K. Holte, N.E. Sharrock, H. Kehlet British Journal of Anaesthesia

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Pathophysiology and clinical implications of perioperative fluid excess K. Holte, N.E. Sharrock, H. Kehlet British Journal of Anaesthesia Volume 89, Issue 4, Pages 622-632 (October 2002) DOI: 10.1093/bja/aef220 Copyright © 2002 British Journal of Anaesthesia Terms and Conditions

Fig 1 Effects of perioperative fluid therapy on the Starling myocardial performance curve. British Journal of Anaesthesia 2002 89, 622-632DOI: (10.1093/bja/aef220) Copyright © 2002 British Journal of Anaesthesia Terms and Conditions

Fig 2 Relationship between cardiac output and fluid administration. General anaesthesia or extensive epidural/spinal anaesthesia result in venodilatation and cardiac depression. Venodilatation leads to a reduction in preload depicted by transfer from Point A (baseline) to B on the normal contractility curve. Cardiac depression results in a fall to a depressed contractility curve (Point C). Restoration of cardiac output with fluid alone is depicted by the line from Point C to D. With resolution of epidural anaesthesia or emergence from general anaesthesia, the patient is apt to be hyperdynamic and fluid overloaded (Point E). By contrast, if extensive epidural/spinal anaesthesia is managed with vasopressors, restoration of contractility (Point C to B) and venous tone (Point B to A) can be achieved without fluid loading. British Journal of Anaesthesia 2002 89, 622-632DOI: (10.1093/bja/aef220) Copyright © 2002 British Journal of Anaesthesia Terms and Conditions