Chapter 23 - Peri-operative intravenous fluid management

Summary

Management of intravenous fluids during thoracic surgery, particularly lung resection, is a longstanding contentious issue between anesthetists and thoracic surgeons. Assessment of the right ventricle pump functions in the thoracic surgical patient is often subjective and technically limited using transthoracic echocardiography. The aim of fluid management in thoracic surgical patients is to maintain normal hydration and accept reduction in urine output in the post-operative period. Traditional anesthetic training dictates that replacement of fluid losses during surgery is the key target for peri-operative fluid management. Fluid losses are calculated based upon the length of fasting, surgical blood loss, evaporative losses from exposed body cavity, and urine excretion. In the modern anesthetic practice, the recommended pre-operative fasting period is 4-6 hours. The purpose of blood transfusion in the perioperative period is for improving oxygen carrying capacity and hemostasis, and supporting circulating volume.