In spite of numerous studies about fluid management and hemodynamic monitoring in thoracic anesthesia, the heterogeneity of the results has led to the fact that there is still no strong evidence on this topic. The historical recommendation of restricted fluid management has been replaced by normovolemia, but there are still many unsolved problems. Most importantly, not only the amount of the fluid, but also its indication, timing, the addition of a vasopressor and/or inotrope, its dosage, protection of glycocalyx layer and several other parameters play a role in the relationship of fluid strategy and overall outcome. Regarding the postoperative outcome, fluid management in its extensive form should be considered as an important part of a strategy.

Goal-directed therapy (GDT) is associated with certain limitations, mainly because “open thorax” can affect the cardiopulmonary interaction. Still, it can give objective hints to achieve stable hemodynamics, protection of glycocalyx, prevention of pulmonary edema and avoidance of postoperative organ injury.

Whereas only a minority of acute ischaemic stroke patients are eligible to reperfusion therapies, all can benefit from optimized supportive care to minimize acute stroke complications. Continuous pulse oximetry monitoring is recommended, and supplemental oxygen given as needed to maintain saturation>94%. During the first 24 hours after onset, when collateral dependence is greatest, blood pressure lowering may best be avoided, unless SBP >220 mm Hg, thrombolytics have been administered, or cardiac or other comorbidities are present; thereafter, gradual blood pressure lowering may safely be started. Initial fluid management should aim for normovolemia, using isotonic fluids; if substantial brain oedema develops, hypertonic fluids can be helpful. Electrolyte imbalances should be corrected and the underlying cause identified and treated. Extremely low and high blood glucose deviations should be avoided; if hyperglycaemia is present, treatment using a subcutaneous insulin sliding scale of moderate intensity is appropriate. Simple formal swallow screening should be performed early in all ischaemic stroke patients. When swallowing is impaired, initiating feeding via NG tube is reasonable within the first 2–3 days after onset. Temperature should be monitored and, if fever develops, antiyretic therapy started immediately and the cause identified and treated. For bladder dysfunction, an indwelling catheter should be avoided if possible to reduce infection rates. Hydration and passive/active movement of paretic extremities are important to prevent venous thromboembolism. In patients with reduced mobility, intermittent pneumatic compression devices should be employed. It is reasonable to use pharmacological thromboprophylaxis in patients at high risk of DVT (e.g. immobile, history of prior venous thromboembolism) and low risk of intracranial hemorrhage (e.g. small infarct less than 3 cm in diameter), and subcutaneous low-molecular-weight heparins are somewhat more effective than unfractionated heparin. Initial management of delirium should include non-pharmacological behavioral measures, including periodic verbal reassurances and reorientation, providing rooms with windows and clocks, facilitating sensory input with eyeglasses and hearing aids, and promoting a usual sleep-wake cycle.