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Intraoperative Fluid Management—What and How Much?^*

^* From the Department of Anesthesia, Stanford University School of Medicine, Stanford, CA.

Correspondence to: Myer H. Rosenthal, MD, FCCP, Department of Anesthesia—Room H3580, Stanford University School of Medicine, Stanford, CA 94305; e-mail: mhr{at}leland.stanford.edu

An approach to intraoperative fluid management based on a monitored physiologic application of the Starling principles of cardiac function is recommended to individualize therapy to optimize hemodynamic function and tissue perfusion. The complexity of intraoperative fluid administration, beginning with preoperative cardiovascular function followed by innumerable intraoperative considerations, including anesthetic pharmacology, positive pressure ventilation, operative site, and surgical technique may lead to serious intraoperative and postoperative complications. Emphasis must be given to intraoperative fluid shifts resulting in hidden fluid loss and intravascular hypovolemia that must be replaced. Explanations for this fluid redistribution have included tissue trauma, endotoxemia, and proinflammatory cytokines with resultant increased capillary permeability.

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