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New Guidelines On Fluid Management During High-Risk Surgery

New journal launches on 27th June 2012 with important for fluid management during surgery. was agreed by the Clinical Leaders of the English Enhanced , set up by the UK Department of Health to improve recovery after .

The statement provides important evidence-based guidelines for fluid management in high-risk patients, including the training of all anaesthetists in the use of cardiac output measuring . These , such as the Oesophageal Doppler, are rarely used in high risk NHS patients, despite clear evidence that inadequate fluid management increases mortality after surgery by up to three-fold (the recent NCEPOD report found that arterial lines, central lines and cardiac output monitoring were only used in 27%, 14% and 5% of the high risk group). The consensus statement is backed up by evidence from NICE, GIFTASUP and the Department of Health.

The authors state that “perceived lack of resources is not a viable excuse. NICE have concluded that we can’t afford NOT to use intra-operative fluid management technologies where indicated. Practitioners should not be constrained by lack of availability of such technology.” Crucially, the authors also recommends a regular audit of compliance with these guidelines.

In the launch editorial of Perioperative Medicine, Editors-in-Chief Monty Mythen and Mark Hamilton state that “cardiac output monitoring was rarely used in high-risk patients and inadequate intra-operative monitoring was associated with a three-fold increase in mortality”. They add that “achieving superior outcomes in surgery may require that hospitals invest in expensive resources, such as intensivist-staffed intensive care units, high nurse-to-bed ratios, advanced technology, and specialist services.”


“Perioperative Fluid Management: Consensus statement from the Enhanced Recovery Partnership” Monty G Mythen, Michael Swart, Nigel Acheson, Robin Crawford, Kerri Jones, Martin Kuper, John S McGrath and Alan Horgan.Perioperative Medicine 2012, 1:5.