Management of Fluid Therapy in the PACU

Major surgery may be associated with significant loss of intravascular fluids, electrolytes, and blood. If not, patient comorbidities, or surgical or anesthetic techniques may render the patient to a hypovolemic state. It is very common to infuse fluids during and after surgery, whenever hypotension ensues. However, if fluids are overused, the fluid creep may aggravate hemodilutional coagulopathy and tissue edema, which give rise to further bleeding, organ injuries, delayed wound healing, and infections.

It is imperative to continuously reassess the volume status of the patient and consider or measure the effect of each intervention or complication on the hemodynamic status of the patient. Evolving hemodynamic monitors look promising, when combined with the history and physical examination of the patient. Specifically, the effect of the mechanical ventilator and the analgesic medications should be included in the assessment of the intravascular volume of the patient.