In the recent issue of Anesthesiology there is an article and an accompanying editorial that provide us with somewhat contradictory conclusions. The study did not find any difference in outcome of intermediate risk orthopedic surgery between the patients who received goal-directed hemodynamic therapy or usual treatment determined by an anesthesiologist in charge of the case. Maheshwari and Sessler correctly stated that future studies should include patients who undergo surgery requiring more severe volume changes than patients in the reported study did, possibly implying that such group of patients would do well regardless of the goal-directed hemodynamic therapy.

Despite no differences in outcome the patients who were treated with goal-directed hemodynamic therapy received 1.5 times more fluid than the patients in the controlled group. Basic physiology of venous system helps to elucidate...

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