Fluid management before, during and after elective surgery.

PURPOSE OF REVIEW: Fluid management is regarded as a cornerstone of successful perioperative care, but fluid prescription is not always treated that way. New insights and guidelines have become available very recently.

RECENT FINDINGS: Although most of the recent scientific attention went to resuscitation fluids and the place of hydroxyethyl starches, recent guidelines also emphasize the importance of fluid prescription in a maintenance and a replacement setting. The use of balanced solutions over saline 0.9% gains momentum because recent evidence shows the deleterious effect of chloride-containing solutions on relevant clinical endpoints. Where the debate on the use of starches in septic and critically ill patients seems to be settled after recent trials pointed out several safety issues in the absence of a proven benefit, their intraoperative use is still a matter of debate. A presumably correct use in this setting was proposed recently.

SUMMARY: The combination of a careful prescription of maintenance fluids, additional replacement solutions tailored to the patient's eventual extra needs and a rational but nonaggressive goal-directed approach to resuscitation fluids seems to be the best practice to avoid fluid-related morbidity. Isotonic balanced crystalloids seem the best pragmatic choice for resuscitation purposes. In certain well defined conditions, colloids can still be used.