Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Miscellaneous issues• Abdominal and thoracic surgery involving significant fluid shifts.• Acute renal failure patient.• Sepsis.• Acute heart failure.• Severe hypovolaemia.• Complex circulatory situations.Recommendations for postoperative fluid managementNo intravenous infusion should be continued simply because it is a‘routine’ component of clinical care. Intravenous fluids areprescription-only medicines and must have clinical indications. Foodand fluids should be provided orally or enterally; intravenousinfusions should be discontinued as soon as possible.In patients requiring continuing intravenous maintenance fluids, theseshould be sodium-poor and of low enough volume until the patienthas returned their sodium and fluid balance over the perioperativeperiod to zero. When this has been achieved the intravenous fluidvolume and content should be those required for daily maintenanceand replacement of ongoing losses.Nutritionally depleted patients need cautious refeeding orally,enterally or parenterally, with feeds supplemented in potassium,phosphate and thiamine. If oedema is present, reduced water andsodium load should be considered.While prescribing postoperative intravenous fluids, the prescribermust take care to assess patient’s sodium, chloride, potassium andwater requirements for the next 24 hours.Preoperative fasting times[Appraised by Dr Edwin Borman, January 2010]The department has agreed the following as standards applying to allpatients (other than in obstetrics; see the Obstetric AnaesthetistsHandbook for times appropriate to obstetric patients and the freewater policy). Exceptions must be discussed with a consultant.Anaesthetists Handbook January 2010 225