Perioperative Fluid Therapy

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ISBN: 9780824728823 | 0824728823
Cover: Hardcover
Copyright: 9/6/2006

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Perioperative fluid therapy requires the correct selection, amount, and composition of fluids based on the patient's underlying pathology, state of hydration, and type and duration of surgical stress. Filling a gap in the literature, this source provides a solid foundation to practical perioperative fluid management, fluid solutions, and the utilization of fluids in clinical and surgical environments, and analyzes the composition of body compartments, the regulation of water and electrolytes, and bodily response to traumatic and surgical conditions.

Preface	p. iii
Contributors	p. xiii
Basic Science
Measurement of Body Fluid Volumes In Vivo	p. 1
Introduction: The Dilution Principle	p. 1
Anthropometry	p. 1
The Setting of the Operating Room	p. 2
Total Body Water	p. 3
Extracellular and Intracellular Water	p. 4
Blood Volume and Its Components	p. 6
Other Fluid Volume Measurements	p. 9
Summary and Conclusions	p. 9
References	p. 10
Microvascular Fluid Exchange	p. 13
Introduction	p. 13
Microvessels for Fluid Exchange	p. 13
Starling Equation for Transvascular Fluid Exchange	p. 15
The Three-Pore Model	p. 16
Autoregulation	p. 17
Hemodynamic Effects of Increased Permeability	p. 18
Microvascular Fluid Exchange in the Lung	p. 19
Microvascular Fluid Exchange in the Brain	p. 20
Intravascular Volume Substitution	p. 23
Crystalloid Infusion	p. 23
Colloid Infusion	p. 24
Erythrocyte Transfusion	p. 25
Hypertonic Solutions	p. 26
Permeability-Reducing Therapy	p. 26
References	p. 26
Methods of Assessing Fluid Balance
Invasive Hemodynamic Monitoring	p. 29
Practical Considerations of Fluid Management	p. 29
Pulmonary Artery Catheterization	p. 30
Intrathoracic Blood Volume Measurement	p. 33
Systolic Arterial Pressure Waveform Variability	p. 34
Transesophageal Echocardiography	p. 38
Esophageal Doppler Monitoring	p. 40
Conclusion	p. 42
References	p. 43
Oxygen Delivery as a Goal for Fluid Therapy in Surgical Patients	p. 49
Introduction	p. 49
Conventional Approach to Perioperative Fluid Therapy	p. 49
Basic Concepts	p. 50
The Relationship Between Oxygen Delivery and Oxygen Consumption	p. 51
Critical Oxygen Delivery During Surgery	p. 52
Oxygen Delivery and Infusion Fluids	p. 54
Conclusions About Optimal Perioperative Fluid Therapy	p. 58
Recommendations	p. 58
References	p. 59
Volume Kinetics	p. 63
"Effectiveness" of an Infusion Fluid	p. 63
Analyzing Hemoglobin Changes	p. 63
Hemoglobin Dilution During Surgery	p. 64
Drawbacks of Using Hemoglobin Dilution	p. 65
Volume Kinetics	p. 66
Future Challenges	p. 72
References	p. 73
Pulmonary Edema: Etiology and Measurement	p. 75
Background	p. 75
Clinical Aspects of Pulmonary Edema	p. 75
Theoretical Aspects of Pulmonary Edema	p. 76
Gas Exchange in Pulmonary Edema	p. 78
Measurement of Pulmonary Edema	p. 79
Conclusion	p. 83
References	p. 83
Intravascular Volume Assessment in the Critically Ill Patient	p. 87
Introduction	p. 87
Transesophageal Doppler Echocardiography	p. 87
Pulse Contour Analysis	p. 89
Respiration-Induced Changes	p. 90
Right Atrial Pressure	p. 90
Systemic Arterial Blood Pressure	p. 91
Chest Radiography	p. 92
Clinical Evaluation	p. 94
References	p. 95
Intravenous Fluids
Intravenous Access in Adults	p. 99
Peripheral Venous Access	p. 99
Central Venous Catheters	p. 102
References	p. 105
Vascular Access in Children	p. 107
Introduction	p. 107
Peripheral Venous Access	p. 107
Central Venous Access	p. 112
Pediatric Intravenous Equipment	p. 121
Arterial Cannulation	p. 122
Summary	p. 124
References	p. 125
Glucose Solutions	p. 129
Introduction	p. 129
Basic Needs for Glucose	p. 129
Glucose and the "Stress Response"	p. 130
Glucose and Insulin	p. 130
Glucose Levels During Surgery	p. 130
Indications and Contraindications for Glucose	p. 133
Conclusion	p. 134
References	p. 134
Crystalloid Solutions	p. 137
Introduction	p. 137
Physiological Principles	p. 138
Conventional Distribution of Fluid Volumes	p. 139
Kinetic Distribution of Fluid Volumes	p. 140
Crystalloid Solutions	p. 142
Surgical Procedures and Blood Loss	p. 145
Adverse Effects of Large-Volume Crystalloid Infusion	p. 146
Effects of Crystalloid Infusion on Immune Function	p. 147
Effects of Crystalloids on Acid-Base Balance	p. 147
Effects on Coagulation	p. 148
References	p. 148
Colloid Fluids	p. 153
Introduction	p. 153
Comparative Discussion of the Principal Colloids	p. 153
Specific Properties of Colloids	p. 156
Conclusion	p. 158
References	p. 159
Hypertonic Solutions	p. 163
History and Background	p. 163
Mechanisms of Hypertonic Solutions	p. 163
Clinical Use	p. 165
Adverse Effects	p. 168
Summary	p. 170
References	p. 170
Oxygen-Carrying Plasma Expanders: A New Class of Fluids for Perioperative Support	p. 175
Introduction	p. 175
Background	p. 175
Scientific and Clinical Challenges	p. 176
Products in Development	p. 176
Time Courses of Volume Expansion with Fluid Infusions	p. 178
Colloids and COP	p. 178
Relationships Between HBOC Volume Expansion and CO	p. 182
HBOCs as Resuscitative Fluids	p. 184
Conclusion and Recommendations	p. 184
References	p. 185
Intravenous Fluid Therapy in Special Situations
Hypovolemic Shock	p. 187
Introduction	p. 187
Etiology	p. 187
Physiological Response to Hypovolemia	p. 188
Pathophysiologic Response to Hypovolemia and Reperfusion Injury	p. 191
Conclusion and Future Developments	p. 194
References	p. 195
Septic Shock	p. 197
Introduction	p. 197
End Points of Resuscitation	p. 198
Choice of Fluids	p. 201
References	p. 203
Prehospital Fluid Therapy	p. 205
Introduction	p. 205
Continued Efforts	p. 205
Civilian Practice	p. 207
The Clinical Use of Hypertonic Solutions	p. 212
Other Aspects	p. 213
Recommendations	p. 214
References	p. 215
Fluid Therapy in Trauma	p. 221
Introduction	p. 221
Etiology of Shock in Acute Trauma	p. 221
Management Principles of Trauma-Related Shock	p. 223
Vascular Access and Flow Rates	p. 224
Hypotensive Resuscitation and Prehospital Fluids	p. 224
Crystalloids and Colloids: Isotonic Solutions	p. 225
Hypertonic Solutions	p. 227
Transfusions: Allogenic	p. 228
Autotransfusion: Autologous	p. 230
Autotransfusion	p. 231
Red Cell Substitutes	p. 231
Conclusion	p. 232
References	p. 232
Fluid Management in the Severely Burned Patient	p. 235
Introduction	p. 235
The Pathophysiology of Burn Shock	p. 235
Resuscitation of Burn Patients	p. 236
End Points of Resuscitation	p. 240
Conclusion	p. 244
References	p. 244
Perioperative Fluid Management of the Neurosurgical Patient	p. 247
Introduction	p. 247
Physical Principles Governing Fluid Movement Between the Intra- and Extravascular Spaces	p. 247
Characteristics of Intravenous Fluids	p. 250
General Principles of Neurosurgical Fluid Administration	p. 254
Monitoring Fluid Administration	p. 256
Fluid Administration in Specific Situations	p. 260
Common Perioperative Electrolyte Abnormalities in Neurosurgical Patients	p. 262
Summary	p. 265
References	p. 265
Fluid Therapy in the Intensive Care Unit	p. 269
Introduction	p. 269
Physiology	p. 269
Fluid Types, Characteristics, and Controversies	p. 271
Patient Assessment	p. 277
Practical Aspects of Fluid Management in the Intensive Care Unit	p. 278
Concluding Remarks	p. 284
References	p. 285
Transfusion of Red Cells and Blood Components in Stressed, Trauma, and Critical Care Patients	p. 289
Introduction	p. 289
Compensatory Mechanisms for Anemia and the Transfusion Decision in Trauma and Critical Care Patients	p. 289
Mixed Venous Oxygen Saturation	p. 292
What Is the Optimum Hb and Cardiac Output in the Trauma Patient?	p. 300
Use and Indications for Blood Transfusion in Trauma and Critically Ill Patients	p. 303
Complications of Blood Transfusion	p. 308
Indications for Platelets, FFP, and Cryoprecipitate in Bleeding Patients	p. 310
Conclusion	p. 313
References	p. 315
Fluid Management of Uncontrolled Hemorrhage	p. 321
Introduction	p. 321
Uncontrolled Hemorrhage	p. 321
Control of Hemorrhage	p. 322
End Points of Resuscitation	p. 323
Resuscitation During Active Hemorrhage	p. 323
Conclusions	p. 331
References	p. 331
Intravenous Fluid Therapy in Daily Practice
Spinal Anesthesia and Fluid Therapy	p. 333
Introduction	p. 333
Crystalloids	p. 333
Colloids	p. 335
Blood Pressure and Augmentation of Blood Volume	p. 337
Plasma Volume Expansion	p. 338
Regional Anesthesia and Physiology	p. 339
Venous Return and Mean Circulatory Filling Pressure	p. 341
Rapid Blood Volume Changes	p. 342
Summary	p. 344
References	p. 345
Fluid Balance in Day Surgery	p. 349
Day Surgery-A Growing Part of Modern Anesthesia	p. 349
Fluids: Fluid Balance in Day Surgery	p. 350
Conclusion	p. 354
References	p. 354
Intravenous Fluid Therapy in Daily Practice: Intraabdominal Operations	p. 357
Introduction	p. 357
Assessment of Fluid Requirement	p. 357
Fluid Shifts During Surgery	p. 357
Types of Fluid	p. 358
Transfusion of Blood and Blood Products	p. 360
Goal-Directed Therapy	p. 361
Conclusion	p. 362
References	p. 362
Fluid Therapy in Cardiac Surgery	p. 365
Introduction	p. 365
What Is So Special About Volume Therapy in Cardiac Surgery?	p. 365
Principles of Volume Replacement Therapy in Cardiac Surgery	p. 366
How to Perform Volume Therapy in Cardiac Surgery	p. 367
How to Monitor Volume Therapy in Cardiac Surgery	p. 371
Side Effects of Different Volume Replacement Strategies	p. 372
Economic Considerations	p. 374
Conclusion	p. 374
References	p. 374
Urology	p. 379
Introduction	p. 379
The Lithotomy Position	p. 379
Body Temperature	p. 379
Blood Lost in Irrigating Fluid	p. 380
Replacing Blood Lost During TURP	p. 381
Fluid Absorption in Urology	p. 382
Blood Loss in More Extensive Operations	p. 383
Indication for Transfusion of Erythrocytes	p. 384
Long-Term Mortality After Prostatectomy	p. 385
References	p. 385
Fluid Therapy in Noncardiac Thoracic Surgery	p. 389
Introduction	p. 389
Pulmonary Blood Flow, Drainage, and Physiology	p. 389
Postpneumonectomy Pulmonary Edema	p. 393
Fluid Management in Esophagectomy and Lung Transplant	p. 401
Conclusions	p. 402
References	p. 402
Fluid Management in Obstetrics	p. 405
Introduction	p. 405
Maternal Physiologic Changes of Pregnancy	p. 405
Maternal Physiologic Changes During the Peripartum Period	p. 406
Fluid Management During Labor and Vaginal Delivery	p. 407
Fluid Management for Obstetric Analgesia and Anesthesia	p. 408
Fluid Management for Labor Analgesia	p. 409
Fluid Management for Cesarean Section	p. 409
Fluid Management in Postpartum Patients	p. 413
Vasopressors in the Management of Regional Anesthesia-Induced Hypotension	p. 414
Fetal Response to Fluid Preload	p. 415
Fluid Management in Special Pregnancy States	p. 415
Conclusion	p. 417
References	p. 418
Perioperative Fluid Therapy in Pediatrics	p. 423
Introduction	p. 423
Physiology	p. 423
Maintenance Requirements	p. 424
Preoperative Assessment	p. 425
Intraoperative Fluid Management	p. 426
Volume Replacement During Infancy	p. 428
Postoperative Fluid Problems	p. 429
Conclusion	p. 430
References	p. 430
Restricted Intravenous Fluid Therapy in Elective Surgery	p. 435
Introduction	p. 435
The (Missing) Evidence for Current Fluid Therapy in Major Surgery	p. 436
The Replacement of Fluid Lost	p. 436
Trials of Goal-Directed Fluid Regimens (Standard Fluid vs. Extra Fluid)	p. 438
Trials on Restricted Intravenous Fluid Therapy	p. 442
Trials of Outpatient Surgery	p. 443
Recommendation: Restricted Intravenous Fluid Therapy in Major Elective Surgery	p. 445
References	p. 446
Adverse Effects of Fluids
Outcome Studies	p. 453
Introduction	p. 453
Albumin	p. 453
Crystalloid vs. Colloid Therapy	p. 454
Morbidity as the End Point	p. 455
Goal-Directed Fluid Therapy	p. 456
References	p. 457
Adverse Reactions to Infusion Fluids	p. 459
Introduction	p. 459
Local Adverse Effects	p. 459
Systemic Adverse Effects	p. 459
Conclusions	p. 471
References	p. 472
Absorption of Irrigating Fluid	p. 477
Introduction	p. 477
Sterile Water	p. 477
Glycine	p. 478
Mannitol	p. 478
Mixtures of Sorbitol and Mannitol	p. 480
Symptoms of Fluid Absorption	p. 480
Extravasation	p. 481
Assessment of Fluid Absorption	p. 482
Pathophysiology	p. 484
Mild and Severe TUR Syndromes	p. 484
Treatment	p. 484
References	p. 485
Effects of Perioperative Fluids on Acid-Base and Electrolyte Status	p. 489
Introduction	p. 489
Acid-Base Interpretation and Treatment	p. 489
Practical Approach to Acid-Base Interpretation	p. 495
Influence of Fluid Infusion on Serum Electrolytes	p. 498
Summary	p. 513
References	p. 513
Fluids and Coagulation	p. 517
Overview of Coagulation	p. 517
Overview of Intravenous Fluids and Coagulation	p. 517
Hemodilution and Coagulation	p. 519
Monitoring of Coagulation	p. 520
Perioperative Coagulation and DIC	p. 521
References	p. 522
Multiple Organ Failure	p. 525
Definitions Pertinent to Multiple Organ Failure	p. 525
The Historical Perspective of Postinjury Organ Failure and Death	p. 526
Epidemiology of Postinjury MOF	p. 528
Shock Is a Potential Modifiable Risk Factor	p. 528
Resuscitation Modulates Ischemia/Reperfusion-Induced SIRS	p. 528
References	p. 534
The Future of Intravenous Fluid Therapy
Perioperative Fluid Therapy: Predictions for the Future	p. 537
References	p. 541
Index	p. 543
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