Role of IV Fluids During Minor Surgery

Minor surgery is generally defined as a surgical procedure which does not require general anesthesia and can be performed electively and in an outpatient setting. Of note, there is no clear official delineation between major and minor surgeries, but minor surgeries are less invasive and less risky (Newsome et al., 2021). Patients undergoing any surgeries are often required to fast from fluid and food beforehand. This, however, can lead to dehydration and place them at risk of organ injury and failure. Administering intravenous (IV) fluids may have positive effects. Conversely, fluid overload may decrease pulmonary function and gut motility (Brandstrup, 2006). Most research on fluid therapy during surgery focuses on major surgery. However, less is understood on the value of IV fluids during minor surgery and how they may affect a patient’s clinical course.

A study found that patients who received 2 liters of IV fluids intra- and postoperatively recovered quicker from the effects of surgery and anesthesia compared to patients without fluids. This was a group of patients undergoing ambulatory gynecologic laparoscopy surgery. Though this is a small volume of IV fluids, it appeared to have immediately measurable effects on patients postoperatively. The authors hypothesized that this was due to a correction of  dehydration. In terms of patient satisfaction, 93% of patients who had intravenous fluids felt the most recent anesthetic experience was better than past ones (Keane & Murray, 2007).  Other trials testing different intravenous fluid volumes on the outcomes of outpatient surgery found similar improvements in self-reported symptoms such as drowsiness and dizziness. In general, the volume of fluids given was approximately the same as the deficit from fasting, which may point to a benefit to replacing fluid losses from fasting. However, this research did not show if IV fluids would be beneficial in minor surgery in terms of external loss of fluid during an operation (Brandstrup, 2006).  

However, patient satisfaction, though important, is a subjective assessment of IV fluids during minor surgery. In two groups of 15 patients undergoing minor gynecologic surgery, there was no obvious clinical benefit of IV fluids administration (Ooi et al., 1992). This study attempted to use objective testing including two tests of psychomotor function. There was no significant difference between postoperative motor reaction times. Notably, the patients in this study were healthy and underwent a short duration of anesthesia. Fluids and hydration may be more important for longer surgeries. 

Furthermore, the benefit of IV fluids during minor surgery may depend on a patient’s risk level. Preoperative administration of 2mL/kg for every hour patients had fasted from fluids decreased incidence and severity of postoperative nausea and vomiting. However, this was for patients scheduled for diagnostic gynecologic laparoscopy, which is typically a less urgent procedure compared to other situations that would require minor surgery (Maharaj et al., 2005). Other factors that may influence recovery include nature and duration of the procedure, individual patient risk, and the anesthesia method used (Ooi et al., 1992).  

Ooi et al. brought up an interesting point in their study: perhaps further research may focus on the benefits of oral fluids versus IV fluids in minor surgery. Oral fluids offer a more cost-effective solution, and patients are often deprived of fluids a long period before minor surgeries (Ooi et al., 1992). Clear fluids may be safe for patients in limited volumes closer to the surgery start time. Another topic of research may focus on the effects of fluid overload compared to hypovolemia. This topic may fuel further investigation into more carefully assessing role of fluids during minor surgery.  

References 

Brandstrup B. Fluid therapy for the surgical patient. Best Pract Res Clin Anaesthesiol. 2006;20(2):265-283. doi:10.1016/j.bpa.2005.10.007 

Keane PW, Murray PF. Intravenous fluids in minor surgery. Their effect on recovery from anaesthesia. Anaesthesia. 1986;41(6):635-637. doi:10.1111/j.1365-2044.1986.tb13059.x 

Maharaj CH, Kallam SR, Malik A, Hassett P, Grady D, Laffey JG. Preoperative intravenous fluid therapy decreases postoperative nausea and pain in high risk patients. Anesth Analg. 2005;100(3):675-682. doi:10.1213/01.ANE.0000148684.64286.36 

Newsome K, McKenny M, Elkbuli A. Major and minor surgery: Terms used for hundreds of years that have yet to be defined. Ann Med Surg (Lond). 2021;66:102409. Published 2021 May 25. doi:10.1016/j.amsu.2021.102409 

Ooi LG, Goldhill DR, Griffiths A, Smith C. IV fluids and minor gynaecological surgery: effect on recovery from anaesthesia. Br J Anaesth. 1992;68(6):576-579. doi:10.1093/bja/68.6.576