Fluid Replacement Therapy Group B

A 54-year old man is undergoing a laparotomy and colon resection for Carcinoma. The anesthesiologist is attempting to calculate the fluid Replacement.

loss 500 ml and urine output is 400 ml What are the compartment that must be considered when calculating ? The patient body weight is 80 kg, 8 hours fasting with bowel preparation blood loss 500 ml and urine output is 400 ml

The patient body weight is 80 kg Total body water= 48 L (60% of body weight in male) Intracellular water= 32 L (40% of total body weight) Extracellular water= 16 L (20% of total body weight) Interstitial (extravascular)= 12 L (3/4 the extracellular water) Intravascular= 12 L (3/4 the extracellular water) Rich in potassium and fixed anions (protein, phosphate and sulphate) Rich in sodium and chloride and low in potassium

Discuss the volume of fluid that should be replaced?

Perioperative fluid application basically must replace two kinds of losses: losses occurring all the time (mainly urine production and insensible perspiration), possibly to another extent than under “normal” conditions. losses occurring exclusively during trauma and surgery (mainly blood losses). 1- replacement of fluid losses from the body via  insensible perspiration and urinary output Maintenance therapy 2-replacement of plasma losses from the circulation due to fluid shifting or acute bleeding. Replacement therapy The first kind of loss affects the entire extracellular space, i.e.  , the intravascular plus the interstitial space, and normally does not lead to a loss of colloid osmotic force from the intravascular space. The second loss induces a primarily isolated intravascular deficit, including losses of all blood components. In practice, we only have access to the vascular space, even when treatment of the entire extracellular compartment is intended

The following factors must be taken into account: 1- Maintenance fluid requirements 2- NPO and other deficits: NG suction, bowel prep 3- Third space losses 4- Replacement of blood loss 5- Special additional losses: diarrhea

What are the signs of preoperative hypovolemia ? Supine Hypotension Tachycardia Cold dry skin Low JVP Pale Oliguria Positive tilt test Positive tilt test (Increase in heart rate of at least 20 beats/minute and a decrease in systolic blood pressure of at least 20 mmHg or more when the patient assumes the upright position)

How to calculate the fluid replacement in the intraoperative period all of which take into consideration the preoperative fluid deficits?

loss 500 ml and urine output is 400 ml The patient body weight is 80 kg, 8 hours fasting with bowel preparation blood loss 500 ml and urine output is 400 ml 120 x 8hrs = 960 ml Maintenance: Number of hours NPO x maintenance fluid requirement. 8 x 120 = 960 and ml 1000 ml for bowel prep = 1960 ml Each 1cc of blood loss is replaced by 3 cc of crystalloid solution Fluid deficit (NPO): 500 ml x 3 = 1500 ml Blood Loss:

Greatest third space losses: *open laparotomies 400 ml of crystalloid Urine output: (4-6 ml/kg/hr possibly), 4 x 80 x 8 = 2560 Third Space Losses: 960 + 1960 + 1500 + 400 + 2560 = 5880 ml Total: Some believe that the third spacing concept is overrated and has given anesthesiologists an excuse for overloading patients with fluids Recent studies suggests that conservative fluid management improves outcomes with colon and pulmonary resections Greatest third space losses: *open laparotomies

What is your choice of fluid for replacement Crystalloid vs Colloids?

Thank You