Practical Applications of Intravenous Fluids in Surgical Patients

Practical Applications of Intravenous Fluids in Surgical Patients


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Product Details

ISBN-13: 9789350903957
Publisher: Jp Medical Ltd
Publication date: 05/28/2013
Pages: 283
Product dimensions: 6.20(w) x 9.40(h) x 0.50(d)

Table of Contents

1 Normal Water Balance 1

Water homeostasis 1

Distribution of total body water 1

Regulation of total body water 2

Regulation of total body water 3

2 Distribution of Body Fluid 38

Units of measurement 38

Osmoles 38

Basic concepts of osmotic activity 38

Difference between osmolality and tonicity 40

Clinical significance of tonicity 40

Osmotic pressure 41

Colloid osmotic pressure 41

Effective osmotic pressure 41

Osmosis 41

Compartmental distribution of total body water 43

Intracellular fluid 45

Extracellular fluid 45

Clinical importance of negative pressure in the interstitial space 49

Summary of total body water 51

Summary of water control in the body 52

3 Pharmacology of Crystalloids 53

Crystalloids 53

Mechanism of actions of crystalloids 55

Types of solutions 55

5% Dextrose 55

Normal saline (isotonic saline) or 0.9% NaCI 59

Dextrose saline (5% Dextrose and 0.9% NaCI) 67

Ringer's lactate 61

Isolyte P 63

Electrolyte contents of commonly used crystalloid intravenous fluids 64

4 Pharmacology of Colloids 66

General characteristics of colloids 66

Types of colloidal plasma substitutes 69

Functions of colloid plasma substitutes 70

Indications of colloids 70

Human albumin 71

Functions of albumin in health 73

Metabolism 73

Albumin in critical illnesses 74

Indications for the infusion of albumin 74

Dextran 79

Types of dextran 79

Clinical effects and advantages 80

Dextran 40 84

Dextran 70 85

Gelatin solutions 86

Haemaccel 93

Gelofusine 95

5 Pharmacology of Hydroxyethyl Starch 99

General pharmacological properties of HES 99

Degree of volume expansion 104

Nomenclature of HES 104

Summary of general pharmacological properties of HES 105

Metabolism of HES 106

Disadvantages 106

Special precautions 112

Clinical uses of hydroxyethyl starch 112

Advantages of HES 113

Evaluation of HES 113

First-generation HES-Hetastarch-HES 450/0.7 113

Second-generation HES-Pentastarch HAES-Steril (200/0.5)-3%, 6%, 10% 114

Third-generation HES:Tetrastarch 117

Pharmacodynamics 117

Pharmacokinetics 118

Indications and clinical use 119

Contraindications 119

Warning and precautions 119

Adverse reactions 120

Tetrastarch in special patient groups 121

Effects on microcirculation and oxygenation by tetrastarch 121

Effects on systemic inflammation and endothelial activation by tetrastarch 122

Characteristics of some available colloids 126

Tetrastarch v/s pentastrach: summary 126

6 Current Consensus on Crystalloids and Colloids in the Perioperative Period 128

Colloid solutions 128

Crystalloid solutions 129

Clinical significance of reflection coefficient 129

Points to remember 129

Accepted statements of colloid/crystalloid 130

Current controversies of fluid and volume management 130

7 Fluid Replacement Therapy 136

Types of fluid used for volume replacement 136

Osmosis 137

Practical fluid balance 137

Mechanism of action of fluids 139

Points to remember 140

Resuscitation of body spaces with various solutions 141

General principles of fluid replacement 141

Perioperative fluid therapy 142

Assessment of daily fluid requirement 143

Maintenance fluids 143

Goals of intraoperative fluid administration 144

Replacement fluids 144

Hole in the bucket analogy 149

8 Perioperative Fluid Therapy in Infants and Children 150

Fluid therapy in infants and children 150

Important differences between infant, children and adult 150

Important points for calculating the fluid requirement 154

Assessment and correction of any fluid deficit 155

Maintenance fluids 155

Neonatal maintenance fluid requirement 155

Infants and older children maintenance fluid requirement 156

Important facts about administering dextrose solutions 156

Avoid dextrose 4% or 5% 157

Fluid and dextrose management during surgery 157

Important points to remember regarding calculation of fluids in infant and children 158

Management of perioperative fluid therapy 159

Important points to remember in perioperative fluid management 159

Importance of composition of intravenous fluids 159

Goals of perioperative fluid administration 161

Preoperative management 161

How to evaluate preoperative deficit 163

Important key points 173

9 Fluids Therapy in Trauma Resuscitation 174

The golden hour 174

Goals of fluid administration 175

Types of fluids for volume replacement 175

Choice of fluids in various conditions 175

Oxygen transport in the high-risk or critically ill surgical patient 180

Route and rate of fluid administration in various conditions 180

End point of fluid therapy and monitoring 181

Measure of preload-central venous pressure 181

Complications of transfusion 182

10 Fluid Therapy in Fever 183

Definition of fever 183

Important facts about fever 183

Temperature control by the hypothalamus 184

Resetting the hypothalamic temperature-regulating centre in febrile diseases 184

Mechanism of action of pyrogens in causing fever-role of interleukin-l 184

Effects of changing the set-point of hypothalamic temperature controller 185

Crisis or flush 186

Fever caused by brain lesions 186

Postoperative fever 187

Clinical significance of fever 187

Assessment 190

Management 190

Assessment for fever when infection is suspected 190

Management for fever when infection is suspected 190

Points to remember before administering anaesthesia 191

Mechanism of action of antipyretics 191

Goals for anaesthetising patients having fever 192

11 Fluids in Intestinal Obstruction 195

Problems faced by anaesthesiologist with intestinal obstruction 195

Systemic derangements with intestinal obstruction 195

Approach towards a patient with intestinal obstruction 200

Preoperative preparation 202

Assessment of adequacy of fluid replacement 205

Important points to remember 205

Clinical response of the patient after infusion of fluids 205

Benefits of volume loading 205

12 Fluid Management in Neurosurgical Patients 206

Principles of water movement across blood-brain barrier (BBB) 206

Basics of fluid movement in the CNS 208

Basic concepts of perioperative management of fluids 214

Intraoperative fluid management of neurosurgical patients 215

Use of hyperosmolar fluid for cerebral dehydration 218

Fluid management in neurosurgical patients under special circumstances patient for craniotomy 222

Fluids during aneurysmal surgery 222

Fluids in patients with diabetes insipidus with traumatic brain injury 223

Fluids in postoperative and neurointensive care units 224

Newer developments 225

13 Fluid Therapy in Traumatic Brain Injury 227

The "Lund concept" for TBI 227

Fluid resuscitation in traumatic brain injured patients 229

Basic concepts in fluid management in traumatic brain injury patients 230

Focus on preventing further injury in traumatic brain injury patients 230

Summary of choice of fluids 238

14 Fluid Therapy in Pre-eclampsia and Eclampsia 239

Incidence of pre-eclampsia 239

Definition of pre-eclampsia 239

Definition of proteinuria 239

Classification of pregnancy induced hypertension 240

Pathophysiology 241

Effects on various systems 242

Clinical importance of oxygen delivery 246

Choice of analgesia/anaesthesia in pre-eclamptic patients 246

Fluid therapy in pre-eclampsia 246

Basic concepts of prehydration 247

Safety precautions while prehydrating patient 247

Prehydration before regional anaesthesia 248

Precautions before initiation of regional analgesia 248

Fluid management in pregnant patients in specific conditions 249

Important points to remember for selecting fluids in PET patients 251

Goals of fluid management in pregnant patients with pre-eclampsia 252

Current consensus in fluid therapy in PET 253

Assessment of renal function and fluid balance 254

Management of acute pulmonary oedema (APO) 254

Care of pre-eclamptic patients after parturition 255

15 Fluid Management in the Ventilated Patient 256

Physiological considerations 256

Homeostatic responses to maintain plasma volume 257

The influence of positive pressure ventilation on fluid balance 260

Summary of IPPV and PEEP on water balance 261

The Starling equation 261

Factors which help to prevent alveolar oedema 263

Goals of fluid management in the ventilated patient 264

Maintenance fluids 265

Clinical applications of central venous pressure (CVP) or pulmonary artery occlusion pressure (PaOP) 266

Replacement fluids 267

Resuscitative fluids 267

Choice of resuscitation fluids 267

Monitoring fluid therapy 272

Minimally invasive methods 273

Invasive measures 274

Conclusion 275

16 Calculation of Fluids 276

Drop rate calculation of fluid 276

Calculations for drug infusions 276

Index 279

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