Anaes · Perioperative fluid & goal-directed therapy
Perioperative fluid & goal-directed therapy
Also known as Goal-directed therapy · GDT · Fluid responsiveness · Stroke volume optimisation · Restrictive fluid · Liberal fluid · Balanced crystalloid
Exam-exhaustive perioperative fluid: liberal vs restrictive vs GDT, crystalloid vs colloid at high level, vasopressor vs fluid for vasodilation, oliguria interpretation, dynamic indices, and RELIEF/OPTIMISE-level evidence framing.
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- Not all hypotension is hypovolaemia — anaesthetic vasodilation often needs vasopressor, not another litre.
- Oliguria is multi-factorial; do not auto-bolus fluid without assessing stroke volume / context.
- Fluid overload harms anastomoses, lungs, and wound healing; under-resuscitation harms kidneys and perfusion.
- HES starches are not routine perioperative resuscitation fluids (AKI/bleeding signals).
- PPV/SVV only work under the right conditions — controlled ventilation, regular rhythm, adequate tidal volume.
Meet the patient
A 68-year-old man is five minutes into general anaesthesia for open hemicolectomy. His blood pressure has fallen to 80 over 40, his arterial trace is flat, and the registrar reaches for a litre of Hartmann's. The patient is warm, has not bled, and the surgical field is dry. (Teaching vignette — [1] owns only kinetics.) [1]
The question is not whether to give fluid — it is whether this is hypovolaemia or vasodilation. Anaesthesia vasodilates the venous capacitance bed; the pressure falls with near-normal volume. A vasopressor restores tone; a reflex litre creates interstitial oedema without fixing the pressure. (Taught doctrine — [1] owns only kinetics.) [1]
References5ShowHide
- [1]Hahn RG Understanding volume kinetics. Acta Anaesthesiol Scand, 2020.PMID 31863457
- [2]Michard F, Boussat S, et al. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med, 2000.PMID 10903232
- [3]Pearse RM, Harrison DA, et al. Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery. JAMA, 2014.PMID 24842135
- [4]Myles PS, Bellomo R, et al. Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. N Engl J Med, 2018.PMID 29742967
- [5]Older PO, Levett DZH, et al. Cardiopulmonary Exercise Testing and Surgery. Ann Am Thorac Soc, 2017.PMID 28511024