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Lecture 3 “Optimal Fluid strategy in the operating Room” Prof. Patricia Yazback Head of the Department of Anesthisia & Critical Care Hotel-Dieu De Francr University Hospital Beirut School of Medicine at The Saint Joseph University Beirut, Lebanon(Lebanon) Main messages: The administration of intravenous fluids before, during, and after surgery at the right time and in the right amounts is of great importance. For major surgeries with significant fluid shifts: it is preferable to use a fluid restricted approach (GDT) associated with the use of a monitoring to guide fluid therapy. The low substituted HES solutions (tetrastarch +++) have minimal clinical influence on hemostasis. No effect on the renal function of low to moderate doses of HES 6%, 130/0,4 It is not recommended to use HES in ICU patients, and in patients with severe sepsis, burns and risk of AKI. “Dynamic parameters should be preferred to guide volume responsiveness and more specifically Oesophag. Echo-Doppler.” (Prof. Yazback) Take home messages: • Goal-Directed fluid approach is suggested. • Dynamic parameters should be preferred to guide volume responsiveness and more specifically Oesophag Echo-Doppler. • Balanced Crystalloids (0,5-1ml/Kg/h) are recommended to replace sensible and insensible losses. • Colloids (Balanced Tetrastarch) may be used to replace blood losses with respect of the actual recommendations.
Lecture 4 “Fluid Management in Cardiac Surgery” Prof. Assem Abel Razek Professor of Anesthesia and Surgical Intensive Care Faculty of Medicine, Alexandria University Alexandria, Egypt Main messages: HYPOVOLEMIA is common among cardiac surgical patient. Optimization of perioperative fluid management may include a combination of fixed crystalloid administration to replace extravascular losses and avoiding fluid excess, together with individualized goal-directed colloid administration to maintain a maximal stroke volume. Tetrastarches are improved in regard to blood loss or need for transfusions compared to older starches. HES130/0.4 is safe as albumin in adult and children undergoing cardiac surgery. Use more than 1000ml HES in cardiac surgery doesn’t associated with increased risk of AKI & RBCs transfusion. “Determining both the need for augmented perfusion and fluid responsiveness is fundamental when making fluid therapy decisions to avoid unjustified fluid administration.” (Prof. Abel Razek) There is no evidence to support routine administration of albumin in hypovolemic states. The use of HES is associated with less fluid accumulation, which might have a significant impact on postoperative morbidity and mortality. We need well designed and categorized multi- centers double blind studies Take home messages: • fluids should be treated as any other intravenous drug therapy. • Determining both the need for augmented perfusion and fluid responsiveness is fundamental when making fluid therapy decisions to avoid unjustified fluid administration. • No solid Evidences or Solid FACTS on the Harm of Colloids and even HES in normal Patients.
Page 1 and 2: Fresenius Kabi Middle East Scientif
Page 3 and 4: Introduction Introduction Fresenius
Page 5 and 6: Lecture 1 “Omega-3 FA” Dr. Khal
Page 7 and 8: Lecture 3 “Importance of Taurine
Page 9 and 10: Lecture 1 “New advances in oncolo
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Page 19 and 20: “Time Always Matters” Saturday,
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