Intraoperative Fluid Management

In this video from Count Backwards from 10, we take a look at how to calculate the hourly intra operative fluid management looking at the 4-2-1 rule to calculate hourly needs, fluid deficit, insensible losses and blood loss.

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[Cemmerman]

Your videos are always so helpful. As an Anesthesiologist Assistant student, I appreciate it so much!

[philiphilz]

Thank you for great and educative short clips on your channel! I like your videos a lot, but please critically review the estimates of insensible losses you mentioned. These estimates you provided are over 15 years old and are well researched today. Today we believe that insensible losses during major abdominal surgery account for only 1ml/kg/h. (see for example: Chappell D. in Anesthesiology 2008 109, 723-40)
Fluid overload is a major problem in perioperative medicine and it is proven, that goal directed fluid therapy improves outcomes (see for example ERAS program data) - but by propagating such over-estimates of hourly fluid administration patients will continue to suffer.

Can you link your source where you get the recommendation for substituting 1ml blood loss with 1 ml crystalloid? I am more aware of 3-4 ml crystalloids or 1 ml of colloid per ml blood lost.

[xijianke]

thank you, but you have two wrong-calculation points: 1100x25%=275, not 225; 225+110+560=895, not 995

[ramashka]

I believe that for lap chole 3 liters fluid is much . We should give always the half of our calculation unless the patient is really dehydrated . New researches are supporting to minimise fluid management as will decrease hospital length of stay ( tissue edema)

[conanwilliams]

No need to add the deficit replacement for emergency surgery patients who have ingested food/fluids within the last 6 hours, right?

[黃紹閔]

Hello, if we give the patient crystalloid fluid before the surgery during the NPO time, according to 100-50-20 rule(first 10kg give 100ml/kg/day...), do we have to add the NPO fluid deficit to the intraoperative fluid supply? Thank you

[Suruk]

our professor didnt gave any example and non of our colleague can calculate correctly 😩