A 70 kg adult male undergoes a 4-hour laparoscopic colectomy. Using the ERAS-endorsed goal-directed fluid therapy concept, which approach best characterises optimal intraoperative fluid management?

• A Administer 4–6 mL/kg/hr as liberal supplemental crystalloid to replace third-space losses
• B Restrict fluids to <500 mL total to avoid pulmonary oedema
• C Titrate fluid boluses to dynamic parameters such as stroke volume variation while targeting euvolaemia ✓
• D Use urine output as the primary end-point targeting >1 mL/kg/hr throughout surgery

Explanation

Contemporary ERAS guidelines and goal-directed fluid therapy (GDFT) recommend titrating IV fluids to dynamic preload indicators such as stroke volume variation (SVV) or pulse pressure variation (PPV), targeting euvolaemia rather than predefined volumes. Older liberal strategies (4–6 mL/kg/hr for third-space losses) increase complications; conversely, rigid restriction risks tissue hypoperfusion. Urine output is a lagging and unreliable intraoperative indicator. Dynamic parameters (SVV >13% suggesting fluid responsiveness) guide bolus therapy.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.