Indications for the use of fluids and blood before and during operation.

Abstract

Trm aEsror;smnaT~ of the anaesthesiologist should not begin in the operating room. He should visit the patient preoperatively, review the medical history, and carry out a thorough examination ff he deems it advisable. This preliminary wslt of the anaesthesiologlst to the patient has many facets and is most helpful in determining the need for :fluids and blood. In this presentation we are concerned prmaarily with three aspects of the use of fluids and blood transfusmns. They are (i) the special indications for use of fluids and certain drugs before and during operation, (ii) the indications for blood transfusions during the same two periods with comments on the emergency use of substatutes and transfusion react-ions, and (m) practical hints concerning supporttve measures. FLUmS AND GERTAIN DRUGS The medical record plus~ the physical examination of the pataent will reveal much information about the status of hydration and the blood electrolytes of the patient before operation. This is important as shown for instance in the recent reports of Keating and Tang ([) on neostlgrnine-resistarlt apnoea m the presence of hypokalaemla and the report of Foster (2) who presented evidence for a possible central action of curare wath low levels of serum potassium in patients Vomiting, protracted diarrhoea, gastric or intestinal suction, ~astro-intestinal fistulas, unusual sweating, and burns ale frequently accompanied jy disturbances in the volume of the body flmds and with changes in the ion composition of the blood. Cardiac failure, cirrhosis~of the hver with ascites, and renal insu~ciency often also cause imbalances of the body fluids and blood electrolytes. Diseases of the endocrine glands especially are associated wilt disturbances of the body fluids and electrolytes. Diabetes mellitus and adrenal insufficiency are of major importance. All these conditions demand appropriate treatment. We shah restrict our discussion, however, to diabetes melhtus, adrenal msuflaciency, water requirements of children after cardiac operations, and the changes associated wath general anaesthesia.