Role of Crystalloids in the Perioperative Setting: From Basics to Clinical Applications and Enhanced Recovery Protocols

Author:

Lorente Juan12ORCID,Hahn Robert3,Jover José24ORCID,Del Cojo Enrique25,Hervías Mónica67ORCID,Jiménez Ignacio28ORCID,Uña Rafael9,Clau-Terré Fernando210,Monge Manuel2ORCID,Llau Juan11ORCID,Colomina Maria212ORCID,Ripollés-Melchor Javier21314

Affiliation:

1. Department of Anesthesiology and Critical Care, Juan Ramón Jiménez University Hospital, 21005 Huelva, Spain

2. Fluid Therapy and Haemodynamics Working Group of the Haemostasis, Fluid Therapy and Transfusional Medicine of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), 28003 Madrid, Spain

3. Karolinska Institute, Danderyds Hospital (KIDS), 171 77 Stockholm, Sweden

4. Department of Anesthesiology and Critical Care, Verge del Lliris Hospital, 03802 Alcoy, Spain

5. Department of Anesthesiology and Critical Care, Don Benito-Villanueva de la Serena Health District, 06400 Don Benito, Spain

6. Department of Anesthesiology and Critical Care, Gregorio Marañón General University Hospital, 28007 Madrid, Spain

7. Paediatric Anaesthesiology Section, Spanish Society of Anesthesiology and Resuscitation (SEDAR), 28003 Madrid, Spain

8. Department of Anesthesiology and Critical Care, Virgen del Rocío University Hospital, 41013 Seville, Spain

9. Department of Anesthesiology and Critical Care, La Paz University General Hospital, 28046 Madrid, Spain

10. Vall d’Hebron Institut Recerca, Vall d’Hebrón University Hospital, 08035 Barcelona, Spain

11. Department of Anesthesiology and Critical Care, Doctor Peset Hospital, 46017 Valencia, Spain

12. Department of Anesthesiology and Critical Care, Bellvitge University Hospital, University of Barcelona, 08907 Barcelona, Spain

13. Department of Anesthesiology and Critical Care, Infanta Leonor Hospital, 28031 Madrid, Spain

14. Department of Toxicology, Universidad Complutense de Madrid, 28040 Madrid, Spain

Abstract

Perioperative fluid management, a critical aspect of major surgeries, is characterized by pronounced stress responses, altered capillary permeability, and significant fluid shifts. Recognized as a cornerstone of enhanced recovery protocols, effective perioperative fluid management is crucial for optimizing patient recovery and preventing postoperative complications, especially in high-risk patients. The scientific literature has extensively investigated various fluid infusion regimens, but recent publications indicate that not only the volume but also the type of fluid infused significantly influences surgical outcomes. Adequate fluid therapy prescription requires a thorough understanding of the physiological and biochemical principles that govern the body’s internal environment and the potential perioperative alterations that may arise. Recently published clinical trials have questioned the safety of synthetic colloids, widely used in the surgical field. A new clinical scenario has arisen in which crystalloids could play a pivotal role in perioperative fluid therapy. This review aims to offer evidence-based clinical principles for prescribing fluid therapy tailored to the patient’s physiology during the perioperative period. The approach combines these principles with current recommendations for enhanced recovery programs for surgical patients, grounded in physiological and biochemical principles.

Publisher

MDPI AG

Subject

General Medicine

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