Fluid Management in Neurosurgical Patients with Coexisting Cardiac Diseases

Neurosurgical patients with underlying cardiac diseases are very sensitive to fluid management. They need careful preoperative cardiac evaluation regarding myocardial ischemia, significant arrhythmia, valvular heart disease, and heart failure. Presence of heart failure in preoperative period will increase perioperative cardiac morbidity. Some may have heart failure. Some may have euvolemia or even hypovolemia. Fluid assessment and fluid responsiveness in cardiac patients are very important. Fluid challenge can be given in cardiac patients. In responders, hemodynamic parameters will change to favorable results. Bedside echocardiogram and passive leg raising (PLR) test are excellent tools for assessing fluid responsiveness. In patient with hypovolemia and hypotension, resuscitation fluid should focus on rapid restoration of circulating volume. Intraoperative hypotension can be minimized with goal-directed fluid combined with protocol management. Postoperative IV fluid requirements should be low in most cases. Fluid balance chart and serum electrolytes should be checked. Cardiac complications (myocardial ischemia, atrial fibrillation, and heart failure) occur commonly, and some neurological conditions such as neurogenic stunned myocardium (NSM) can cause myocardial dysfunction. Appropriate fluid and blood pressure management may decrease or prevent major cardiac events.