Assessment, calculation and composition of replacement fluid is a fundamental tenet of anaesthetic practice. Mounting evidence from the colorectal and enhanced recovery literature shows that attention to detail throughout the perioperative period results in both reduced patient morbidity and length of stay. In addition to our highly tuned clinical acumen, exist a myriad of monitors we can use to augment our decision making and maintain our patients' milieu interieur. As such, one would expect to observe a high degree of consistency in the volumes of fluid given by experienced anaesthetic practitioners to similar groups of patients or at the very least, a degree of internal consistency when looking at an individual anaesthetist's practice. A large retrospective data analysis from the US looking at over 6000 patients has yielded results that are as alarming as they are surprising. Whilst it would appear the God doesn't play dice, we observe the distinct possibility the anaesthetists may! Professor Monty Mythen from UCLH talks to us about his reaction to the paper, the repercussions of poor perioperative fluid management and strategies for getting it right.

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