question

Surgical Fluid Therapy

answer

- Important component of hemodynamic stabilization minimize drug related hypotension and risks of anesthesia - Preoperative resuscitation is also important to optimize patient for anesthesia - Proper choice of replacement fluid therapy dynamic assessment of patient throughout surgery

question

Patient Parameters

answer

- Patient's fluid balance - Electrolyte status - Acid base balance - Concurrent diseases - Blood work changes

question

Preoperative Fluids

answer

- Correct electrolyte abnormalities such as extreme hyperkalemia - Correct hypoglycemia - Correct acid base imbalances optimize preload, stroke volume, and cardiac output

question

Shock Fluid Therapy - Crystalloid Therapy Dog

answer

- 50-90ml/kg IV - Start with 1/4 shock bolus until BP stable

question

Shock Fluid Therapy - Crystalloid Therapy Cat

answer

- 45ml/kg IV - Start with 1/4 shock bolus until Bp stable

question

Shock Fluid Therapy - Synthetic colloids

answer

- Can be added to reduce required volume of fluid of isotonic fluid - Help retain administered fluids - Important in moderate to severe hypovolemic shock with increased capillary permeability can give 1/4 crystalloid with 5ml/kg bolus of synthetic colloid

question

Low Volume Resuscitation

answer

*Give 5ml/kg bolus of hetastartch or other synthetic colloid* - maintenance rate isotonic crystalloids - Head trauma - Pulmonary edema - Pulmonary hemorrhage - Cardiac insufficiency - Chronic low albumin *Hypertonic Saline:* - Can combine with crystalloids - Can't use if dehydrated or electrolyte imbalance

question

Low Volume Resuscitation - Dog rate

answer

4-8ml/kg bolus

question

Low Volume Resuscitation - Cat rate

answer

1-4 ml/kg bolus

question

Acute Hemorrhage:

answer

- Medically typically transfusion at PCV 12% - For surgery ideal to have a minimum of 20%, would prefer 25%-30% - Blood type and cross match

question

hypokalemia: Overview

answer

*Do not administer potassium at rate > 0.5mEq/kg/hr ( K max!)* - follow guidelines for potassium supplementation - avoid supplementation during surgery due to risk of - potassium toxicity with fluid boli - Administration via CRI preferred

question

hypokalemia: Diseases

answer

- Anorexia - Vomiting

question

hyperkalemia: Treatment

answer

*Use saline or balanced electrolyte solutions to reduce levels* - Can use sodium bicarbonate to treat acute hyperkalemia - Safer to give dextrose or insulin with dextrose supplementation (drives potassium inside the cells) - Calcium gluconate can be life saving ( changes the membran actional potential threshold for heart) (cardioprotectant)

question

hyperkalemia: Diseases

answer

- Uroabdomen - Renal failure - Blocked cat

question

Hypocalemia:

answer

*Can treat with IV calcium gluconate* - Do not give bolus quickly, will cause arrhythmia - Always have hooked up to EKG - CRI can be used

question

Hypocalemia: Disease

answer

- Eclampsia

question

Hypomagnesemia:

answer

*Can cause refractory hypokalemia:* - When you are at Kmax and your patient's potassium still sucks... think of this - Do not give in calcium containing fluids supplement with magnesium sulfate

question

Hypomagnesemia: Disease

answer

- DKA

question

Hypoglycemia

answer

*treat underlying cause of hypoglycemia* -bolus of dextrose *1ml/kg* - CRI of 2.5 to 5% in peripheral catheter - Any higher supplementation requires a central line

question

Hypoglycemia - Diseases that cause it

answer

- Insulinoma - Insulin overdose - Liver disease - Xylitol toxicity - Sepsis

question

Intraoperative Fluid Therapy

answer

- 10-15ml/kg/hr average surgical rates - 3-5ml/kg/hr may be fine for healthy patients *prewarming fluids is recommended* - IV bolus of 10-15ml/kg fluids is first line of therapy for hypotension in healthy patient

question

blood loss during surgery

answer

- Blood loss less than 10% of blood volume in a patient with normal PCV and TS can be replaced with crystalloid *Transfusion if more than 25% of blood volume is lost*

question

Pediatric Patients: Common surgery examples where fluid is needed

answer

Patent Ductus Arteriosis Persistent Right Aortic Arch

question

Pediatric Patients: Fluid treatment

answer

- Have less ability to compensate for volume overload more susceptible for hypothermia and hypoglycemia higher maintenance fluid requirement *3-6ml/kg/hr* - Add dextrose for long procedures

question

geriatric patients: Risks to keep in mind

answer

- Decreased renal function and reserve - Decreased cardiac reserve - Less tolerant of fluid overload or dehydration

question

Cardiac Disease

answer

- Avoid larger sodium loads - Consider colloids *3-6ml/kg/hr*

question

Renal Disease

answer

- Consider using mannitol CRI to minimize renal damage - Dopamine infusion to maintain renal output - Place urinary catheter to monitor ins'outs

question

High GI obstruction:

answer

- Pyloric obstruction - Hypochloremic hypokalemic metabolic acidosis saline - Potassium supplementation

question

low GI obstruction:

answer

- Metabolic acidsosis with loss of duodenal reflux which is high in bicarbonate - Higher rate of bacterial migration and toxin migration - Edema of intestines results in less absorption of water, electrolytes, and nutrients

question

Liver Disease: Examples

answer

- Liver tumors - Portosystemic shunt surgery - Gall bladder obstructions

question

Liver Disease: Fluid Treatment

answer

- Avoid fluids with lactate like LRS - Monitor for coagulopathy, low proteins, and low blood glucose - Synthetic colloids or plasma may be required - Dextrose supplementation - Avoid overhydration especially in PSS surgery

question

Pancreatitis

answer

- Severe inflammation leads to vasodilation and hypotension - Metabolic acidosis common - Fix hypotension to increase perfusion to pancreas

question

Brain Surgery/Cerebral Trauma

answer

- Avoid overzealous isotonic crystalloid administration - Administer mannitol or lasix - Keep BP and BG in normal range: too high or too low is bad

question

Suggested Targets: Colloid osmotic pressure

answer

14-20mmhg

question

Suggested Targets: CVP

answer

6-8cm water

question

Suggested Targets: Mean arterial pressure

answer

>80, ideal, >60 acceptable

question

Suggested Targets: Systolic blood pressure

answer

>90

question

Suggested Targets: Urinary output

answer

>1-2ml/kg/hr

question

Suggested Targets: Heart Rate

answer

80-120bpm in dogs

question

Suggested Targets: Plasma albumin

answer

>2.0g/dl

question

Suggested Targets: TP

answer

>3.5 g/dl

question

Suggested Targets: PCV

answer

>25%-30%

question

Suggested Targets: Base Def

answer

+4 to -4 Dog

question

Suggested Targets: Lactate

answer

<2mmol

VTE 325: Surgical Fluid therapy – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards