Abstract
Fluid therapy using massive crystalloids started in the 1960's for the purpose of resuscitation for acute hemorrhagic shock. Although the concept was “fluid resuscitation”, its concept was converted to the fluid regimen for surgery. The exsistence of non-functional extracellular volume (nfECV) developed the concept of “third space”, and it also facilitated the massive crystalloid use during surgery. Although the leaders of this “fluid resuscitation”, Shires and Moore warned potential users about the adverse effect of massive infusion, this concept of massive crystalloid infusion has prevailed, and has been still a recognized procedure up to the present. Recently, it has been confirmed that massive crystalloid infusion is significantly related to postoperative complications through weight gain. The concept of third space was re-evaluated, and the existence of nfECV is now being denied. It has been shown that postoperative ECV depends on the in-out balance of crystalloids. The concept of “edema steals water” may be wrong, and “crystalloid makes edema” may be justified. We should try to reduce postoperative edema to avoid massive crystalloid load. We should be particularly aware of sodium overload, since intraoperatively-administered sodium remains several days postoperatively.
