FLUID BALANCE AND FLUID REPLACEMENT SOLUTIONS

More than 22 million blood components are transfused each year in the United States,^[103] many to surgical and obstetric patients. The transfusions of RBCs, platelets, fresh frozen plasma, and cryoprecipitate have the potential for improving clinical outcomes in perioperative and peripartum settings. Benefits include improved tissue oxygenation and decreased bleeding; however, transfusions are not without risks or costs. Transmission of infectious diseases (e.g., hepatitis, human immunodeficiency virus infection), hemolytic and nonhemolytic transfusion reactions, immunosuppression, alloimmunization, and other complications are potential sequelae of blood component therapy. Although RBCs and coagulation products have excellent volume-expanding capacity, they are not considered in this chapter (see Chapter 47 ).

In 1994, the American Society of Anesthesiologists convened the Task Force on Blood Component Therapy to develop evidence-based guidelines on the proper indications for perioperative and peripartum administration of RBC, platelets, fresh frozen plasma, and cryoprecipitate. This section details only basic crystalloid, colloid, and hypertonic solution recommendations applicable to typical surgical and obstetric patients. Information about infants, children, and special clinical settings is found elsewhere in this book ( Table 46-20 ) (see Chapter 58 ).