Liberal or restricted fluid administration: are we ready for a proposal of a restricted intraoperative approach?

Background: Fluid management in the perioperative period has been extensively studied but, despite that, “the right amount” still remains uncertain. The purpose of this paper is to summarize the state of the art of intraoperative fluid approach today. Discussion: In the current medical literature there are only heterogeneous viewpoints that gives the idea of how confusing the situation is. The approach to the intraoperative fluid management is complex and it should be based on human physiology and the current evidence. Summary: An intraoperative restrictive fluid approach in major surgery may be beneficial while Goal-directed Therapy should be superior to the liberal fluid strategy. Finally, we propose a rational approach currently used at our institution.