Editorial Views  |   May 2019
Perioperative Fluid Management: Turning Art to Science
Author Notes
  • From the Department of Anesthesiology, University of Utah, Salt Lake City, Utah.
  • This editorial accompanies the article on p. 728.
    This editorial accompanies the article on p. 728.×
  • Accepted for publication January 27, 2019.
    Accepted for publication January 27, 2019.×
  • Address correspondence to Dr. Hopf: harriet.hopf@hsc.utah.edu
Article Information
Editorial Views / Renal and Urinary Systems / Electrolyte Balance
Editorial Views   |   May 2019
Perioperative Fluid Management: Turning Art to Science
Anesthesiology 5 2019, Vol.130, 677-679. doi:10.1097/ALN.0000000000002663
Anesthesiology 5 2019, Vol.130, 677-679. doi:10.1097/ALN.0000000000002663
Appropriate fluid management is a cornerstone of anesthetic practice.1  Unfortunately, there is disagreement as to how to translate that goal into practice. Anesthesiologists know that too much fluid may lead to complications from side effects, including tissue edema, poor cardiac function, or pulmonary compromise. Too little fluid may also be harmful, potentially leading to inadequate tissue perfusion, impaired wound healing, and higher risk of deep venous thrombosis. Textbooks provide guidelines for calculating fluid management, based on patient and surgical factors, but they are not strongly evidence-based, and interpretation and implementation vary widely. Although there are many randomized trials of fluid management and outcome, most compare fixed volumes of a colloid, usually a hydroxyethyl starch solution, and a crystalloid, usually a balanced salt solution, without any measure of physiologic comparability.2  Thus, it is unclear whether the outcomes of the trials result from the type of solution, the relative volume of solution, or both. The study by Kabon et al.3  in this issue of Anesthesiology represents a step in the right direction: in relatively healthy patients undergoing major abdominal surgery, the effects of crystalloid versus tetrastarch hydroxyethyl starch colloid fluid administration on outcome were compared using goal-directed, that is physiologically comparable, rather than fixed-dose fluid administration. In contrast to a number of previous studies comparing fixed doses of colloid and crystalloid, there were no differences in major or minor composite outcomes, mortality, or hospital readmission, suggesting that effective volume may be more important than type of fluid.