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Perioperatives Volumenmanagement

Perioperative fluid management

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Zusammenfassung

Eine adäquate perioperative Infusionstherapie ist wesentlich für das perioperative Outcome eines Patienten. Eine Optimierung der perioperativen Flüssigkeitstherapie führt zu einer Verbesserung des postoperativen Outcomes, verringert perioperative Komplikationen und reduziert die Hospitalisierung. Sowohl Hypo- als auch Hypervolämie können zu einer erhöhten Rate perioperativer Komplikationen führen. Hauptziel ist die Euvolämie mittels GDT („goal-directed therapy“: zielorientierte perioperative Volumentherapie), eine Kombination aus Volumenmanagement und Inotropika, um die Perfusion während der Operation zu optimieren. Das perioperative Flüssigkeitsmanagement sollte jedoch auch die prä- und postoperativen Perioden berücksichtigen. Das schließt die präoperative Gabe kohlenhydratreicher Getränke bis 2 h präoperativ genauso ein, wie die postoperative Phase, in der die Per-os-Hydratation frühzeitig begonnen und eine übermäßige i.v. Flüssigkeitszufuhr vermieden werden sollte. Die Implementierung eines umfassenden multimodalen zielgerichteten Volumenmanagements in einem ERAS-Protokoll ist effizient, der genaue Stellenwert bleibt aber momentan noch unklar.

Abstract

An appropriate perioperative infusion management is pivotal for the perioperative outcome of the patient. Optimization of the perioperative fluid treatment often results in enhanced postoperative outcome, reduced perioperative complications and shortened hospitalization. Hypovolemia as well as hypervolemia can lead to an increased rate of perioperative complications. The main goal is to maintain perioperative euvolemia by goal-directed therapy (GDT), a combination of fluid management and inotropic medication, to optimize perfusion conditions in the perioperative period; however, perioperative fluid management should also include the preoperative and postoperative periods. This encompasses the preoperative administration of carbohydrate-rich drinks up to 2 h before surgery. In the postoperative period, patients should be encouraged to start per os hydration early and excessive i.v. fluid administration should be avoided. Implementation of a comprehensive multimodal, goal-directed fluid management within an enhanced recovery after surgery (ERAS) protocol is efficient but the exact status of indovodual items remains unclear at present.

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Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Deutschland

    B. E. Wellge & J. R. Izbicki

  2. Klinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Deutschland

    C. J. Trepte & C. Zöllner

  3. Universitätsklinik für Allgemein- und Viszeralchirurgie, Klinikum Oldenburg, Rahel-Strauss-Straße 10, 26133, Oldenburg, Deutschland

    M. Bockhorn

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  1. B. E. Wellge
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B. E. Wellge, C. J. Trepte, C. Zöllner, J. R. Izbicki und M. Bockhorn geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Wellge, B.E., Trepte, C.J., Zöllner, C. et al. Perioperatives Volumenmanagement. Chirurg 91, 121–127 (2020). https://doi.org/10.1007/s00104-020-01134-6

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