Volume Management and Resuscitation in Colorectal Surgery

Abstract

The maintenance of intravascular volume during and after colorectal surgery is important in the optimization of perioperative outcomes. Techniques for optimizing cardiac output using minimally invasive monitoring have been studied extensively with many authorities now advocating some form of intraoperative stroke volume optimization. The excess administration of crystalloid solutions causes significant postoperative morbidity yet recent trials investigating the optimal type of fluid to be used have failed to show any benefit from the administration of colloids over crystalloids. Saline-based fluids are known to cause metabolic disturbance in the form of hyperchloraemia and acidosis but until recently no outcome data on their use was available. Large-scale observational studies now suggest that balanced solutions carry significant benefits when compared to saline-based solutions. This article reviews the recent literature describing the controversies in perioperative fluid management in colorectal surgery.