In a patient with decompensated heart failure requiring urgent non-cardiac surgery, how much volume optimization do you pursue preoperatively, and at what point does the risk of further surgical delay outweigh the benefit of continued diuresis?

This is an interesting question and a challenging situation for a patient. I think that the ideal scenario would be for the patient to be euvolemic clinically prior to surgery. I am very aggressive with intravenous diuretics. I think that a discussion with the patient, with the surgeon, and with ane...