When surgery is emergent, involves the abdomen and the patient has been vomiting for several days preoperatively, then fluid requirements are very different.
Question: What fluid loss do you expect the patient to have had before surgery?
When surgery is emergent, involves the abdomen and the patient has been vomiting for several days preoperatively, then fluid requirements are very different.
Question: What fluid loss do you expect the patient to have had before surgery?
Answer: The patient may be severely water- and electrolyte-depleted. Large volumes of fluid are needed to resuscitate the patient, preferably before surgery. Vomiting leads to loss of hydrogen and chloride ions; sodium chloride solution helps replace this loss. Potassium ions are also lost into the bowel, so added potassium may be needed. Serum electrolytes must be checked before and after fluid resuscitation.
Question: Why should the patient be resuscitated with fluid preoperatively, rather than just performing surgery as quickly as possible?
When surgery is emergent, involves the abdomen and the patient has been vomiting for several days preoperatively, then fluid requirements are very different.
Question: What fluid loss do you expect the patient to have had before surgery?
Answer: The patient may be severely water- and electrolyte-depleted. Large volumes of fluid are needed to resuscitate the patient, preferably before surgery. Vomiting leads to loss of hydrogen and chloride ions; sodium chloride solution helps replace this loss. Potassium ions are also lost into the bowel, so added potassium may be needed. Serum electrolytes must be checked before and after fluid resuscitation.
Question: Why should the patient be resuscitated with fluid preoperatively, rather than just performing surgery as quickly as possible?
Answer: Induction of anaesthesia drops the blood pressure and impairs the myocardium much more in a hypovolaemic patient, and this could be fatal.