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Blood volume is normal after pre-operative overnight fasting.

M Jacob1, D Chappell, P Conzen

  • 1Clinic of Anaesthesiology, Ludwig-Maximilians University Munich, Nussbaumstrasse 20, 80336 Munich, Germany. matthias.jacob@med.uni-muenchen.de

Acta Anaesthesiologica Scandinavica
|March 15, 2008
PubMed
Summary

Pre-operative fasting does not significantly reduce blood volume (BV) in healthy patients. This suggests vasopressors, not just fluids, may help manage hypotension during anesthesia.

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Area of Science:

  • Anesthesiology
  • Physiology
  • Surgical Care

Background:

  • Pre-operative fasting is commonly believed to cause intravascular volume deficits, leading to fluid loading protocols to prevent hypotension.
  • However, excessive fluid administration in major abdominal surgery can negatively impact patient outcomes.
  • This study investigated actual intravascular blood volume (BV) post-fasting.

Purpose of the Study:

  • To directly measure total intravascular blood volume (BV) after a 10-hour pre-operative fast.
  • To compare measured BV with calculated normal values in non-fasted individuals.
  • To inform anesthetic fluid management strategies.

Main Methods:

  • Fifty-three gynecological cancer patients undergoing general anesthesia after a 10-hour fast were studied.
  • Total plasma volume (PV) and red cell volume (RCV) were measured using the double-label technique.
  • Normal BV values were individually calculated based on patient age, height, and weight.

Main Results:

  • Measured BV, RCV, and PV after fasting were 4123±589 ml, 1244±196 ml, and 2879±496 ml, respectively.
  • These values were not significantly different from calculated normal volumes (3882±366 ml, 1474±134 ml, and 2413±232 ml).
  • A slight anemia was indicated by the measured hematocrit (0.35±0.03).

Conclusions:

  • Cardiopulmonary healthy patients maintain normovolemia even after prolonged pre-operative fasting.
  • Hypotension during anesthesia induction may be better managed with vasopressors than with indiscriminate fluid loading.
  • Findings challenge standard fluid management protocols for fasted patients.