Fluids in abdominal surgery: what is the goal?

In the early 2000s, the approach to perioperative fluid management in major abdominal surgery underwent a paradigm change in favor of restrictive, rather than standard or liberal, fluid regimens. The basis for this shift in philosophy was a result of randomized controlled trials such as one by Brandstrup et al., which demonstrated improved morbidity and outcomes with perioperative fluid restriction (1). With similar results reported across a variety of other prospective trials, the practice of perioperative fluid restriction garnered more support and acceptance (2,3).