Review Article

Intraoperative Fluid Therapy for Major Surgeries: A Narrative Review


Intraoperative fluid equilibrium is a decisive matter in perioperative anesthesia management, because most of evaluation studies consider intraoperative fluid administration as a major participating agent in improving or worsening patient outcomes after surgery and it revolves within the responsibility of an anesthesiologist. The understanding of fluid physiology in the human body, clinical features of available intravenous fluid, and nature of surgery indeed will contribute to the success plan of management. Maintaining of patients’ physiological milieu by preserving normal extracellular volume, adequate tissue perfusion, and a balanced acid base condition are the main goals of intraoperative fluid infusion. This review was conducted to overview fundamental basics of fluid therapy during the intraoperative period. Due to the dearth of supporting data for appropriate volume and the available definitions of restrictive and liberal are diffident, the polemic about which particular method of volume expansion still exists. Colloid versus crystalloid controversy in surgical patients is still going on and this would again be encouraged to be a topic for many clinical trials in the future. The current findings’ trend prefers guided and restricted intraoperative fluid therapy with isotonic balanced crystalloids because such fluids are cost effective and have fewer side effects than other fluids.

Grocott MP, Mythen MG, Gan TJ. Perioperative fluid management and clinical outcomes in adults. Anesth Analg. 2005;100(4):1093-106.

Doherty M, Buggy D. Intraoperative fluids: how much is too much? Br J Anaesth. 2012;109(1):69-79.

Moemen ME. Fluid therapy: Too much or too little. Egyptian Journal of Anaesthesia. 2010;26(4):313-8.

Schol PB, Terink IM, Lancé MD, Scheepers HC. Liberal or restrictive fluid management during elective surgery: a systematic review and meta-analysis. Journal Clinical Anesthesia. 2016;35:26-39.

Holte K. Pathophysiology and clinical implications of peroperative fluid management in elective surgery. Dan Med Bull. 2010;57(7):B4156.

Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery. Anesth Analg. 2005;101(2):601-5.

Della Rocca G, Vetrugno L, Tripi G, Deana C, Barbariol F, Pompei L. Liberal or restricted fluid administration: are we ready for a proposal of a restricted intraoperative approach? BMC Anesthesiology. 2014;14(1):62-9.

Bailey AG, McNaull PP, Jooste E, Tuchman JB. Perioperative crystalloid and colloid fluid management in children: where are we and how did we get here? Anesth Analg. 2010;110(2):375-90.

Gan TJ. Colloid or Crystalloid: Any Differences in Outcomes? Review Course Lectures. 2011;7-12.

Kayilioglu SI, Dinc T, Sozen I, Bostanoglu A, Cete M, Coskun F. Postoperative fluid management. World J Crit Care Med. 2015;4(3):192-201.

Tatara T, Nagao Y, Tashiro C. The effect of duration of surgery on fluid balance during abdominal surgery: a mathematical model. Anesth Analg. 2009;109(1):211-6.

Boland MR, Noorani A, Varty K, Coffey JC, Agha R, Walsh SR. Perioperative fluid restriction in major abdominal surgery: systematic review and meta-analysis of randomized, clinical trials. World J Surg. 2013;37(6):1193-202.

Brandstrup B. Fluid therapy for the surgical patient. Best Practice & Research Clinical Anaesthesiology. 2006;20(2):265-83.

Pang Q, Liu H, Chen B, Jiang Y. Restrictive and liberal fluid administration in major abdominal surgery. Saudi med J. 2017;38(2):123-31.

Brady MC, Kinn S, Stuart P, Ness V. Preoperative fasting for adults to prevent perioperative complications. The Cochrane Library. 2003.

Raghunathan K, Singh M, Lobo DN. Fluid management in abdominal surgery: what, when, and when not to administer. Anesthesiology Clinics. 2015;33(1):51-64.

Arkiliç CF, Taguchi A, Sharma N, Ratnaraj J, Sessler DI, Read TE, et al. Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery. 2003;133(1):49-55.

Holte K, Klarskov B, Christensen DS, Lund C, Nielsen KG, Bie P, et al. Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: a randomized, double-blind study. Ann Surg. 2004;240(5):892-9.

Holte K, Kehlet H. Fluid therapy and surgical outcomes in elective surgery: a need for reassessment in fast-track surgery. J Am Coll Surg. 2006;202(6):971-89.

Bundgaard‐Nielsen M, Secher N, Kehlet H. ‘Liberal’vs.‘restrictive’perioperative fluid therapy–a critical assessment of the evidence. Acta Anaesthesiol Scand. 2009;53(7):843-51.

Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet. 2002;359(9320):1812-8.

Kalyan J, Rosbergen M, Pal N, Sargen K, Fletcher S, Nunn D, et al. Randomized clinical trial of fluid and salt restriction compared with a controlled liberal regimen in elective gastrointestinal surgery. Br J Anesth. 2013;100(13):1739-46.

Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I. Effect of intraoperative fluid management on outcome after intraabdominal surgery. J American Society of Anesthesiologists. 2005;103(1):25-32.

Lobo SM, Ronchi LS, Oliveira NE, Brandão PG, Froes A, Cunrath GS, et al. Restrictive strategy of intraoperative fluid maintenance during optimization of oxygen delivery decreases major complications after high-risk surgery. Critical Care. 2011;15(5):R226.

Holte K, Foss NB, Andersen J, Valentiner L, Lund C, Bie P, et al. Liberal or restrictive fluid administration in fast-track colonic surgery: a randomized, double-blind study. Br J Anesth. 2007;99(4):500-8.

Hilton AK, Pellegrino VA, Scheinkestel CD. Avoiding common problems associated with intravenous fluid therapy. Med J Aust. 2008;189(9):509-13.

Guidet B, Soni N, Della Rocca G, Kozek S, Vallet B, Annane D, et al. A balanced view of balanced solutions. Critical Care. 2010;14(5):325-36.

Chowdhury AH, Cox EF, Francis ST, Lobo DN. A randomized, controlled, double-blind crossover study on the effects of 2-L infusions of 0.9% saline and plasma-lyte® 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg. 2012;256(1):18-24.

McFarlane C, Lee A. A comparison of Plasmalyte 148 and 0.9% saline for intra‐operative fluid replacement. Anaesthesia. 1994;49(9):779-81.

Kim S, Huh K, Lee J, Kim S, Jeong S, Choi Y, editors. Comparison of the effects of normal saline versus Plasmalyte on acid-base balance during living donor kidney transplantation using the Stewart and base excess methods. Transplantation proceedings. Elsevier: 2013;45(6):2191-6.

Hahn R, Svensen C. Plasma dilution and the rate of infusion of Ringer's solution. Br J Anaesth. 1997;79(1):64-7.

Williams EL, Hildebrand KL, McCormick SA, Bedel MJ. The effect of intravenous lactated Ringer's solution versus 0.9% sodium chloride solution on serum osmolality in human volunteers. Anesth Analg. 1999;88(5):999-1003.

Khajavi MR, Etezadi F, Moharari RS, Imani F, Meysamie AP, Khashayar P, et al. Effects of normal saline vs. lactated ringer's during renal transplantation. Renal failure. 2008;30(5):535-9.

Soni N. British consensus guidelines on intravenous fluid therapy for adult surgical patients (GIFTASUP): Cassandra's view. Anaesthesia. 2009;64:235-8.

Shaw AD, Bagshaw SM, Goldstein SL, Scherer LA, Duan M, Schermer CR, et al. Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte. Ann Surg. 2012;255(5):821-9.

Chowdhury AH, Cox EF, Francis ST, Lobo DN. A randomized, controlled, double-blind crossover study on the effects of 1-L infusions of 6% hydroxyethyl starch suspended in 0.9% saline (Voluven) and a balanced solution (Plasma Volume Redibag) on blood volume, renal blood flow velocity, and renal cortical tissue perfusion in healthy volunteers. Ann Surg. 2014;259(5):881-7.

Cittanova M, Leblanc I, Legendre C, Mouquet C, Riou B, Coriat P. Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients. Lancet. 1996;348(9042):1620-2.

Wilkes MM, Navickis RJ, Sibbald WJ. Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery: a meta-analysis of postoperative bleeding. Ann Thorac Surg. 2001;72(2):527-33.

Reviewers CIGA. Human albumin administration in critically ill patients: systematic review of randomised controlled trials. Br Med J. 1998:235-40.

Arya VK. Basics of fluid and blood transfusion therapy in paediatric surgical patients. Indian J Anaesth. 2012;56(5):454-62.

Garrioch SS, Gillies MA. Which intravenous fluid for the surgical patient? Curr Opin Crit Care. 2015;21(4):358-63.

Ali Z, Prabhakar H. Fluid management during neurosurgical procedures. J Neuroanaesthesiol Crit Care. 2016;3(4):35-40.

Shander A, Lobel GP, Javidroozi M. Anesthesia for Patients with Anemia. Anesthesiology Clinics. 2016;34(4):711-30.

Abraham‐Nordling M, Hjern F, Pollack J, Prytz M, Borg T, Kressner U. Randomized clinical trial of fluid restriction in colorectal surgery. Br J Surg. 2012;99(2):186-91.

Holte K, Hahn RG, Ravn L, Bertelsen KG, Hansen S, Kehlet H. Influence of “liberal” versus “restrictive” intraoperative fluid administration on elimination of a postoperative fluid load. J American Society of Anesthesiologists. 2007;106(1):75-9.

Stephens R, Mythen M. Optimizing intraoperative fluid therapy. Curr Opin Anesthesiol. 2003;16(4):385-92.

Randell T, Niskanen M. Management of physiological variables in neuroanaesthesia: maintaining homeostasis during intracranial surgery. Curr Opin Anesthesiol. 2006;19(5):492-7.

Tommasino C. Fluids and the neurosurgical patient. Anesthesiology Clinics of North America. 2002;20(2):329-46.

Tommasino C, Moore S, Todd MM. Cerebral effects of isovolemic hemodilution with crystalloid or colloid solutions. Crit Care Med. 1988;16(9):862-8.

Lindroos A-C. Perioperative fluid therapy in neurosurgery: Effects on circulatory and haemostatic variables. Helda 2013.

Shenkin HA, Bezier HS, Bouzarth WF. Restricted fluid intake: rational management of the neurosurgical patient. J Neurosurg. 1976;45(4):432-6.

Gemma M, Cozzi S, Tommasino C, Mungo M, Calvi MR, Cipriani A, et al. 7.5% hypertonic saline versus 20% mannitol during elective neurosurgical supratentorial procedures. J Neurosurg Anesthesiol. 1997;9(4):329-34.

Alvis-Miranda HR, Castellar-Leones SM, Moscote-Salazar LR. Intravenous fluid therapy in traumatic brain injury and decompressive craniectomy. Bull Emerg Trauma. 2014;2(1):3-14.

Rovlias A, Kotsou S. The influence of hyperglycemia on neurological outcome in patients with severe head injury. Neurosurgery. 2000;46(2):335-9.

Lam AM, Winn HR, Cullen BF, Sundling N. Hyperglycemia and neurological outcome in patients with head injury. J Neurosurg. 1991;75(4):545-51.

Scheingraber S, Rehm M, Sehmisch C, Finsterer U. Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. J American Society of Anesthesiologists. 1999;90(5):1265-70.

Drummond JC, Patel PM, Cole DJ, Kelly PJ. The Effect of the Reduction of Colloid Oncotic Pressure, With and Without Reduction of Osmolality, on Posttraumatic Cerebral Edema. Surv Anesthesiol. 1999;43(1):20-1.

Strauss R, Stansfield C, Henriksen R, Villhauer P. Pentastarch may cause fewer effects on coagulation than hetastarch. Transfusion. 1988;28(3):257-60.

Cully MD, Larson CP, Silverberg GD. Hetastarch coagulopathy in a neurosurgical patient. Anesthesiology: J American Society of Anesthesiologists. 1987;66(5):706-707.

Claes Y, Van Hemelrijck J, Van Gerven M, Arnout J, Vermylen J, Weidler B, et al. Influence of hydroxyethyl starch on coagulation in patients during the perioperative period. Anesth Analg. 1992;75(1):24-30.

Lehmann G, Marx G, Förster H. Bioequivalence Comparison between Hydroxyethyl Starch 130/0.42/6: 1 and Hydroxyethyl Starch 130/0.4/9: 1. Drugs in R & D. 2007;8(4):229-40.

Khan ZH, Tabatabai SA. Head injuries, pathophysiology and management. Jahad Daneshgahi: Tehran University of Medical Sciences. 1992:30-42.

Ogden AT, Mayer SA, Connolly Jr ES. Hyperosmolar agents in neurosurgical practice: the evolving role of hypertonic saline. Neurosurgery. 2005;57(2):207-15.

Ziai WC, Toung TJ, Bhardwaj A. Hypertonic saline: first-line therapy for cerebral edema? J Neurol Sci. 2007;261(1):157-66.

Visweswaran P, Massin EK, Dubose T. Mannitol-induced acute renal failure. J Am Soc Nephrol. 1997;8(6):1028-33.

Quentin C, Charbonneau S, Moumdjian R, Lallo A, Bouthilier A, Fournier-Gosselin M-P, et al. A comparison of two doses of mannitol on brain relaxation during supratentorial brain tumor craniotomy: a randomized trial. Anesth Analg. 2013;116(4):862-8.

Petrozza PH. Hypertonic Saline: Is It Time? J Neurosurg Anesthesiol. 1996;8(2):174.

Bhatoe HS. Intravenous Fluids in Head Injury. Indian Journal of Neurotrauma. 2005;2(01):1-2.

Huang S-J, Chang L, Han Y-Y, Lee Y-C, Tu Y-K. Efficacy and safety of hypertonic saline solutions in the treatment of severe head injury. Surgical Neurology. 2006;65(6):539-46.

Luostarinen T, Niiya T, Schramko A, Rosenberg P, Niemi T. Comparison of hypertonic saline and mannitol on whole blood coagulation in vitro assessed by thromboelastometry. Neurocritical Care. 2011;14(2):238-43.

Jantzen J-PA. Prevention and treatment of intracranial hypertension. Best Practice & Research Clinical Anaesthesiology. 2007;21(4):517-38.

Polderman KH, Girbes AR. Severe electrolyte disorders following cardiac surgery: a prospective controlled observational study. Critical Care. 2004;8(6):R459.

Pradeep A, Rajagopalam S, Kolli H, Patel N, Venuto R, Lohr J, et al. High volumes of intravenous fluid during cardiac surgery are associated with increased mortality. HSR Proc Intensive Care Cardiovasc Anesth. 2010;2(4):287-96.

Habicher M, Perrino A, Spies CD, von Heymann C, Wittkowski U, Sander M. Contemporary fluid management in cardiac anesthesia. J Cardiothorac Vasc Anesth. 2011;25(6):1141-53.

Young R. Perioperative fluid and electrolyte management in cardiac surgery: a review. J Extra Corpor Technol. 2012;44(1):P20-6.

Vretzakis G, Kleitsaki A, Aretha D, Karanikolas M, editors. Management of intraoperative fluid balance and blood conservation techniques in adult cardiac surgery. Heart Surg Forum; 2011, 14 (1):28-39.

Shaw A, Raghunathan K. Fluid management in cardiac surgery: colloid or crystalloid? Anesthesiology Clinics. 2013;31(2):269-80.

Boldt J. Volume therapy in cardiac surgery: does the kind of fluid matter? J Cardiothorac Vasc Anesth. 1999;13(6):752-63.

Ley S, Miller K, Skov P, Preisig P. Crystalloid versus colloid fluid therapy after cardiac surgery. Heart and Lung: Journal of Critical Care. 1990;19(1):31-40.

Schumacher J, Klotz K. Fluid therapy in cardiac surgery patients. Appl Cardiopulm Pathophysiol. 2009;13:138-42.

Waters JH, Gottlieb A, Schoenwald P, Popovich MJ, Sprung J, Nelson DR. Normal saline versus lactated Ringer’s solution for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair: an outcome study. Anesth Analg. 2001;93(4):817-22.

Reddy S, McGuinness S, Parke R, Young P. Choice of fluid therapy and bleeding risk after cardiac surgery. J Cardiothorac Vasc Anesth. 2016;30(4):1094-103.

Boldt J. Volume Therapy in Cardiac Surgery. Ann Card Anaesth. 2005;8:104-116.

Green RS, Hall RI. Con: starches are not preferable to albumin during cardiac surgery: a contrary opinion. J Cardiothorac Vasc Anesth. 2008;22(3):485-91.

Jacob M, Bruegger D, Rehm M, Welsch U, Conzen P, Becker BF. Contrasting effects of colloid and crystalloid resuscitation fluids on cardiac vascular permeability. Anesthesiology: J American Society of Anesthesiologists. 2006;104(6):1223-31.

Van der Linden PJ, De Hert SG, Deraedt D, Cromheecke S, De Decker K, De Paep R, et al. Hydroxyethyl starch 130/0.4 versus modified fluid gelatin for volume expansion in cardiac surgery patients: the effects on perioperative bleeding and transfusion needs. Anesth Analg. 2005;101(3):629-34.

Knutson JE, Deering JA, Hall FW, Nuttall GA, Schroeder DR, White RD, et al. Does intraoperative hetastarch administration increase blood loss and transfusion requirements after cardiac surgery? Anesth Analg. 2000;90(4):801-7.

Bayer O, Schwarzkopf D, Doenst T, Cook D, Kabisch B, Schelenz C, et al. Perioperative fluid therapy with tetrastarch and gelatin in cardiac surgery—a prospective sequential analysis. Crit Care Med. 2013;41(11):2532-42.

Arslantas MK, Kara HV, Tuncer BB, Yildizeli B, Yuksel M, Bostanci K, et al. Effect of the amount of intraoperative fluid administration on postoperative pulmonary complications following anatomic lung resections. J Thorac Cardiovasc Surg. 2015;149(1):314-21. e1.

Holte K, N. E. Sharrock, and Henrick. Kehlet. Pathophysiology and clinical implications of perioperative fuid excess. Br J Anaesth. 2002;89:622-32.

Wei S, Tian J, Song X, Chen Y. Association of perioperative fluid balance and adverse surgical outcomes in esophageal cancer and esophagogastric junction cancer. Ann Thorac Surg. 2008;86(1):266-72.

Cagini L, Capozzi R, Tassi V, Savignani C, Quintaliani G, Reboldi G, et al. Fluid and electrolyte balance after major thoracic surgery by bioimpedance and endocrine evaluation. Eur J Cardiothorac Surg. 2011;40(2):e71-e6.

Siemionow K, Cywinski J, Kusza K, Lieberman I. Intraoperative fluid therapy and pulmonary complications. Orthopedics. 2012;35(2):e184-e91.

Licker M, Triponez F, Ellenberger C, Karenovics W. Fluid Therapy in Thoracic Surgery: A Zero-Balance Target is Always Best! Turk J Anaesthesiol Reanim. 2016;44(5):227-9.

Assaad S, Popescu W, Perrino A. Fluid management in thoracic surgery. Curr Opin Anesthesio. 2013;26(1):31-9.

Chau EHL, Slinger P, editors. Perioperative fluid management for pulmonary resection surgery and esophagectomy. Seminars in cardiothoracic and vascular anesthesia; 2014: SAGE Publications Sage CA: Los Angeles, CA.

Ashes C, Slinger P. Volume management and resuscitation in thoracic surgery. Current Anesthesiology Reports. 2014;4(4):386-96.

Licker M, de Perrot M, Spiliopoulos A, Robert J, Diaper J, Chevalley C, et al. Risk factors for acute lung injury after thoracic surgery for lung cancer. Anesth Analg. 2003;97(6):1558-65.

Zeldin R, Normandin D, Landtwing D, Peters R. Postpneumonectomy pulmonary edema. J Thorac Cardiovasc Surg. 1984;87(3):359-65.

Casado D, López F, Marti R. Perioperative fluid management and major respiratory complications in patients undergoing esophagectomy. Dis Esophagus. 2010;23(7):523-8.

Searl CP, Perrino A. Fluid management in thoracic surgery. Anesthesiology Clinics. 2012;30(4):641-55.

Ishikawa S, Griesdale DE, Lohser J. Acute kidney injury after lung resection surgery: incidence and perioperative risk factors. Anesth Analg. 2012;114(6):1256-62.

Verheij J, van Lingen A, Raijmakers PG, Rijnsburger ER, Veerman DP, Wisselink W, et al. Effect of fluid loading with saline or colloids on pulmonary permeability, oedema and lung injury score after cardiac and major vascular surgery. Br J Anaesth. 2005;96(1):21-30.

Luan H, Ye F, Wu L, Zhou Y, Jiang J. Perioperative blood transfusion adversely affects prognosis after resection of lung cancer: a systematic review and a meta-analysis. BMC Surgery. 2014;14(1):34.

Schneider F. Effect of blood transfusions on lung transplant rejection. A24 improving outcomes following lung transplantation: Am Thoracic Soc; 2011. p. A1132-A.

Price JD, Sear J, Venn R. Perioperative fluid volume optimization following proximal femoral fracture. Cochrane Database Syst Rev. 2004;1(1).

Peng K, Li J, Cheng H, Ji F-h. Goal-directed fluid therapy based on stroke volume variations improves fluid management and gastrointestinal perfusion in patients undergoing major orthopedic surgery. Med Princ Pract. 2014;23(5):413-20.

Venn R, Steele A, Richardson P, Poloniecki J, Grounds M, Newman P. Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures. Br J Anaesth. 2002;88(1):65-71.

Moppett I, Rowlands M, Mannings A, Moran C, Wiles M. LiDCO-based fluid management in patients undergoing hip fracture surgery under spinal anaesthesia: a randomized trial and systematic review. Br J Anaesth. 2014;114(3):444-59.

Holte K, Kristensen BB, Valentiner L, Foss NB, Husted H, Kehlet H. Liberal versus restrictive fluid management in knee arthroplasty: a randomized, double-blind study. Anesth Analg. 2007;105(2):465-74.

Sinclair S, James S, Singer M. Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. Br Med J. 1997;315(7113):909-12.

Mittermayr M, Streif W, Haas T, Fries D, Velik-Salchner C, Klingler A, et al. Hemostatic changes after crystalloid or colloid fluid administration during major orthopedic surgery: the role of fibrinogen administration. Anesth Analg. 2007;105(4):905-17.

Langeron O, Doelberg M, Ang E-T, Bonnet F, Capdevila X, Coriat P. Voluven®, a lower substituted novel hydroxyethyl starch (HES 130/0.4), causes fewer effects on coagulation in major orthopedic surgery than HES 200/0.5. Anesth Analg. 2001;92(4):855-62.

Dart AB, Mutter TC, Ruth CA, Taback SP. Hydroxyethyl starch (HES) versus other fluid therapies: effects on kidney function. Cochrane Database Syst Rev. 2010;1(1).

Van der Linden P, Ickx BE. The effects of colloid solutions on hemostasis. Can J Anesth. 2006;53(2):S30.

Rosencher N, Kerkkamp HE, Macheras G, Munuera L, Menichella G, Barton DM, et al. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion. 2003;43(4):459-69.

Lemaire R. Strategies for blood management in orthopaedic and trauma surgery. Bone & Joint Journal. 2008;90(9):1128-36.

Sümpelmann R, Becke K, Brenner S, Breschan C, Eich C, Höhne C, et al. Perioperative intravenous fluid therapy in children: guidelines from the Association of the Scientific Medical Societies in Germany. Ped Anesth. 2017;27(1):10-8.

Paut O, Lacroix F. Recent developments in the perioperative fluid management for the paediatric patient. Curr Opin Anesthesiol. 2006;19(3):268-77.

Visram A. Intraoperative fluid therapy in neonates. Southern African Journal of Anaesthesia and Analgesia. 2016;22(2):46-51.

Nair SG, Balachandran R. Perioperative fluid and electrolyte management in paediatric patients. Indian J Anaesth. 2004;48(5):355-64.

Bell EF, Acarregui MJ. Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2008;1.

Murat I, DUBOIS MC. Perioperative fluid therapy in pediatrics. Pediatr Anesth. 2008;18(5):363-70.

Mandee S, Butmangkun W, Aroonpruksakul N, Tantemsapya N, Bormann B, Suraseranivongse S. Effects of a restrictive fluid regimen in pediatric patients undergoing major abdominal surgery. Ped Anesth. 2015;25(5):530-7.

Sümpelmann R, Becke K, Crean P, Jöhr M, Lönnqvist P-A, Strauss JM, et al. European consensus statement for intraoperative fluid therapy in children. Eur J Anaesthesiol. 2011;28(9):637-9.

Way C, Dhamrait R, Wade A, Walker I. Perioperative fluid therapy in children: a survey of current prescribing practice. Br J Anaesth. 2006;97(3):371-9.

Suempelmann R, Mader T, Eich C, Witt L, Osthaus WA. A novel isotonic‐balanced electrolyte solution with 1% glucose for intraoperative fluid therapy in children: results of a prospective multicentre observational post‐authorization safety study (PASS). Ped Anesth. 2010;20(11):977-81.

Sümpelmann R, Mader T, Dennhardt N, Witt L, Eich C, Osthaus WA. A novel isotonic balanced electrolyte solution with 1% glucose for intraoperative fluid therapy in neonates: results of a prospective multicentre observational postauthorisation safety study (PASS). Ped Anesth. 2011;21(11):1114-8.

Houghton J, Wilton N. Choice of isotonic perioperative fluid in children. Anesth Analg. 2011;112(1):246.

Elbourne D, Initiative NNN. A randomized trial comparing the effect of prophylactic intravenous fresh frozen plasma, gelatin or glucose on early mortality and morbidity in preterm babies. Eur J pediat. 1996;155(7):580-8.

Paul M, Dueck M, Joachim Herrmann H, Holzki J. A randomized, controlled study of fluid management in infants and toddlers during surgery: hydroxyethyl starch 6%(HES 70/0.5) vs lactated Ringer's solution. Ped Anesth. 2003;13(7):603-8.

Barcelona SL, Thompson AA, CotÉ CJ. Intraoperative pediatric blood transfusion therapy: a review of common issues. Part II: transfusion therapy, special considerations, and reduction of allogenic blood transfusions. Ped Anesth. 2005;15(10):814-30.

IssueVol 4 No 2 (2018): Spring QRcode
SectionReview Article(s)
Major surgery intraoperative fluid therapy liberal vs restrictive intravenous fluids

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Khan ZH, Karvandian K, Zebardast J, Hussein HA. Intraoperative Fluid Therapy for Major Surgeries: A Narrative Review. Arch Anesth & Crit Care. 2018;4(2):468-476.