In multiple surgical specialties, proper implementation of 3 tenets--early feeding, perioperative euvolemia
, and multimodal pain control--reduces the length of hospital stay, improves patient satisfaction, reduces complications, lowers health care costs, and most importantly hastens patient recovery.
This is explained by the fact that DRD2 receptors participate in the inhibition of ion transport through proximal tubule cells in conditions when there is an optimal quantity of water (euvolemia
) and a moderate increase in the volume of body fluids.
There was no significant statistical difference between severity of hyponatremia and volume status of the patients ['p'= 0.7168] with predominance of euvolemia
. Similarly, Mary Grace et al studied a total of 100 consecutive patients, hyponatremia (55% male 45% female) with a mean age of 60 [+ or -] 16 years.
Although these models suggest that the amount of fluid infused is not enough to cause RV failure if euvolemia
is maintained, our assumptions and limitations do not allow us to conclude that rapid fluid infusions are safe in all clinical settings.
Preoperative goals include establishing adequate control of blood pressure and achieving euvolemia
. Alpha-blockade for 7-14 days should be used to normalize blood pressure.
Patients with clinical euvolemia
, Urine [Na.sup.+]>20 mmol/l, serum uric acid [less than or equal to]4 mg/dl, normal renal function (serum creatinine and blood urea) and absence of thyroid or pituitary insufficiency were classified as having SIAD.
; no edema, ascites, or signs of hypovolemia 4.
Later, the diagnostic criteria for SIADH were propounded by Barrter and Schwartz, which includes hypoosmolar hyponatremia, inappropriately concentrated urine (in the presence of hypo-osmolality), clinical euvolemia
, elevated urinary sodium, normal thyroid and adrenal functions, and absence of diuretics .
These pathways are designed to accelerate patient recovery and focus on certain key components--early feeding, maintenance of euvolemia
, optimization of pain control (with limitation of systemic opioids), and early ambulation [5, 7-12].
Intravenous fluids should be administered to achieve euvolemia
and electrolytes replenished as needed.
We then reviewed the apnea test for completeness including documenting prerequisites (temperature [greater than or equal to] 36[degrees]C, systolic blood pressure [greater than or equal to] 100 mmHg, PaCO2 40 [+ or -] 5 mmHg, and PaO2 [greater than or equal to] 90 mmHg and euvolemia
), procedural details (e.g., amount of oxygen supplied in L/min and absence of respiratory effort), and the final PaCO2.