Please explain fluid shifts post-op vascular surgery

[bella14k]

Can someone explain the fluid shifts associated with vascular surgery (ex: Repair of AAA) ? Please explain mechanisms or patho

Thanks

[Corey Narry, MSN, RN, NP]

There are always going to be fluid shifts in any type of surgery involving the chest and abdominal cavity. The mechanism is complex and multi-factorial. I suggest you read this article and learn some of the basis of fluid volume management in the surgical population:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3159903/pdf/2110-5820-1-2.pdf

In terms of your question, vascular surgery of the descending aorta such as in the repair of a Thoraco-abdominal or Abdominal Aortic Aneurysms present other challenges in fluid management more so than in other types of chest and abdominal surgeries. In these surgeries, the kidneys and the spinal cord are two organ functions that must be watched closely after surgery and fluid volume management plays a role in making sure their function is preserved.

Adequate Renal function may be compromise or spared depending on the location of the aortic cross clamp and the amount of time that elapsed while the aorta is clamped. As you know, this is because blood flow to the kidneys via the renal arteries that branch off the aorta keeps that organ working. Post-operatively, adequate perfusion pressure to the kidneys (via maintaining a target MAP) are important and in most cases, adequate intravascular fluid volume is the mainstay of therapy.

See: The Pathophysiology of Aortic Cross-clamping and Unclamping : Anesthesiology

The other consideration is spinal cord perfusion in thoraco-abdominal aortic aneurysm repairs. The Artery of Adamkiewicz arises from the thoracic aorta and supplies blood to the lumbar and sacral segments of the spinal cord. Any compromise to blood flow in this artery whether during surgical repair in the OR or after during an episode of hypotension could lead to hypo-perfusion of the lumbar and sacral spinal cord and may lead to permanent paraplegia. Again, maintenance of perfusion is usually achieved with adequate intravascular fluid volume.

See: .pdf"]Spinal cord protection during vascular surgery

[Biffbradford]

If you still need more, try searching "third spacing". Hope that helps.

[ghillbert, MSN, NP]

Also look at CPB sequelae for procedures done on bypass

[Esme12, ASN, BSN, RN]

Bella....Juan was very good to you....was this homework?

Here is an excellent resource....Nursing Center - CE Article