How do you decide if patients without contraindications should receive IV fluids during the pre-operative period if they are undergoing surgery during their hospitalization?

I agree with Dr. @Dr. First Last. Volume status determination remains subjective, and a combination of urine output (and color!), physical exam, patient history, and vital sign review often provides conflicting information requiring subtle interpretation. Hypervolemia leading to pulmonary edema will often (appropriately) delay surgery for volume optimization.

On the other hand, hypovolemia should be avoided when possible. In the orthopedic trauma population, hypovolemia due to internal blood loss from fracture often goes underrecognized, and scheduling uncertainty can lead to (relatively) extended NPO periods for my inpatients preoperatively. In general, patients are preload dependent during induction, and even previously compensated, mild ...

This is an interesting question. The concern is that patients with hypovolemia who undergo anesthesia/surgery will develop acute kidney injury and/or hypotension. Conversely, hypervolemia can lead to problems in the postoperative setting (as shown by the ERAS literature). The current recommendations are for patients to have oral fluids up to 2 hours prior to surgery. This approach should prevent hypovolemia. However, this approach is not always feasible for hospitalized patients.

I think that the decision for intravenous fluids depends on the circumstances, including the patient’s volume status. If a patient has not been taking fluids due to problems with the gastrointestinal tract (e.g., obstruction, inflammation, withdrawal) or with an in...