British Double Agents and Operation Fortitude: A New Perspective

On June 6th, 1944, Allied forces stormed the beaches of Normandy as a part of Operation Overlord, the Allied invasion of France. While they experienced pockets of stiff resistance, Allied troops sustained far fewer casualties than they had expected. The reason for this was due to Operation Fortitude, a deception mission that intended to fool Hitler about the time and location of the Allied invasion mission. The use of double agents by British Intelligence services was essential for the effective execution of Fortitude. The story of the double agents goes beyond their success during Fortitude. Double agents were initially recruited as German agents, but key agents immediately turned themselves in to British authorities upon reaching the nation. These agents decided to become involved with British Intelligence due to broader circumstances that were happening in Europe. The emergence of Fascist regimes disrupted the political landscape of Europe and led to widespread condemnation from political and social spheres. Their development as double agents became crucial to their effectiveness during Operation Fortitude. Their successful infiltration of German Intelligence allowed them to convince Hitler and German High Command that the main Allied invasion force would come at the Pas de Calais instead of Normandy. The result was that the Allies met an unprepared German defense force on D-Day and were able to advance past the beaches. The work of the double agents during Fortitude saved thousands of Allied lives and was vital to the success of Operation Overlord.

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

© 2014, Canadian Anesthesiologists' Society.Optimal perioperative fluid management is an important component of Enhanced Recovery After Surgery (ERAS) pathways. Fluid management within ERAS should be viewed as a continuum through the preoperative, intraoperative, and postoperative phases. Each phase is important for improving patient outcomes, and suboptimal care in one phase can undermine best practice within the rest of the ERAS pathway. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state. To achieve this, prolonged fasting is not recommended, and routine mechanical bowel preparation should be avoided. Patients should be encouraged to ingest a clear carbohydrate drink two to three hours before surgery. The goals of intraoperative fluid management are to maintain central euvolemia and to avoid excess salt and water. To achieve this, patients undergoing surgery within an enhanced recovery protocol should have an individualized fluid management plan. As part of this plan, excess crystalloid should be avoided in all patients. For low-risk patients undergoing low-risk surgery, a “zero-balance” approach might be sufficient. In addition, for most patients undergoing major surgery, individualized goal-directed fluid therapy (GDFT) is recommended. Ultimately, however, the additional benefit of GDFT should be determined based on surgical and patient risk factors. Postoperatively, once fluid intake is established, intravenous fluid administration can be discontinued and restarted only if clinically indicated. In the absence of other concerns, detrimental postoperative fluid overload is not justified and “permissive oliguria” could be tolerated.