Fluid resuscitation during major abdominal surgery with which agent is associated with the best survival data?

Fluid resuscitation during major abdominal surgery with which agent is associated with the best survival data?

• A. 5% Albumin
• B. 6% Hydroxyethyl starch
• C. Dextran 70
• D. Isotonic crystalloids

Answer: (D)

Fluid resuscitation during major abdominal surgery aims to maintain perfusion while minimizing edema and coagulopathy. Isotonic crystalloids are associated with the best survival data because they safely expand the intravascular volume without the risks tied to synthetic colloids. Hydroxyethyl starch and dextran have been linked to higher rates of kidney injury, coagulopathy, and adverse outcomes in trials, so they do not improve survival. Albumin can be useful in certain hypoalbuminemic states but has not consistently shown a survival advantage and is more costly. Isotonic crystalloids, such as normal saline or balanced solutions, provide reliable volume expansion with a favorable safety profile, and modern practice—favoring balanced crystalloids to reduce hyperchloremic acidosis—supports better outcomes.

Fluid resuscitation during major abdominal surgery aims to maintain perfusion while minimizing edema and coagulopathy. Isotonic crystalloids are associated with the best survival data because they safely expand the intravascular volume without the risks tied to synthetic colloids. Hydroxyethyl starch and dextran have been linked to higher rates of kidney injury, coagulopathy, and adverse outcomes in trials, so they do not improve survival. Albumin can be useful in certain hypoalbuminemic states but has not consistently shown a survival advantage and is more costly. Isotonic crystalloids, such as normal saline or balanced solutions, provide reliable volume expansion with a favorable safety profile, and modern practice—favoring balanced crystalloids to reduce hyperchloremic acidosis—supports better outcomes.