Newly Published
Clinical Focus Review  |   February 2019
Perioperative Fluid Therapy for Major Surgery
Author Notes
  • From Duke University School of Medicine, Durham, North Carolina (T.E.M.); and Alfred Hospital and Monash University, Melbourne, Australia (P.S.M.).
  • Deborah J. Culley, M.D., served as Handling Editor for this article.
    Deborah J. Culley, M.D., served as Handling Editor for this article.×
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication September 25, 2018. Accepted for publication November 29, 2018.
    Submitted for publication September 25, 2018. Accepted for publication November 29, 2018.×
  • Correspondence: Address correspondence to Dr. Myles: Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Commercial Rd., Melbourne, VIC 3004, Australia. p.myles@alfred.org.au. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Renal and Urinary Systems / Electrolyte Balance / Clinical Focus Review
Clinical Focus Review   |   February 2019
Perioperative Fluid Therapy for Major Surgery
Anesthesiology Newly Published on February 14, 2019. doi:10.1097/ALN.0000000000002603
Anesthesiology Newly Published on February 14, 2019. doi:10.1097/ALN.0000000000002603
The goal of IV fluid administration is to restore and maintain tissue fluid and electrolyte homeostasis and central euvolemia, while avoiding salt and water excess. This will in turn facilitate tissue oxygen delivery without causing harm. Achieving optimal IV fluid therapy should improve perioperative outcomes and is a key component in many perioperative guidelines and pathways.1,2  IV fluids, like other medications, should only be given in well-defined protocols according to individual needs.3 
There have been numerous studies of fluid and hemodynamic optimization over the past 20 yr. Most of these studies were very small single-center studies, sometimes with conflicting results.4,5  However, in recent years several large multicenter randomized controlled trials and observational studies using electronic medical records have been published on these topics in major medical journals.6–12  These efforts have greatly improved the evidence base and are a credit to our specialty.