*2.2.6 Fluid and blood products*

The goal of fluid management is to maintain normovolemia and a hematocrit between 30 and 35% [49]. Hemodilution and polycythemia both carry the risk of perioperative cerebral ischemia [50]. So, careful titration and control of blood viscosity are vital; this is accomplished by replacing insensible losses, blood loss, and urine output with a combination of normal saline and 5% albumin or blood products. Though some studies have recommended a hypervolemia state to avoid the issues associated with hypotension and decreased cerebral perfusion [51]. Arterial blood gas, electrolyte, glucose, and hematocrit should be measured at regular intervals throughout the case with the target of maintaining normal values. It has been suggested that hematocrit of about 30–35% balances the oxygen blood content and blood viscosity and promotes sufficient oxygen delivery extrapolated from the cardiac surgery. Advanced cardiac output monitoring is utilized in assessing volume status, fluid responsiveness, and guiding fluid therapy, and the need for vasopressors.
