Goal-directed Perioperative Fluid Management

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Abstract
PRINCIPLES of perioperative fluid management have received increased interest in recent years within type and amount of crystalloid and colloid, the concept of individualized goal-directed cardiovascular optimization (GDT), and finally assessed on a procedure-specific basis. In this issue, Kimberger et al. ,1 investigated the underlying tissue mechanisms during GDT management with crystalloids or colloids for abdominal surgery with a colonic anastomosis. This elegant experimental study in pigs included detailed techniques of postsurgical assessments of conventional cardiovascular variables (blood pressure, heart rate, urinary output) and microcirculatory blood flow and tissue oxygen tension in healthy and perianastomotic colonic tissue. Three types of fluid management were instituted at the end of surgery: restricted Ringer lactate (RL) versus GDT RL or GDT colloid to achieve a mixed venous oxygen saturation (Svo2) greater than 60%. The results show no significant differences between the groups in conventional cardiovascular functional parameters or urinary output, but an increased oxygen tension in healthy colonic tissue compared with RL and a further increase with GDT colloid compared with GDT RL. Of special interest, oxygen tension in perianastomotic tissue increased to 245% with GDT colloid versus 147% in the GDT RL group versus 116% in the restricted RL group. Furthermore, microcirculatory flow was higher with GDT colloid. Interestingly, anastomotic tissue edema was not different between groups.