CASE 9 FLUID REPLACEMENT THERAPY Group B A

CASE 9 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.

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 m. L/kg/hr • Second ten kilos x 2 m. L/kg/hr • Every kilo after that x 1 m. L/kg/hr • E. g. a 70 -kg adult will require (10 × 4 ) + (10 × 2) + (50 × 1) = 110 m. L/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 m. L/kg/h • Moderate tissue trauma without significant bowel exposure (e. g. cholecystectomy, hysterectomy) 6 m. L/kg/h • Severe tissue trauma (aortic aneurysm repair, most bowel surgery) 8 m. L/kg/h Intraoperative blood loss: • Crystalloids: 3 m. L of crystalloid for each 1 m. L of blood loss. • Colloids: 1 ml of colloids for each 1 ml of blood loss. Urine output (0. 5 -1 cc/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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