Fluid Replacement Therapy in Surgical Patients: Considerations & Calculations
Learn about the essential factors to consider when calculating fluid replacement in surgical patients undergoing procedures such as colon resection. Understand the signs of preoperative hypovolemia, how to calculate intraoperative fluid requirements, and when to use crystalloids versus colloids. This comprehensive guide provides insights into managing fluid therapy effectively during surgical interventions.
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Presentation Transcript
CASE 9 FLUID REPLACEMENT THERAPY Group B
A A 54 54- -year colon resection for colon resection for carcinoma. attempting to calculate the fluid attempting to calculate the fluid replacement. year- -old man is undergoing a laparotomy and old man is undergoing a laparotomy and carcinoma. The anesthesiologist is The anesthesiologist is replacement.
What are the components that must be considered when calculating the volume of fluid that should be replaced? Weight Preoperative fluid deficits (NPO status, vomiting, diarrhea, etc.). Insensitive fluid losses (Type and Duration of surgery). Intraoperative blood loss. Urine output Type of fluid replacement (Crystalloid or colloid)
What are the signs of preoperative hypovolemia? Increased heart rate. Decreased blood pressure. Dry skin. Pale. Decreased urine output.
How to calculate the fluid replacement in the intraoperative period? How to calculate maintenance fluid requirements? 4:2:1 rule First ten kilos x 4 mL/kg/hr Second ten kilos x 2 mL/kg/hr Every kilo after that x 1 mL/kg/hr E.g. a 70-kg adult will require (10 4 ) + (10 2) + (50 1) = 110 mL/h of maintenance. Preoperative fluid deficit? Normal maintenance requirements (4:2:1 rule) x number of hours of fasting NPO The deficit is infused over 3 hours, 1/2 in the first hour and the rest over the next 2 hours. Patient s pre-procedural volume status may vary due to: vomiting, diarrhea, ileus, fever, burns, ascites, effusions, hemorrhage, bowel preparations, or diuretics.
How to calculate the fluid replacement in the intraoperative period Third space and invisible estimated losses: Minimal trauma to the tissues (e.g. arthroscopy, hand surgery) 4 mL/kg/h Moderate tissue trauma without significant bowel exposure (e.g. cholecystectomy, hysterectomy) 6 mL/kg/h Severe tissue trauma (aortic aneurysm repair, most bowel surgery) 8 mL/kg/h Intraoperative blood loss: Crystalloids: 3mL of crystalloid for each 1mL of blood loss. Colloids: 1ml of colloids for each 1ml of blood loss. Urine output (0.5-1cc/kg/hr)
Which of Fluids: Crystalloid vs Colloids, you can use and when to use? Colloids: Fluids containing molecules sufficiently large enough to prevent transfer across capillary membranes. Replacement volume = volume lost. Used in emergency situation when we need rapid volume replacement. Crystalloid: Combination of water & electrolytes. Replacement volume = 3 times the volume lost. Used to correct blood loss and for maintenance.
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