Liberal or restrictive fluid administration in fast-track colonic surgery: a randomized, double-blind study

Background. Evidence-based guidelines on optimal perioperative fluid management have not been established, and recent randomized trials in major abdominal surgery suggest that large amounts of fluid may increase morbidity and hospital stay. However, no information is available on detailed functional outcomes or with fast-track surgery. Therefore, we investigated the effects of two regimens of intraoperative fluids with physiological recovery as the primary outcome measure after fast-track colonic surgery. Methods. In a double-blind study, 32 ASA I–III patients undergoing elective colonic surgery were randomized to ‘restrictive ’ (Group 1) or ‘liberal ’ (Group 2) perioperative fluid adminis-tration. Fluid algorithms were based on fixed rates of crystalloid infusions and a standardized volume of colloid. Pulmonary function (spirometry) was the primary outcome measure, with secondary outcomes of exercise capacity (submaximal exercise test), orthostatic tolerance, cardiovascular hormonal responses, postoperative ileus (transit of radio-opaque markers), postoperative nocturnal hypoxaemia, and overall recovery within a well-defined multimodal, fast-track recovery programme. Hospital stay and complications were also noted. Results. ‘Restrictive ’ (median 1640 ml, range 935–2250 ml) compared with ‘liberal ’ flui