|  Sign up!  


Return to Course Listing



CME: Perioperative Goal Directed Therapy - What can we do outside the abdomen?


Program Description / Statement of Need:

In this online CME self-learning program:


Enhanced recovery after surgery (ERAS) is a multimodal perioperative care pathway designed to attenuate the stress response during a patient’s surgical procedure and preserve organ function while promoting early recovery.1 While this approach is not new, it has not always been widely employed in spite of supporting evidence from a range of randomized controlled trials, systematic reviews, and meta-analyses.This literature suggests that ERAS programs are safe, cost-effective, and minimize the length of stay in a hospital without compromising quality of care.ERAS programs are successful in part because they are proactive in nature, comprised of interventions beginning during preoperative planning and continuing through intraoperative management and postoperative care.


One essential component of successful ERAS implementation is effective perioperative fluid management. Fluid administration is a cornerstone of intensive and perioperative care, with the ultimate goal being the maintenance of intravascular volume in a fashion that incurs the fewest complications. There is a wide spectrum of risk inherent in different fluid managements strategies. Clinical manifestations of under-resuscitation include complications ranging from the inconvenient and unpleasant (e.g., dizziness and post-operative nausea and vomiting) to those that acutely complicate the course of care such as: acute kidney injury and impaired wound healing as a result of inadequate blood flow to surgical anastamoses. On the other hand, over-resuscitation engenders risks such as pulmonary edema and function and its ensuing complications, which include post-operative coagulopathy, abdominal compartment syndrome, and gastrointestinal edema among several others.


A representative survey of over 700 consultant surgeons in the U.K. conducted early in the last decade found that less than a third of respondents felt that patients’ fluids and electrolytes were being managed to their satisfaction. Moreover, more experienced surgeons (those in practice over five years) were more likely to favor a restrictive fluid management approach as compared to surgeons who were newer to practice, constituting a variation in care unexplained by a firm rooting in professional guidelines or the biomedical literature. That clinical trials, opinion papers, and a survey of U.S. and European anesthesiologists continue to examine and debate the question of optimal perioperative fluid management strategies suggest that the problem has neither abated over the last decade, nor is it contained within the U.K.’s borders. The variations in practice that exist, in addition to the remedies suggested by the respondents in the survey conducted by Lobo et al., suggest that a practice gap continues to this day. Such strategies include “improvement in education,” with examples of desired activities including “problem-oriented ward rounds, written guidelines, and discussion of patient scenarios.”



  • Introduction to Perioperative goal directed therapy: what can we do outside the abdomen?
  • Goal-directed therapy (GDT) in orthopedic surgery: clinical studies and statistics
  • GDT in major vascular surgery: clinical studies and statistics
  • GDT in microvascular surgery: clinical studies and statistics


Target Audience:

This program has been designed for a multidisciplinary physician and nurse audience including: ICU / Anesthesia / Peri-op / Intensivists / Trauma / Critical Care

Program Objectives:

By the end of the session the participant will be able to:

    • o Optimize intraoperative fluid therapy in patients undergoing orthopedic, major vascular, or microvascular surgeries
    • o Identify risk factors for complications in high-risk patients undergoing surgery
    • o Apply pharmacotherapy effectively in conjunction with fluid therapy intraoperatively



    Release Date: November 01, 2014
    Expiration Date: November 01, 2016

    Faculty: William Hand MD

    Faculty Disclosure and Resolution of COI:

     As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved through  content review ScientiaCME.


    Faculty Disclosure: Dr.  Hand, MD discloses that he is a consultant / speaker for Edwards Lifesciences.


    Disclosures of Educational Planner: Charles Turck, PharmD is an officer and part owner of ScientiaCME, LLC, which has received a grant from the commercial supporter of this program: Edwards Lifesciences .


    Commercial Support Disclosure: This program is supported by an educational grant from Edwards Lifesciences 


    Viewing Requirements:



    Windows 2000 or above
    Internet Explorer 5.5
    Adobe Acrobat Reader*

    Mac OS 10.2.8
    Adobe Acrobat Reader*
    Internet Explorer is not supported on the Macintosh


    *Required to view Printable PDF Version


    Privacy Policy



    -Read the learning objectives and faculty disclosures above

    -Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowedge gained by participating in this CME activity.

    -View the on-line program. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.

    -Take the post-test

    -Complete the program evaluation and CME registration. A CE certificate will be emailed to you.

    Perform Pre-Test (optional)
    Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

    Download the Presentation (optional)


    View the online program


    Perform Post-Test

    Complete the Symposium Evaluation and Request CE Certificate

This program is supported by Educational Grants from Edwards Lifesciences.


Your feedback is important to us. Please Contact Us to let us know how to make this site better. Thank you.