageal Doppler monitor for fluid replacement in major abdominal surgery. Anaesthesia 2008; 63 (1) 44-51
• 25 Srinivasa S, Taylor MH, Sammour T, Kahokehr AA, Hill AG. Oesophageal Doppler-guided fluid administration in colorectal surgery: critical appraisal of published clinical trials. Acta Anaesthesiol Scand 2011; 55 (1) 4-13
• 26 Shah MR, Hasselblad V, Stevenson LW , et al. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA 2005; 294 (13) 1664-1670
• 27 Stewart RM, Park PK, Hunt JP , et al; National Institutes of Health/National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Clinical Trials Network. Less is more: improved outcomes in surgical patients with conservative fluid administration and central venous catheter monitoring. J Am Coll Surg 2009; 208 (5) 725-735 , discussion 735–737
• 28 Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest 2008; 134 (1) 172-178
• 29 Roche AM, Miller TE, Gan TJ. Goal-directed fluid management with trans-oesophageal Doppler. Best Pract Res Clin Anaesthesiol 2009; 23 (3) 327-334
• 30 Noblett SE, Snowden CP, Shenton BK, Horgan AF. Randomized clinical trial assessing the effect of Doppler-optimized fluid management on outcome after elective colorectal resection. Br J Surg 2006; 93 (9) 1069-1076
• 31 Wakeling HG, McFall MR, Jenkins CS , et al. Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. Br J Anaesth 2005; 95 (5) 634-642
• 32 Holte K, Kehlet H. Fluid therapy and surgical outcomes in elective surgery: a need for reassessment in fast-track surgery. J Am Coll Surg 2006; 202 (6) 971-989
• 33 Rahbari NN, Zimmermann JB, Schmidt T, Koch M, Weigand MA, Weitz J. Meta-analysis of standard, restrictive and supplemental fluid administration in colorectal surgery. Br J Surg 2009; 96 (4) 331-341
• 34 MacKay G, Fearon K, McConnachie A, Serpell MG, Molloy RG, O'Dwyer PJ. Randomized clinical trial of the effect of postoperative intravenous fluid restriction on recovery after elective colorectal surgery. Br J Surg 2006; 93 (12) 1469-1474
• 35 Senagore AJ, Emery T, Luchtefeld M, Kim D, Dujovny N, Hoedema R. Fluid management for laparoscopic colectomy: a prospective, randomized assessment of goal-directed administration of balanced salt solution or hetastarch coupled with an enhanced recovery program. Dis Colon Rectum 2009; 52 (12) 1935-1940
• 36 Kehlet H. Fast-track colorectal surgery. Lancet 2008; 371 (9615) 791-793
• 37 Wind J, Polle SW, Fung Kon Jin PH , et al; Laparoscopy and/or Fast Track Multimodal Management Versus Standard Care (LAFA) Study Group; Enhanced Recovery after Surgery (ERAS) Group. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 2006; 93 (7) 800-809
• 38 Abraham-Nordling M, Hjern F, Pollack J, Prytz M, Borg T, Kressner U. Randomized clinical trial of fluid restriction in colorectal surgery. Br J Surg 2012; 99 (2) 186-191
• 39 Walsh SR, Tang T, Bass S, Gaunt ME. Doppler-guided intra-operative fluid management during major abdominal surgery: systematic review and meta-analysis. Int J Clin Pract 2008; 62 (3) 466-470