fluid management in surgery ppt

1 L. 13. Body sodium - may affect fluid between compartments, weight gain between dialysis treatments, and the success of fluid removal during hemodialysis 19 Proper management of fluid and electrolytes facilitates crucial homeostasis that allows cardiovascular perfusion, organ system function, and cellular mechanisms to respond to surgical illness. Many disease processes result in changes that could result The term "open abdomen" refers to a surgically created defect in the abdominal wall that exposes abdominal viscera. Often, their training and instincts favor over . Kinetic analyses and outcome-oriented studies have provided more insight into fluid management. Fluids and anesthesia. Fluid therapy is often poorly taught, poorly understood and poorly done 'Fluid therapy should be directed not only to effective volume expansion of a leaky circulation but also to micro vascular protection'.. Fluid and electrolyte management are paramount to the care of the surgical patient. Fluid Resuscitation/Treatment of Dehydration For dehydration,shock,blood loss-isotonic Normal Saline or Lactated Ringers Give 20ml/kg as bolus.then repeat your exam Repeat bolus if symptoms of dehydration are still present After patient shows improvement you can change to glucose containing IV fluids Calculate fluid need based on degree of dehydration and Aim to correct fluid deficit over 48 hours with 0.9% sodium chloride and 5% dextrose. There is growing evidence that fluid administration should be individualized and take into account patient characteristics, nature of the acute illness and . FLUID AND ELECTROLYTE MANAGEMENT OF THE SURGICAL PATIENT BODY FLUIDS TOTAL BODY WATER Water 50-60% total body weight Lean tissues higher water content Young adult M 60% total body weight is TBW Young adult F it is 50% TBW adjusted 10-20% for obese & 10% for malnourished Newborns 80% total body weight 1 yr of age 65% total body weight World's Best PowerPoint Templates - CrystalGraphics offers more PowerPoint templates than anyone else in the world, with over 4 million to choose from. Sandra D. Taylor, A.N. Malnutrition in surgical patients Surgical Nutrition Training Module Level 1 Philippine Society of General Surgeons Committee on Surgical Training. The cytokine response to infection and injury, the so-called "Systemic Inammatory Response Syndrome", has a major . Symptomatic: 1. Perioperative fluid replacement for children and infants is a complex and somewhat controversial topic. Fluid Management 1 / 45. For example, a child who weighs 12 kg will require 1200 ml (12 x 10 x 10) over 48 hours, or 600 ml each day in addition to their maintenance. Major surgery is a considerable physiologic insult that can be associated with significant morbidity and mortality. The more extensive the procedure the greater the needs . Ensure normal iCa level - review source of bleeding and stop bleeding promptly 500 mL fluids bags should be used within the neonatal population - both term and preterm. Title: Management of the Trauma Patient Author: Hieu Ton-That Last modified by: cmonaha Created Date: 9/2/2008 7:37:05 PM Document presentation format: Management of postoperative fluid therapy should be done considering both patients' status and intraoperative events. Despite the common . case presentation Presentation Transcript. MAINTAINENCE FLUID DURING SURGERY - The maintenance fluid used during surgery should be isotonic such as 0.9% sodium chloride or Ringer lactate /Hartmann's solution in infants. Discussing the different types of IV fluids. the fact that fluid management is one of the commonest tasks in hospital involving complex decisions on opti-mal volume, rate, and type of fluid to be given. Fluids and electrolytes can be delivered through an intravenous (IV) catheter, which is a thin, plastic tube inserted into a vein in your child's arm or leg. Tract Total 2600 ml 400 ml Total 2600 ml Practically Daily Input/Output balance = +500ml Porcine Management and Surgical Procedures - Title: PowerPoint Presentation Author: Dipa Last modified by: Dipa Created Date: 12/12/2012 2:52:37 PM Document presentation format: . Fluid lost from naso-gastric tubes, fistulae, drains if not considered. In surgeries like esophagectomy, the risk of pulmonary complications was related to the surgical approach with transthoracic carrying the highest risk and poor preoperative pulmonary status .In transthoracic approach for esophagectomy, an intraoperative and 5-day postoperative fluid regimen in excess of 8 liters was an independent risk factor for pulmonary . Intraoperative fluid management within enhanced recovery after surgery protocols . As with adults, using UOP as the sole measure of efficacy is controversial and often misleading. In the absence of tools directly assessing . This is an open access article distributed under the terms of the Creative Commons Attribution License, One of the most common uses of fluid therapy is for patient support during the perianesthetic period. Bile. 10.1213/ANE.0b013e3181ddddd . dr abdollahi afshar hospital. Zero-balance fluid therapy should be aimed for. Decisions regarding whether to provide fluids during anesthesia and the type and volume used depend on many factors, including the patient's signalment, physical condition, and the length and type of the procedure. 1. Definitive investigation is made via CT scanning with contrast. (2015) Controversies of the Anesthetic Management of Lumbar Drains for Aortic Surgery. Archives of Surgery, 1955 138 patients (99 abdominal, 39 hernias) 30 day mortality - 28% - 47% emergency surgery, 9% elective Morbidity - 70% - 56% surgical complications Risk factors included transfusion, ASA, serum sodium, creatinine Perioperative Mortality After Non-hepatic General Surgery They'll give your presentations a professional, memorable appearance - the kind of sophisticated look that today's audiences expect. For children under 30 kg, 1 ml/kg per hour is recommended; for children over 30 kg, 0.5 ml/kg per hour is the goal. 1 , 2 Major surgical operations require a period of fasting during which oral antidiabetic medications . Various physiologic and hormonal effects must be considered in order to deliver rational . Urine output is regarded as the resuscitation goal in pediatric burn management. These patients have noncardiogenic pulmonary . Fluid Management Tong Joo (TJ) Gan, MD, FRCA, FFARCS (I) Professor of Anesthesiology Vice Chairman Clinical Research Duke University Medical Center Durham, North Carolina. MetroHealth Medical Center April, 2004 Body Fluid Composition Body Fluid Composition Perioperative . Download Presentation. 3. constitutes 50-70 % of total body weight fat contains little water, the lean individual has a greater proportion of water to total body weight than the obese person total body . In these critically ill patients, pay careful attention to early recognition of potential complications in the intensive care unit (ICU), including pneumothorax, IV line infections, skin breakdown, inadequate nutrition, arterial occlusion at the site of intra-arterial monitoring devices, DVT and . Nonpulmonary thoracotomy surgery. Fluids should be titrated on an "as needed basis" to maintain euvolemia. diabetes insipidus; evaporative losses with fever, abdominal surgery) -Management: - fluid resuscitation - haemorrhagic cause: transfusion of red cells and blood products. Lumbar Drain Management Thoracic Aortic Aneurysm Surgery Presented By Tonya L. Page MSN, APRN, ACNP-BC . In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. Dpt of Surgical Gastroenterology, Hvidovre University HospitalHenrik Kehlet, MD, DMSc, Professor ( now: Section of Surgical Pathophysiology, Rigshospitalet )Jens Andersen and all doctors working in the colorectal section and with outpatient patients Research nurses: Lotte . Fluctuations in Spinal Cord Perfusion Pressure: A Harbinger of Delayed Paraplegia After Thoracoabdominal Aortic Repair, AATS Aortic Management of the Trauma Patient Hieu Ton-That, MD, FACS Loyola University Medical Center Division of Burns, Trauma and Surgical Critical Care. Patients with diabetes undergo surgical procedures at a higher rate than do nondiabetic people. Dr. Muhammad Saifullah HOUSE SURGEON (SU-III) 2. . Fluids & Electrolyte Management of the surgical patient. Knowledge of the compartmentalization of body fluids forms the basis for understanding pathologic shifts in these fluid spaces in disease states. Heart failure (HF) is one of the most common reasons for admission to hospital. Fluid therapy to restore and/or maintain tissue perfusion may affect patient outcomes in perioperative, emergency, and intensive care. 5 Intraoperative and Postoperative Fluid Therapy Anesthesia interrupts normal baroreceptor reflexes Fluid loss from blood loss, sequestration, trauma and manipulation of tissues, evaporative losses 500ml of blood loss tolerated fairly well Replacement of losses with isotonic fluid at rate of 500- 1000ml/hr Central venous pressure and/or Swan-Ganz catheter Step 1: Calculate Preoperative Fluid Losses. Correct over a period of 48 hrs as rapid correction may lead to cerebral edema. Knowledge of the compartmentalization of body fluids forms the basis for understanding pathologic shifts in these fluid spaces in disease states. Guidance. 1 These programs aim to reduce complications and promote an earlier return to normal activities. . IV therapy is the fastest way to replenish fluids and electrolytes in an infant or child who has severe dehydration, especially if he or she has a serious . Correction of intravascular hypovolemia is a key component of the prevention and management of acute kidney injury (AKI), but excessive fluid administration is associated with poor outcomes, including the development and progression of AKI. Many colorectal surgeons rely on traditional theories and approaches in addressing perioperative fluid management issues. Objectives To define malnutrition and discuss its impact on the surgical patient To identify malnutrition in hospitalized surgical patients. Lumbar cerebrospinal fluid drainage for thoracoabdominal aortic surgery: Rationale and practical considerations for management. Postoperative care units are run by an anesthesiologist or a surgeon, or a team formed of both. . resuscitation are : 1. adults with >15-20% burns 2. child with 10% burns 3. electric burn with haemochromogens in the urine 4. the extremes of age or elderly patients with preexsisting cardiac or . the output from the kidneys, the . 3. Inclusion of patients in medical, surgical, and neurological ICUs helped diversify the . 2016;4(5):1412. Perioperative fluid management In major surgical cases such as cardiac surgery, fluid passage to third space is 15-20 ml/kg/h, in premature infants it is 50 ml/kg/h.1 J Anesth Crit Care Open Access. Historically, fluid management has been as much an art as a science - a fine line must be negotiated between an adequate resuscitation and one of fluid overload. Critically ill patients require individualized fluid types, volumes, infusion rates, and durations tailored to their volume status and fluid therapy goal based on the underlying illness. Intraoperative fluid management within ERAS protocols should be viewed as a continuum through the preoperative, intraoperative, and postoperative period. Number of Views: 1827. Fluid Management PowerPoint Presentation. Although beneficial in certain patients, the act of keeping an abdominal cavity open has physiologic . Fluid therapy in Burns Fluid resuscitation in first 24 hours Fluid therapy from 24 to 48 hours Fluid therapy after first 48 hours Indication of I.V. Maintenance of water ,sodium and potassium for surgical water losses in patients undergoing anesthesia For surgical patients you must consider these additional factors in your fluid replacement . Resectoscope: An endoluminal surgical device compris-ing an endoscope (hysteroscope or cystoscope), sheaths for inow and outow, and an ''element'' that interfaces a spe-ciallydesignedelectrode(orpairofelectrodes)witharadio-frequency electrosurgical generator Purpose and Scope The objective of this guideline is to provide clinicians The overall aim is to keep patients euvolemic, while avoiding excessive fluid administration. The main concerns are missing a potentially treatable underlying cause or complication of ARDS. Presentation Transcript. Free Quiz: http://adv.icu/38hADDK 10% off EACH Month your MyNurisngMastery subscription: https://adv.icu/. 6. 1 2016 Kudsioglu et al. 41. They can present with abdominal pain and fever, typically 5-7 days post-operatively. Estrera, A. et al., 2016. environment is defined by the intake of fluid and electrolytes versus. Fluid management does not use a one-size-fits-all approach. ANATOMY OF BODY FLUIDS Total Body Water Intracellular Fluid Extracellular Fluid Osmotic Pressure. Transfusion via blood warmer. Surgical procedures are divided into three classes based on the extent of surgery: Minor, major, and complex. Conclusion. Fluid management is a major part of junior doctor prescribing; whether working on a surgical firm with a patient who is nil-by-mouth or with a dehydrated patient on a care of the elderly firm, this is a topic that a junior doctor utilises on a regular basis.. basic science 9/08/09 j. p. stokes. - Maintenance fluid to be calculated by Holliday and segar The management goal is to optimize metabolic control through close monitoring, adequate fluid and caloric repletion, and judicious use of insulin. Enhanced Recovery after Surgery. Faculty Disclosure It is the policy of The France Foundation to ensure balance, independence, objectivity, and scientific rigor in all its sponsored . 2,3 The ERAS protocols have been associated with . It is associated with long in-patient stays, and has a high in-hospital and post-discharge morbidity and mortality, whether left ventricular ejection fraction (LVEF) is reduced (HFREF) or normal (HeFNEF).1,2 Congestion, or fluid overload, is a classic clinical feature of patients presenting with HF. Deficit therapy is the management of fluid and electrolyte losses that occur before the patient's presentation. - PowerPoint PPT presentation. Total Body Water constitutes 50-70 % of total body weight fat contains little water, the lean individual has a greater proportion of water to . This occurs in the hospital. In early post-op period if there is hypotension, disproportionate anaemia think of internal bleeding unless proved otherwise & inadequate fluid replacement. Fluid and Electrolyte Management of the Surgical Patientu000b Hashmi. Types of the fluids, amount of the fluid given and timing of the administration are the main topics that determine the fluid . Fluid therapy is an important component of management for many diseases that affect sheep, goats, and cervids. The optimal type of fluid to be administered during major surgery remains to be determined. Traditionally, the first step in determining the hourly fluid requirements for a child described by Holliday and Segar and coined as the "4/2/1" rule: For children < 10 kg their hourly fluid needs are body weight (kg) x 4. cyto-kines. Knowledge of the compartmentalization of body fluids forms the basis for understanding pathologic shifts in these fluid spaces in disease states. The underlying basis for all guided fluid management is that optimal vascular volume improves cardiac output, with "optimal" being defined as sufficient volume to bring patients toward the top of the Frank Starling . Estimated maintenance requirements follow the 4/2/1 rule: 4 cc/kg/hr for the first 10 kg, 2 cc/kg/hr for the second 10 kg, and 1 cc/kg/hr for every kg above 20. Proper management of fluid and electrolytes facilitates crucial homeostasis that allows cardiovascular perfusion, organ system function, and cellular mechanisms to respond to surgical illness. Title: PowerPoint Presentation Author: The following drugs should be discontinued prior to Predominantly, fluid resuscitation is carried out intravenously and the most commonly used resuscitation formula is the pure crystalloid Parkland formula. Fluid and Electrolyte Management of the Surgical Patient Dr Abdollahi Afshar Hospital. Fluid management output, loss intake, produce 12. Simply multiply the maintenance fluid requirements (cc/hr) times the amount of time since the patient took PO intake. Surgery, like any injury, elicits a series of reactions including release of stress hormones and inammatory mediators, i.e. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. Description: Pediatric Fluid Management and Blood Product Therapy Joy Loy, M.D. For children 10 . Winner of the Standing Ovation Award for "Best PowerPoint Templates" from Presentations Magazine. 0.9% saline to correct volume deficit 2. Also the high adoption rate of advanced surgical procedures and the rising burden of chronic diseases are the key factors affecting fluid management systems market trends over the forecast period of 2021 to 2028 . Intracellular fluid - how much water is held in the body's cells 2. Postoperative abdominal surgery: Fluid requirements may be twice or three times that noted above. Pediatric Fluid Management. Fluid and Electrolyte Management of the Surgical Patient - . 4. Maintenance intravenous fluids (IVFs) are used to provide critical supportive care for children who are acutely ill. IVFs are required if sufficient fluids cannot be provided by using enteral administration for reasons such as gastrointestinal illness, respiratory compromise, neurologic impairment, a perioperative state, or being moribund from an acute or chronic illness. Dr. . There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses . Extracellular fluid - water outside of cells in tissues and body spaces such as the chest and abdomen 3. Intravenous fluid management in patients with acute lung injury and the acute respiratory distress syndrome (ALI/ARDS) can be particularly challenging. To provide clinicians with recommendations for oral fluid management before elective surgery in children of all ages. The common fluid and electrolyte changes, their causes and management The common acid base imbalances and their treatment Introduction Knowledge about fluid electrolyte and acid base changes and their management is basic to the care of the surgical patient. Fluid overload is frequently found in acute kidney injury patients in critical care units. Malnutrition is a syndrome. They'll give your presentations a professional, memorable appearance - the kind of sophisticated look that today's audiences expect. Management is with bowel rest, intravenous antibiotics, and potential surgical intervention if a major leak. The occurrence of one or more postoperative complications adversely effects both short-term and long-term survival and increases healthcare costs [1,2].The prevention of postoperative morbidity is a key factor in providing high-quality, high-value . 2. Page 41. Fluid management for an infant with gastroschisis can be complex and requires strict attention to the rapidly changing needs of the neonate, who may be critically ill. After birth, neonates with gastroschisis are subject to tremendously increased insensible fluid losses related to exposure of the eviscerated bowel. Fluid Management . "Early Recovery after Surgery Fluid Management" is the property of its rightful owner. Leaving an abdominal cavity temporarily open has been well described for several indications, including damage control surgery and abdominal compartment syndrome. fluid therapy is often poorly Fluid and Electrolyte Management of the Surgical Patient - . FLUID REQUIREMENTS Sources Losses (35ml/kg/day) Urine Water 1500 ml Food 800 ml Stool 200 ml Oxidation 300 ml Skin 500 ml (0.5~1ml/kg/hr) (12ml/kg/day) 1500 ml Resp. Recent studies have shown the relationship of fluid overload with adverse outcomes; hence, manage and optimization of fluid balance becomes a central component of the management of critically ill patients. 5. If a neonate weighs less than birth weight, utilise birth weight in all fluid calculations, unless specified by the medical team. For surgical patients, appropriate selection and administration of fluids can mitigate against organ failure, whereas improper dosing can exacerbate already injured systems. 1. In critically ill patients, in order to restore cardiac output, systemic blood pressure and renal .

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