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Practice Practice Pointer

Perioperative fluid therapy

BMJ 2012; 344 doi: (Published 26 April 2012) Cite this as: BMJ 2012;344:e2865
  1. Rupert M Pearse, clinical reader1,
  2. Gareth L Ackland, clinician scientist, honorary consultant2
  1. 1Barts and The London School of Medicine and Dentistry, Queen Mary’s University of London, London EC1M 6BQ, UK
  2. 2University College London/University College Hospitals NHS Trust, Wolfson Institute for Biomedical Research, London WC1E 6BT
  1. Correspondence to: R Pearse Adult Critical Care Unit, Royal London Hospital, London E1 1BB r.pearse{at}

Intravenous fluid therapy is an important aspect of perioperative care, but doctors often prescribe fluid with limited knowledge of its benefits and risks. This article provides an evidence based summary of current best practice in the prescription of fluid for patients undergoing major non-cardiac surgery.

Patient outcomes after major non-cardiac surgery can be improved considerably through more effective perioperative care.1 Factors such as advancing age, comorbidity, and complex surgical procedures can result in postoperative morbidity and mortality rates similar to those found with common acute medical emergencies.1 2 3 Patients who survive postoperative complications experience functional limitation and reduced long term survival.1 2 3 Doctors often prescribe intravenous fluid with limited knowledge of the benefits and risks of this treatment. Doctors in training commonly express frustration at the lack of clear guidance on the optimal approach to fluid therapy. The debate that followed recent UK guidelines aimed at standardising best practice highlights the uncertainty in this area, even among experienced practitioners.4 5

We review the evidence from clinical studies, systematic reviews, and practice guidelines to provide a summary of current best practice in the prescription of fluid for patients undergoing major non-cardiac surgery.


We searched various databases, including Clinical Evidence and the Cochrane Collaboration, for articles which would define clinical practice by using the search terms: surgery; fluid, intra-venous; perioperative; blood transfusion. We also consulted several UK and international experts in formulating the contents of this review and sought comments on the final version.

We recognise the considerable variation in clinical practice in this area. The article focuses on key aspects of the topic affecting the majority of patients who would benefit from a standardised and individual approach to fluid prescribing. Our aim is to provide simple guidance for the less experienced or less expert clinician …

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