SMERNICE ZA PERIOPERATIVNO ZDRAVLJENJE S TEKOČINAMI (GUIDELINES FOR PERIOPERATIVE FLUID TREATMENT)

Abstract

Introduction.The maintainaning of optimal perioperative fluid and electrolyte balance in the perioparative period (before, during and after an operation) is a crucial for anaesthesia and intensive therapy. Fluid treatment interferes with the metabolism and functioning of all organ systems, therefore it is important that the patient gets the right type and quantity of fluid at the right time. Perioperative fluid therapy should be guided by the patient’s condition and type of the operation procedure. In fluid therapy, one should take into consideration the need for fluid maintenance (basal metabolism needs), preoperative fluid loss correction (e.c. duration of preoperative starving, especially in children), and aim for good tissue perfusion with an adequate fluid load. The final goal of fluid replacement is to maintain fluid and electrolyte balance, intravascular volume and consequently cardiovascular stability (adequate cardiac output), organ perfusion and tissue oxygenation. Before, during and after surgery balanced fluids should be used, in order to minimise disturbances to the electrolyte balance. In our article, literature of perioperative fluid replacement is reviewed. The results of the latest research have provoked a lot of criticism and disagreement about colloids. Only guidelines about crystalloid application are presented.Conclusions. The latest guidelines for perioperative fluid therapy emphasise the application of balanced intravenous fluids that minimise electrolyte and acid base balance disturbances. It is important to individualise the amount of the intravenous fluid to avoid hyper- or hypovolemia. The correct choice of the type of solution is equally important as any other medication that influences the patient’s outcome.