Indications for Preoperative IV Fluids 

Administering preoperative intravenous (IV) fluids is vital for optimal patient outcomes. The goal of perioperative fluid management is to maintain homeostasis, electrolyte balance, and central euvolemia while preventing salt and water overload [1]. When not managed appropriately, these conditions profoundly affect surgery success and patient outcomes [12]. Because fluid management begins in the period leading up to surgery, indications for preoperative IV fluids are essential knowledge for physicians and other providers involved in the procedure. 

To understand the indications for preoperative IV fluids, healthcare providers must recognize the adverse effects caused by necessary preoperative fasting [12]. While fasting reduces the risk of pulmonary aspiration during anesthesia, it can inadvertently lead to dehydration and electrolyte imbalances [12]. As a result, intravenous fluids must be administered to restore the body’s normal equilibrium of fluids and electrolytes. To determine the appropriate amount and type of intravenous fluid to administer, physicians should evaluate a patient’s hydration status using their clinical expertise and diagnostic tests. This assessment helps them decide whether to use crystalloids for overall rehydration or colloids for specific volume expansion needs [8]. 

Administering IV fluids in pediatric patients is more complex, and the margin for error is significantly narrower. According to studies, specific fluid rate and composition considerations are crucial due to children’s unique physiological responses and fluid requirements [7]. Deciding on preoperative IV fluids for children should be guided by clear indications to avoid adverse outcomes. Children have an elevated metabolic rate, a more rapid respiratory rate, and a larger surface area relative to their weight—all factors that contribute to considerable fluid loss [9]. Therefore, healthcare providers should consider the appropriate administration rate, the child’s maintenance requirements, and the fluid’s composition to ensure optimal hydration before an operation [5]. 

While managing fluids is essential for quality patient care, physicians should be aware of potential complications requiring careful consideration and monitoring. Studies have shown that Enhanced Recovery After Surgery (ERAS) protocols that include preoperative fluid management may significantly improve outcomes and decrease recovery times [13]. However, preoperative IV fluids administered beyond indications can lead to issues such as hypervolemia, imbalances in electrolytes, and edema [3]. These complications can impact several vital organ systems, with the lungs, brain, and kidneys being particularly susceptible [6]. Healthcare personnel should routinely evaluate patients’ fluid status and monitor their response to intravenous fluids to prevent adverse side effects [2].  

Preoperative IV fluid therapy is a cornerstone of surgical care. This proactive approach to fluid management reduces complications, optimizes patient outcomes, and facilitates quicker recovery times, ultimately promoting overall patient well-being and satisfaction with their care. Effective fluid management programs tailored to patients’ needs require essential collaboration among anesthesiologists, surgeons, nurses, and pharmacists. By tailoring IV fluid therapy to each patient’s needs, clinicians can support the physiological demands of surgery while preventing significant morbidity and mortality. 

References 

1. Castera MR, Borhade MB. Fluid Management. [Updated 2023 Oct 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532305 

2. Claure-Del Granado, R., & Mehta, R. L. (2016). Fluid overload in the ICU: evaluation and management. BMC nephrology, 17(1), 109. https://doi.org/10.1186/s12882-016-0323-6 

3. Ghose, A., Harvey, M., & Edmunds, S. (2020). Fluid and electrolyte balance in children. Anaesthesia & Intensive Care Medicine, 21(12), 649-656. https://doi.org/10.1016/j.mpaic.2020.10.004 

4. Hansen B. (2021). Fluid Overload. Frontiers in veterinary science, 8, 668688. https://doi.org/10.3389/fvets.2021.668688 

5. Lee, H., & Kim, J. T. (2023). Pediatric perioperative fluid management. Korean journal of anesthesiology, 76(6), 519–530. https://doi.org/10.4097/kja.23128 

6. Lewis, S. R., Pritchard, M. W., Evans, D. J., Butler, A. R., Alderson, P., Smith, A. F., & Roberts, I. (2018). Colloids versus crystalloids for fluid resuscitation in critically ill people. The Cochrane database of systematic reviews, 8(8), CD000567. https://doi.org/10.1002/14651858.CD000567.pub7 

7. Malbrain, M. L. N. G., Langer, T., Annane, D., Gattinoni, L., Elbers, P., Hahn, R. G., De Laet, I., Minini, A., Wong, A., Ince, C., Muckart, D., Mythen, M., Caironi, P., & Van Regenmortel, N. (2020). Intravenous fluid therapy in the perioperative and critical care setting: Executive summary of the International Fluid Academy (IFA). Annals of intensive care, 10(1), 64. https://doi.org/10.1186/s13613-020-00679-3 

8. Mathew, A., & Rai, E. (2021). Pediatric perioperative fluid management. Saudi journal of anaesthesia, 15(4), 435–440. https://doi.org/10.4103/sja.sja_140_21 

9. Miller, T. E., & Myles, P. S. (2019). Perioperative Fluid Therapy for Major Surgery. Anesthesiology, 130, 825–832. https://doi.org/10.1097/ALN.0000000000002603 

10. Terris, M. (2020). Fluid and electrolyte balance in children. DOI:https://doi.org/10.1016/j.paed.2020.06.002 

11. Voldby, A. W., & Brandstrup, B. (2016). Fluid therapy in the perioperative setting—a clinical review. Journal of intensive care, 4, 27. https://doi.org/10.1186/s40560-016-0154-3 

12. Zhu, A. C., Agarwala, A., & Bao, X. (2019). Perioperative Fluid Management in the Enhanced Recovery after Surgery (ERAS) Pathway. Clinics in colon and rectal surgery, 32(2), 114–120. https://doi.org/10.1055/s-0038-1676476