Fluid retention during surgery poses a significant challenge to perioperative management because excessive fluid accumulation can impair organ function and wound healing and increase morbidity. Effective strategies for managing fluid retention during surgery involve a combination of precise fluid administration, pharmacologic intervention, and vigilant monitoring of physiological parameters to maintain hemodynamic stability while avoiding complications such as edema and electrolyte imbalance.
Surgery causes significant physiological stress that triggers the release of hormones such as aldosterone and antidiuretic hormone (ADH). These hormones promote fluid retention by increasing sodium and water reabsorption in the kidneys. At the same time, surgical trauma activates an inflammatory response that increases capillary permeability and allows fluid to leak into the tissues. This fluid shift can cause swelling (edema) and reduce circulating blood volume. To address these challenges, clinicians can use balanced crystalloids instead of saline as intravenous (IV) fluids. Balanced crystalloids prevent complications such as hyperchloremic acidosis that can occur with excessive saline use (1). Advanced hemodynamic monitoring tools, including cardiac output and stroke volume analysis, help guide fluid administration to maintain balance without overloading or depleting the patient’s fluid reserves.
Pharmacologic intervention is critical in the management of fluid retention during and after surgery, especially in patients predisposed to complications such as those with heart failure or chronic kidney disease. Diuretics, such as furosemide, are commonly used to promote urinary excretion of excess fluid. However, they must be used with caution, as excessive diuresis can lead to dehydration and electrolyte disturbances, including low potassium or sodium levels. Electrolyte monitoring and repletion are often required to address these issues (2). In cases of significant fluid retention or dilutional hyponatremia, vasopressin receptor antagonists offer a targeted solution. These drugs block fluid retention without disrupting sodium balance, making them particularly useful in complex surgeries such as liver transplantation or cardiac surgery (3).
Minimizing surgical trauma is another effective way to reduce fluid retention. Minimally invasive techniques, such as laparoscopic or robotic surgery, cause less tissue damage than traditional open surgery. This reduces the inflammatory response and associated capillary leakage, resulting in better fluid management and faster recovery. Perioperative measures such as maintaining normothermia also play a vital role. Hypothermia during surgery can impair renal function and exacerbate fluid retention through vasoconstriction and hormonal imbalance. Techniques such as warming blankets, heated IV fluids, and active warming devices help maintain body temperature and mitigate these effects.
For severe cases of fluid retention, especially in patients with acute kidney injury or refractory fluid overload, continuous renal replacement therapy (CRRT) is an advanced treatment option. CRRT is a form of dialysis that removes excess fluid and toxins while maintaining electrolyte balance. It is particularly useful in critically ill patients who cannot tolerate traditional diuretic therapy. Early implementation of CRRT has been shown to improve outcomes by allowing gradual fluid removal without causing hemodynamic instability (4).
In conclusion, the management of fluid retention during surgery is a multifaceted process that requires precision and adaptability. By combining tailored fluid therapy, pharmacologic interventions, minimally invasive techniques, and innovative monitoring, clinicians can effectively address the challenges posed by fluid retention. These evidence-based strategies improve surgical outcomes, enhance recovery, and reduce the risk of complications, demonstrating the importance of a proactive approach to perioperative care.
References
- Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med. 2013;369(13):1243-1251. doi:10.1056/NEJMra1208627
- Kellum JA, Lameire N; KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013;17(1):204. Published 2013 Feb 4. doi:10.1186/cc11454
- Schrier RW. Water and sodium retention in edematous disorders: role of vasopressin and aldosterone. Am J Med. 2006;119(7 Suppl 1):S47-S53. doi:10.1016/j.amjmed.2006.05.007
- Hoste EA, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411-1423. doi:10.1007/s00134-015-3934-7