Liberal vs. Restrictive Fluid Administration in Major Surgery

There is ongoing controversy about the relative merits of restrictive versus liberal perioperative intravenous fluid administration for patients undergoing major surgery. In an international randomized trial, researchers compared these two approaches in 3000 relatively high-risk patients who were undergoing major abdominal surgery; all patients were older (age, ≥70) or had heart disease, diabetes, renal impairment, or severe obesity. The liberal-fluid group received a bolus of balanced crystalloid (10 mL/kg body weight) during induction of anesthesia, and fluid rates of 8 mL/kg/hour until the end of surgery and 1.5 mL/kg/hour for 1 day postoperatively. The restrictive-fluid group received fluids at roughly half those rates.

At 24 hours after…