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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2017 Apr 19
Copyright © 2017 EDIZIONI MINERVA MEDICA
Comparison of absolute fluid restriction versus relative volume redistribution strategy in low central venous pressure anesthesia in liver resection surgery: a randomized controlled trial
Jan ZATLOUKAL 1 ✉, Richard PRADL 1, Jakub KLETEČKA 1, Tomáš SKALICKÝ 2, Václav LIŠKA 2, 3, Jan BENES 1, 3
1 Department of Anesthesiology and Intensive Care, The University Hospital and The Faculty of Medicine in Plzen, Charles University Prague, Plzen, Czech Republic; 2 Department of Surgery, The University Hospital and The Faculty of Medicine in Pilsen, Charles University Prague, Plzen, Czech Republic; 3 Faculty of Medicine in Plzen, Biomedical Centre, Charles University in Prague, Plzen, Czech Republic
BACKGROUND: Lowering central venous pressure (CVP) can decrease blood loss during liver resection and it is associated with improved outcomes. Multiple CVP reducing maneuvers have been described, but direct comparison of their effectiveness and safety has never been performed.
METHODS: Patients undergoing resections of 2 or more liver segments were equally randomized to absolute fluid restriction (AR, N = 17) or relative volume redistribution group (RR, N = 17). The ease of reaching low CVP, blood loss, morbidity and mortality were assessed. Besides, the effect of Pringle maneuver and utility of stroke volume variation (SVV) were analyzed.
RESULTS: Both methods of CVP reduction were equally effective (0.7 ± 0.9 vs. 0.9 ± 1. protocolized steps in the AR and RR group; p=0.356) and safe (no difference in observed blood loss, intraoperative hemodynamic parameters, lactate levels, morbidity and mortality). Patients in the AR group received smaller amount of fluids in the preresection period (120 (100150) vs. 600 (500700) ml; p<0.001), and had slightly longer hospital stay (10 (814) vs. 8 (711); p=0.045). Low CVP was predicted by SVV>10% with 81.4% sensitivity and 77.1% specificity. Reduced blood loss and transfusion rate was observed when Pringle maneuver was used.
CONCLUSIONS: In our study, absolute fluid restriction and relative volume redistribution seemed to be equally effective and safe methods of lowering CVP in patients undergoing liver resection. According to our data high SVV might be considered as a low CVP replacement. Pringle maneuver reduced blood loss and transfusion requirement.
KEY WORDS: Hepatectomy - Central venous pressure - Pringle maneuver - Hemodynamics - Fluid therapy