title: Rapid weight loss is associated with preoperative hypovolemia in morbidly obese patients.
abstract: BACKGROUND
  In morbidly obese patients (MO), adequate levels of venous return (VR) and left ventricular filling pressures (LVFP) are crucial in order to augment perioperative safety. Rapid weight loss (RWL) preparation with very low calorie diet is commonly used aiming to facilitate bariatric surgery. However, the impact of RWL on VR and LVFP is poorly studied.
  
  
  METHODS
  In this prospective, controlled, single-center study, we hypothesized that RWL-prepared MO prior to bariatric surgery can be hypovolemic (i.e., low VR) and compared MO to lean controls with conventional overnight fasting. Twenty-eight morbidly obese patients were scheduled consecutively for bariatric surgery and 19 lean individuals (control group, CG) for elective general surgery. Preoperative assessment of VR, LVFP, and biventricular heart function was performed by a transthoracic echocardiography (TTE) protocol to all patients in the awake state. Assessment of VR and LVFP was made by inferior vena cava maximal diameter (IVCmax) and inferior vena cava collapsibility index- (IVCCI) derived right atrial pressure estimations.
  
  
  RESULTS
  A majority of MO (71.4 %) were hypovolemic vs. 15.8 % of lean controls (p < 0.001, odds ratio = 13.3). IVCmax was shorter in MO than in CG (p < 0.001). IVCCI was higher in MO (62.1 ± 23 %) vs. controls (42.6 ± 20.8; p < 0.001). Even left atrium anterior-posterior diameter was shorter in MO compared to CG.
  
  
  CONCLUSIONS
  Preoperative RWL may induce hypovolemia in morbidly obese patients. Hypovolemia in MO was more common vs. lean controls. TTE is a rapid and feasible tool for assessment of preload even in morbid obesity.
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, 90185, Umeå, Sweden. tomi.poso@anestesi.umu.se
authors.forename: Tomi
authors.initials: T
authors.lastname: Pösö
authors.forename: Doris
authors.initials: D
authors.lastname: Kesek
authors.forename: Roman
authors.initials: R
authors.lastname: Aroch
authors.forename: Ola
authors.initials: O
authors.lastname: Winsö
mesh_terms: D000328:Adult; D015992:Body Mass Index; D031204:Caloric Restriction / Q000009:adverse effects*; D002303:Cardiac Output, Low / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D004038:Diet, Reducing / Q000009:adverse effects*; D004452:Echocardiography / Q000379:methods; D005260:Female; D015391:Gastroplasty / Q000379:methods; D006801:Humans; D020896:Hypovolemia / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000178:diet therapy / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D015431:Weight Loss