Perioperative Fluid Therapy for Major Surgery

Timothy E. Miller, M.B., Ch.B., F.R.C.A.; Paul S. Myles, M.B., B.S., M.P.H., D.Sc., F.A.N.Z.C.A.


Anesthesiology. 2019;130(5):825-832. 

In This Article

Abstract and Introduction


The goal of IV fluid administration is to restore and maintain tissue fluid and electrolyte homeostasis and central euvolemia, while avoiding salt and water excess. This will in turn facilitate tissue oxygen delivery without causing harm. Achieving optimal IV fluid therapy should improve perioperative outcomes and is a key component in many perioperative guidelines and pathways.[1,2] IV fluids, like other medications, should only be given in well-defined protocols according to individual needs.[3]

There have been numerous studies of fluid and hemodynamic optimization over the past 20 yr. Most of these studies were very small single-center studies, sometimes with conflicting results.[4,5] However, in recent years several large multicenter randomized controlled trials and observational studies using electronic medical records have been published on these topics in major medical journals.[6–12] These efforts have greatly improved the evidence base and are a credit to our specialty.

This article reviews the latest evidence on perioperative IV fluid therapy for major surgery, focusing on the type and volume of fluids, and including suitable criteria to guide such therapy. Although a full review of hemodynamic optimization using advanced monitoring is beyond the scope of this review, it will be briefly covered as the two topics are interrelated.