Many questions have arisen and much controversy has emerged regarding how much fluid should be given perioperatively, which fluids should be given, when they should be given, and whether outcomes can be influenced. It’s been called the “Great Fluid Debate.” In fact, one might ask whether the anesthesiologist can even make a difference in the long run. Several goals of fluid administration have been identified: Tissue perfusion should be optimized; and heart rate, stroke volume, hemoglobin, and oxygen saturation should be appropriately manipulated.
But just how to achieve these end points, and whether they can be done by fluid administration, remains unclear. Our current standard therapy—cannulate a vein, give fluids to maintain blood pressure, and make up for supposed losses—has been challenged for almost a century. Canon noted that fluids administered before operative control of an injury were ineffective,1 an observation emphasized by Bickell and others some 70 years later.2,3 Nevertheless, standard U.S. Army protocols called for massive crystalloid resuscitation in the arena of war—especially in Vietnam—to preserve the kidneys. Thus, the Da Nang lung, or adult respiratory distress syndrome, was born.
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