title: Blood volume is normal after pre-operative overnight fasting.
abstract: BACKGROUND
  Pre-operative fasting is assumed to cause a deficit in intravascular blood volume (BV), as a result of ongoing urine production and insensible perspiration. Standard regimes consist of volume loading prior or simultaneous to any anaesthetic procedure to minimise the risk of hypotension. However, fluid overload in the context of major abdominal surgery has been shown to deteriorate patient outcome. Our study aimed to quantify total intravascular BV after fasting by direct measurements and to compare it with calculated normal values in comparable non-fasted patients.
  
  
  METHODS
  After 10 h of fasting, total plasma volume (PV) and red cell volume (RCV) were measured via the double-label technique (indocyanine green dilution and erythrocytes labelled with fluorescein, respectively) following induction of general anaesthesia in 53 gynaecological patients suffering from malignoma of the cervix. The corresponding normal values were calculated individually from age, body height and body weight.
  
  
  RESULTS
  Measured BV, RCV and PV after fasting were 4123+/-589, 1244+/-196 and 2879+/-496 ml, respectively. The differences to the corresponding calculated normal values were not significant (3882+/-366, 1474+/-134 and 2413+/-232 ml, respectively). The measured haematocrit reflected a slight anaemic state (0.35+/-0.03).
  
  
  CONCLUSIONS
  Our data suggest that even after prolonged pre-operative fasting, cardio-pulmonary healthy patients remain intravascularly normovolaemic. Therefore, hypotension associated with induction of general or neuraxial anaesthesia should perhaps be treated with moderate doses of vasopressors rather than with undifferentiated volume loading.
authors.affiliation: Clinic of Anaesthesiology, Ludwig-Maximilians University Munich, Nussbaumstrasse 20, 80336 Munich, Germany. matthias.jacob@med.uni-muenchen.de
authors.forename: M
authors.initials: M
authors.lastname: Jacob
authors.forename: D
authors.initials: D
authors.lastname: Chappell
authors.forename: P
authors.initials: P
authors.lastname: Conzen
authors.forename: U
authors.initials: U
authors.lastname: Finsterer
authors.forename: M
authors.initials: M
authors.lastname: Rehm
mesh_terms: D000768:Anesthesia, General; D001810:Blood Volume; D004396:Coloring Agents / Q000008:administration & dosage; D003287:Contrast Media / Q000008:administration & dosage; D005215:Fasting; D005260:Female; D019793:Fluorescein / Q000008:administration & dosage; D006400:Hematocrit; D006801:Humans; D007044:Hysterectomy; D007208:Indocyanine Green / Q000008:administration & dosage; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000601:surgery*
chemical_list: D004396:Coloring Agents; D003287:Contrast Media; D007208:Indocyanine Green; D019793:Fluorescein