Preoperative Furosemide: To Give or Not to Give?

No consensus exists on whether patients who use loop diuretics should receive them or have them withheld on the morning of surgery. Providers are left to weigh relative risk for acute kidney injury against risk for volume overload on an individual basis.

Investigators conducted a double-blind block-randomized trial in 212 chronic furosemide users who were scheduled for surgery at three North American centers. Half the patients received their usual dose of furosemide on the morning of surgery, and half received placebo. Two thirds of patients had Revised Cardiac Risk Index scores of 0 or 1 (JW Gen Med Sep 17 1999). Exclusion criteria included baseline hypotension, autonomic dysfunction, severe aortic stenosis, or decompensated heart failure. …