Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Miscellaneous issuesHypovolaemia due predominantly to blood loss should be treated witheither a balanced crystalloid (Hartmann’s solution) or a balancedcolloid (Volulyte or Isoplex) until packed red cells (allogeneic orautologous) are available.Excessive losses from gastric aspiration or vomiting should betreated preoperatively with balanced crystalloid solutions with anappropriate potassium supplement. Hypochloraemia is an indicationfor the use of 0.9% saline, supplemented with potassium. Take carenot to produce sodium overload.Losses from diarrhoea, ileostomy, small bowel fistula or ileus shouldbe replaced volume for volume with Hartmann’s solution.‘Saline depletion’ due to excessive diuretic exposure should bemanaged with Hartmann’s solution.Mechanical bowel preparation is not indicated in elective colorectaloperations, unless there are anticipated problem with faecaloverloading that might create technical difficulties with the procedure,e.g. laparoscopic colectomy and low rectal carcinoma. When it isindicated, Hartmann’s solution should be started evening before theday of the surgery (one litre every 8-12 hours).Care should be taken in patients with impaired renal function andhyperkalemia while using balanced solutions containing potassium.Recommendations for intraoperative fluid managementIn patients undergoing major abdominal, orthopaedic surgery,intraoperative treatment with intravenous fluids to achieve an optimalvalue of stroke volume should be used where possible as this mayreduce postoperative complication rates and duration of hospital stay.LiDCO (Lithium indicator dilution calibration system)haemodynamic monitor should be used where possible when strokevolume measurements are indicated during the preoperative,intraoperative and postoperative periods.Indications for stroke volume measurement:• High risk surgical patients.224 Anaesthetists Handbook January 2010