Maintenance Fluid Therapy in Surgical Patients

Recommended Fluid Type

Balanced crystalloid solutions, such as Ringer's Lactate or Plasmalyte, are preferred over 0.9% saline for maintenance fluid therapy in most surgical patients due to their lower risk of hyperchloremic metabolic acidosis and adverse renal events, as recommended by the British Journal of Anaesthesia and World Journal of Emergency Surgery 1, 3
Balanced solutions have an electrolyte composition closer to plasma, which helps maintain acid-base balance and reduces the risk of hyperchloremia, according to Clinical Nutrition 2

A mildly positive fluid balance (+1-2 L) by the end of surgery is recommended to protect kidney function, as suggested by the British Journal of Anaesthesia 1
Excessive fluid administration should be avoided as it can lead to complications such as organ dysfunction, pulmonary complications, ventilator dependence, gut edema, and poor wound healing, as warned by the World Journal of Emergency Surgery 4
Intraoperative fluid administration rates of 1-2 ml/kg/h are recommended to minimize the risk of postoperative lung injury, according to the British Journal of Anaesthesia 5

0.9% saline is recommended as first-line fluid therapy in patients with traumatic brain injury, as suggested by the British Journal of Anaesthesia 5
Hypotonic solutions should be avoided in neurosurgical patients due to the risk of cerebral edema, as warned by the British Journal of Anaesthesia 5
Albumin is not recommended in neurosurgical patients or those with traumatic brain injury, according to the British Journal of Anaesthesia 5

Routine use of albumin or synthetic colloids for intraoperative fluid administration is not recommended, as suggested by the British Journal of Anaesthesia and Anaesthesia 1, 6
Crystalloid solutions should be preferred over colloids due to the reported risks of renal failure and hemostasis disorders with colloids, according to Anaesthesia 6, 7
Despite colloids having greater volume expansion capacity than crystalloids, this does not translate to improved outcomes in terms of mortality or postoperative complications, as reported by Anaesthesia 6

Fluid administration should be individualized based on objective measures of hypovolemia, as suggested by the World Journal of Emergency Surgery 4
Goal-directed fluid therapy using flow measurements is recommended for open surgery and high-risk patients with comorbidities, blood loss, or prolonged procedures, according to Clinical Nutrition 2
Postoperative intravenous fluids should be minimized to maintain normovolemia and avoid fluid excess, as recommended by Clinical Nutrition 2
The enteral route should be used as early as possible, and intravenous fluids should be discontinued as soon as practicable, according to Clinical Nutrition 2

Be cautious with 0.9% saline in patients requiring large volumes as it may lead to hyperchloremic metabolic acidosis, as warned by the World Journal of Emergency Surgery 3
In patients with hemorrhagic shock requiring large volume resuscitation, balanced solutions may be particularly beneficial compared to 0.9% saline, according to Anaesthesia 6
Patients with reduced cardiac function or comorbidities may benefit most from goal-directed fluid therapy to optimize cardiac output and end-organ perfusion, as suggested by the World Journal of Emergency Surgery 3