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Perioperative fluid balance stress response the third space By Birgitte Brandstrup MD PhD Surgical Gastroenterol

The aims of perioperative fluid therapy. To correct preoperative deficits To meet basal requirements To replace losses due to surgery To ?keep physiological parameters within an accepted normal range.. Surgical losses. "The third space loss"Evaporation from the surgical woundBloss and exudat

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Perioperative fluid balance stress response the third space By Birgitte Brandstrup MD PhD Surgical Gastroenterol

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    1. Perioperative fluid balance ”stress response” & ”the third space” By Birgitte Brandstrup MD PhD Surgical Gastroenterological Department Glostrup University Hospital

    2. The aims of perioperative fluid therapy To correct preoperative deficits To meet basal requirements To replace losses due to surgery To  keep physiological parameters within an accepted normal range.

    3. Surgical losses ”The third space loss” Evaporation from the surgical wound Bloss and exudation.

    5. Methods

    6. Measurement of the ECV Choose a tracer Wait until it is completely dissolved Measure the concentration Calculate the volume of distribution

    7. Measurement of the ECV

    9. Measurement of the ECV

    10. Measurement of the ECV

    13. Haemorrhagic shock

    15. Abdominal surgery

    16. Abdominal surgery

    17. Abdominal surgery

    18. Abdominal surgery

    19. Abdominal surgery

    20. Thoracic surgery

    21. Thoracic surgery

    22. Discussion

    23. Discussion

    24. Overall conclusion

    25. Perspiration from abdominal wounds

    26. Perspective

    28. Intra-operative intervention

    33. 156 patients undergoing major elective GI operations were randomised to either Liberal intraoperative fluid therapy (LG) or Restricted intravenous fluid therapy (RG)

    34. Intervention

    41. Physiological consequences of fluid overload

    43. Restricted intravenous fluid therapy in colorectal surgery

    44. What is restricted fluid therapy? Standard fluid therapy: Loss should be replaced and fluid overload is not important Includes the following: Preloading of neuroaxial blockade Replacement of third space loss Replacement of blood loss with crystalloids Restricted fluid therapy: Losses should be replaced but fluid overload is important and should be avoided Claims the following: Preloading of neuroaxial blockade is ineffective and unnecessary There is no third space loss in elective surgery Blood should be replaced with colloids

    45. Claim

    46. Restricted intravenous fluid therapy in colorectal surgery

    47. Arterial blood pressure

    48. Heart rate

    49. Number of patients receiving pressor substances during operation

    51. Number of patients with postoperative hypotension

    52. Fact

    53. Claim

    55. Fluid overload and tissue oxygenation 42 elective major abdominal surgery patients was randomised to either HES or LR to achieve a CVP of 8-12 mmHg. HES group: 2920 ml HES + 3050 ml LR = 5970 ml. LR group: LR: 11740 ml Tissue oxygen tension was measured at induction of anaesthesia, after 60 and 120 min., at the end of surgery, and on the morning of the 1. Postoperative day.

    57. Fact

    58. Claim

    59. Fluid overload and GI-function 20 patients undergoing major GI surgery randomised to either Standard fluid management (>3 l water and 154 mmol sodium/day) Intravenous fluid and water restriction (<2 l water and 77 mmol sodium/day)

    62. Fluid overload and GI-function 156 patients undergoing major elective GI operations was randomised to either Liberal intraoperative fluid therapy (LG) or Restricted intravenous fluid therapy (RG)

    65. Fact

    66. Claim

    67. Fluid and cardio-pulmonary function

    68. Fluid and cardio-pulmonary function

    69. Fluid and cardio-pulmonary function

    70. Fluid and cardio-pulmonary function

    71. Conclusions The existence of the non anatomic 3-space loss is based on flawed methodology Fluid overload does not affect blood pressure Fluid overload causes hyper-chloraemic acidosis Fluid overload seems to impair tissue oxygenation Fluid overload with crystalloids impairs GI function Fluid overload impairs cardio-pulmonary function

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