ENHANCING INTRAVENOUS FLUID ADMINISTRATION IN COLORECTAL SURGERY

Compared to other surgical procedures, colorectal surgery possesses elevated rates of postoperative complications and mortality (Tevis & Kennedy, 2016).  For the nurse anesthetist, correct intravenous fluid (IVF) resuscitation during colorectal surgery can reduce the risk of adverse patient outcomes. This project evaluated recent anesthesia literature to determine optimal strategies for intraoperative fluid resuscitation during colorectal surgery. The literature review yielded two significant findings: (1) comorbidity laden patients or those enduring major colorectal procedures benefit the most from goal-directed fluid therapy (GDFT), and (2) restricted fluid methodologies are appropriate for healthy patients undergoing minor colorectal surgery. Next, a retrospective practice audit of Kaiser Permanente (KP) anesthesia providers was conducted to observe adherence to the latest fluid resuscitation recommendations and assess adverse patient outcomes corresponding to practitioner non-compliance.  Twenty-four colorectal surgery patient records were examined. Total administered intraoperative fluid volumes were compared to a maximum volume of 2,500 to 3,000 ml. These total volumes were chosen as they are associated with reduced adverse perioperative outcomes in colorectal procedures (Asklid et al., 2017; Myles et al., 2018; Thacker et al., 2019). Eight patients received volumes greater than 3,000 ml, while 13 patients received more than 2,500 ml. No patients experienced adverse perioperative complications. Due to the COVID-19 pandemic, the project could not examine a large sample size; thus, these findings should be considered as circumstantial. The study should serve as a pilot model for future more extensive investigations. However, the study identified that 33% of anesthesia providers were non-compliant with the maximum intraoperative fluid volume of 3,000 ml IVF and 54% were non-compliant with the ideal fluid volume of 2,500 ml. Based on our findings, we advocate for an anesthesia provider re-education plan and recommend strategies for successful education roll-out and adoption.