Fluid management during neurosurgical procedures

Historical bias has favored fluid restriction in patients with brain pathology. The efficacy of fluid restriction on brain edema remains unproven, and the consequences of fluid restriction, if pursued to the point of hypovolemia, can be devastating. Perioperative fluid management has undergone significant advances over the past few decades, and medical practice needs to be guided by physiologic principles (osmotic pressure, osmolarity and osmolality, colloidoncotic pressure, Starling's hypothesis, interstitial clearance, hydrostatic forces and interstitial compliance and blood-brain barrier function).