Fluid therapy

Peri-operative fluid therapy is a fundamental part of the management of the high-risk surgical patient. Knowledge of the physicochemical and pharmacological effects of the available crystalloid and colloid solutions should guide their use. In addition to differences in tissue distribution and plasma volume expansion many of these solutions have significant effects on haemorrheology, haemostasis, vascular integrity and inflammatory cell function. When considering colloid solutions differentiation between the properties of the carrier solution and the dissolved colloid is important. Pre-operative risk assessment leading to institution of appropriate monitoring to guide fluid therapy is essential. Fluid therapy should be titrated to specific endpoints. Use of techniques which allow optimization of stroke volume, cardiac output and oxygen delivery have been shown to be beneficial. Monitoring of tissue perfusion as an endpoint will become increasingly important