• Septic shock
• liberal fluid resuscitation
• myocardial function
• organ failure
• restrictive fluid resuscitation

• Acute ischemic stroke
• Elderly
• Fluid balance
• Fluid overload
• Group-based trajectory model
• Prognosis

• ICU delirium
• acute kidney injury (AKI)
• cerebral lymph congestion
• mean systemic filling pressure (MSVP)
• pressure support ventilation (PSV)
• systemic vascular resistance (SVR)
• venous bagging
• venous congestion

• albumin therapy
• cirrhosis
• hypoalbuminemia
• sepsis
• volume resuscitation

• Humans
• Hypoalbuminemia/drug therapy
• Hypoalbuminemia/etiology
• Albumins/therapeutic use
• Sepsis/complications
• Liver Cirrhosis/complications
• Liver Cirrhosis/drug therapy
• Water-Electrolyte Imbalance
• Inflammation/drug therapy

• Humans
• Shock, Septic
• Multiple Organ Failure/therapy
• Hospital Mortality
• Resuscitation/methods
• Respiration, Artificial
• Fluid Therapy/methods
• Vasoconstrictor Agents/therapeutic use

• sepsis
• fluid balance
• health related quality of life
• critical care outcomes

• Infant
• Child
• Humans
• Female
• Male
• Shock, Septic
• Quality of Life
• Intensive Care Units, Pediatric
• Sepsis
• Water-Electrolyte Balance

• K23 HD096018 NICHD NIH HHS
• R01 HD073362 NICHD NIH HHS
• R03 HD104001 NICHD NIH HHS

• Antibiotics
• Cirrhosis
• Intravenous fluids
• Septic shock
• Steroids
• Vasopressors

• UL1 TR001863 NCATS NIH HHS

Prudent administration of fluids helps restore or maintain hemodynamic stability in the setting of perioperative blood loss. However, fluids may arguably exacerbate the existing coagulopathy. We sought to investigate the influence of balanced crystalloid and synthetic gelatine infusions on coagulation and fibrinolysis in healthy volunteers. This prospective randomized crossover study included 25 males aged 18–30 years. Infusions performed included 20 mL/kg of a balanced crystalloid solution (Optilyte^®) or 20 mL/kg of gelatine 26.500 Da (Geloplasma^®) in a random order over a period of 2 weeks. Laboratory analysis included conventional coagulation parameters and rotational thromboelastometry (ROTEM) assays. We confirmed a decrease in fibrinogen concentration and the number of platelets, and prolongation of PT after infusions. Compared to baseline values, differences in the ROTEM assays’ results after infusions signified the decrease in coagulation factors and fibrinogen concentration, causing impaired fibrin polymerization and clot structure. The ROTEM indicator of clot lysis remained unaffected. In the case of both Optilyte^® and Geloplasma^®, the results suggested relevant dilution. Gelatine disrupted the process of clot formation more than balanced crystalloid. Infusions of both crystalloid and saline-free colloid solutions causing up to 30% blood dilution cause significant dilution of the coagulation factors, platelets, and fibrinogen. However, balanced crystalloid infusion provides less infusion-induced coagulopathy compared to gelatine.

This review summarizes the peri-operative anesthesiological approaches to esophagectomy considering the best up-to-date, evidence-based medicine, discussed from the anesthesiologist’s standpoint.

Esophagectomy is the only curative therapy for esophageal cancer. Despite the many advancements made in the surgical treatment of this tumour, esophagectomy still carries a morbidity rate reaching 60%. Patients undergoing esophagectomy should be referred to high volume centres where they can receive a multidisciplinary approach to treatment, associated with better outcomes. The anesthesiologist is the key figure who should guide the peri-operative phase, from diagnosis through to post-surgery rehabilitation. We performed an updated narrative review devoted to the study of anesthesia management for esophagectomy in cancer patients.

We searched MEDLINE, Scopus and Google Scholar databases from inception to May 2021. We used the following terms: “esophagectomy”, “esophagectomy AND pre-operative evaluation”, “esophagectomy AND protective lung ventilation”, “esophagectomy AND hemodynamic monitoring” and “esophagectomy AND analgesia”. We considered only articles with abstract written in English and available to the reader. We excluded single case-reports.

Pre-operative anesthesiological evaluation is mandatory in order to stratify and optimize any medical condition. During surgery, protective ventilation and judicious fluid management are the cornerstones of intraoperative “protective anesthesia”. Post-operative care should be provided by an intensive care unit or high-dependency unit depending on the patient’s condition, the type of surgery endured and the availability of local resources. The provision of adequate post-operative analgesia favours early mobilization and rapid recovery. Anesthesiologist has an important role during the peri-operative care for esophagectomy. However, there are still some topics that need to be further studied to improve the outcome of these patients.

• Esophagectomy
• hemodynamic monitoring
• perioperative cardiac risk assessment
• perioperative fluid management
• protective lung ventilation