Application of perioperative hemodynamics today and potentials for tomorrow

Perioperative screening and management in elective complex hepatobiliary surgery

“…This study demonstrated that routine CVP monitoring is not essential for all liver resections [39,40 ▪ ]. Systematic reviews, metanalyses and randomized control trials (RCTs) of patients undergoing partial hepatectomy have observed that use of a low CVP was safer and did not result in deleterious effects [38,39,40 ▪ ,41].…”

“…The main goal is of optimizing tissue perfusion. Recommendations highlight that intraoperative mean arterial pressure (MAP) below 60-70 mmHg is associated with myocardial injury, acute kidney injury (AKI) and death [38,39,47]. On the other hand, systolic pressures above 160 mmHg, if left untreated, is also associated with myocardial injury.…”

“…Despite these studies, routine use of terlipressin is not a common practice. Several series have looked into the differences between crystalloids and colloids [4 ▪▪ ,39,40 ▪ ,42,43]. No meaningful differences in outcomes have been observed but balanced salt solutions are always recommended against isotonic saline or dextrose solutions.…”

“…Studies emphasize that perioperative hypotension is associated with myocardial, renal and cerebral injury and increased mortality. Personalized targets for each patient's blood pressure is recommended based on physiology and baseline values [39,40 ▪ ]. The main goal is of optimizing tissue perfusion.…”

“…In the event of any hypotension, fluid responsiveness needs to be assessed and then decision of fluid bolus or use of vasopressors should be made. Norepinephrine is the vasopressor of choice followed by vasopressin and dobutamine is indicated whenever an ionotrope is required [4 ▪▪ ,38,39,40 ▪ ].…”