Optimisation of Fluid Therapy in Colorectal Surgery

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dc.contributor.advisor Soop, M en
dc.contributor.author Srinivasa, Sanket en
dc.date.accessioned 2013-02-03T22:07:19Z en
dc.date.issued 2011 en
dc.identifier.uri http://hdl.handle.net/2292/19974 en
dc.description.abstract Fluid administration is an important aspect of perioperative care in colorectal surgery. It has been largely guided by experimental evidence from the 1950s and extrapolated observations from injured soldiers during the Korean and Vietnam War. Recent improvements in perioperative care have led to renewed scrutiny of perioperative fluid management and challenged conventional wisdom with regards to the ideal quantity of fluid to be administered for patients undergoing colorectal surgery. Chapter one introduces this topic with discussion of optimised perioperative care, fluid and electrolyte physiology, composition of intravenous fluids and their clinical implications. It discusses the history of fluid therapy and concludes that avoidance of fluid overload -fluid restriction– and individualised fluid therapy are considered as ideal fluid regimens in colorectal surgery, thus outlining the direction of the rest of the thesis- comparison of the two and exploring their place within the perioperative environment. The prevalent heterogeneity in perioperative care and its influence on fluid administration is demonstrated in chapter two. Chapter three explores the feasibility of intraoperative fluid restriction and establishes a baseline for future comparative studies whilst also showing an important association between increasing fluid amounts and adverse clinical outcomes. Chapter four shows interest and equipoise concerning the use of individualised fluid therapy in clinical practice. It also demonstrates that the Oesophageal Doppler Monitor (ODM) is the most favoured instrument to conduct individualised fluid therapy. Chapter five is a systematic review of the methodology of the published trials exploring ODM-guided fluid therapy in colorectal surgery. It outlines the methodology and limitations of prevalent evidence and allows for the design of prospective studies. Chapter six is a prospective study of individualised fluid therapy in rectal surgery. Chapter seven is a prospective, randomised trial of individualised fluid therapy versus fluid restriction in patients undergoing colectomy within an otherwise optimised perioperative care environment. The prospective studies show that individualised fluid administration and fluid restriction provide equivalent outcomes in an otherwise optimised environment. The findings of this thesis have important scientific and clinical implications which are discussed in chapter eight and nine. en
dc.publisher ResearchSpace@Auckland en
dc.relation.ispartof PhD Thesis - University of Auckland en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/3.0/nz/ en
dc.title Optimisation of Fluid Therapy in Colorectal Surgery en
dc.type Thesis en
thesis.degree.grantor The University of Auckland en
thesis.degree.level Doctoral en
thesis.degree.name PhD en
dc.rights.holder Copyright: The Author en
dc.rights.accessrights http://purl.org/eprint/accessRights/OpenAccess en
pubs.elements-id 372852 en
pubs.record-created-at-source-date 2013-02-04 en


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http://creativecommons.org/licenses/by-nc-nd/3.0/nz/ Except where otherwise noted, this item's license is described as http://creativecommons.org/licenses/by-nc-nd/3.0/nz/

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