CON: Fluid Restriction for Cardiac Patients During Major Noncardiac Surgery Should be Replaced by Goal-Directed Intravascular Fluid Administration

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Abstract
Oncerns have been expressed that over- hydration may result in pulmonary edema, car- diac complications, delayed recovery of gastro- intestinal motility, compromised tissue oxygenation, wound healing problems, and blood coagulation im- pairment (1-3). Patients with a cardiac comorbidity undergoing major noncardiac surgery may be partic- ularly vulnerable and, therefore, perioperative fluid restriction might appear to be beneficial. However, there are at least 4 prospective random- ized trials showing that a goal-directed perioperative plasma volume expansion decreases major postoper- ative morbidity and the duration of hospitalization significantly (4-7). In all these studies, stroke volume in the descending aorta was assessed by esophageal Doppler monitoring. Two hundred mL of colloids were given over 10 min and stroke volume was as- sessed every 15 min. This was repeated until no fur- ther increase in stroke volume was detected. Indeed,