Invasive central venous monitoring during hepatic resection: unnecessary for most patients

O'Connor, David C.; Seier, Kenneth; Gönen, Mithat; McCormick, Patrick J.; Correa‐Gallego, Camilo; Parker, Benjamin A.; Weiser, Emily L.; Balachandran, Vinod P.; DeMatteo, Ronald P.; D’Angelica, Michael I.; Kingham, Peter; Allen, Peter J.; Drebin, Jeffrey A.; Jarnagin, William R.; Fischer, Mary

doi:10.1016/j.hpb.2020.03.020

Cited by 4 publications

(3 citation statements)

References 11 publications

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“…Clinical experience has showed that hepatic venous pressure could be effectively ameliorated by controlling low central venous pressure, thereby controlling blood loss and promoting separation of the liver parenchymal [22,23]. Other studies have reported that dexmedetomidine is one of the commonly used sedative and analgesic drugs in clinical practice with a high safety and reliability profile [24,25]. It can effectively inhibit sympathetic excitability, protect liver and kidney function by improving arteriole diameter, minimize the degree of ischemic reperfusion injury, and improve impaired cognitive function in patients [26,27].…”

Section: Discussionmentioning

confidence: 99%

Effects of controlled low central venous pressure combined with dexmedetomidine on the blood loss, renal function and cognitive function in patients undergoing laparoscopic hepatectomy

2023

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This study aims to investigate the effects of controlled low central venous pressure combined with dexmedetomidine on the blood loss, renal function and cognitive function in patients undergoing laparoscopic hepatectomy. From January 2021 to October 2022, 90 patients treated with laparoscopic hepatectomy in Huai’an First People’s Hospital were selected as subject objects and equally divided into the study group and control group in a random method. The blood loss, surgical duration, duration of hepatic portal occlusion, serum bilirubin, creatinine, urea nitrogen, hemoglobin, plasma albumin, interleukin (IL)-6 and cognitive function in the two groups were compared. Patients in the study group receiving the combination of controlled low central venous pressure and dexmedetomidine showed less blood loss and shorter time of hepatic portal occlusion as compared to the control group. The levels of serum bilirubin, creatinine and urea nitrogen were significantly increased at postoperative 3 days compared with preoperation in the study and control groups. In particular, these factors were higher in control group than that in the control group at postoperative 3 days, indicating better liver function and renal function of patients in the study group than those in the control group. The levels of hemoglobin and plasma albumin observed in study group 3 days after surgery were higher than those in the control group. At 1 day after surgery, the level of IL-6 was significantly lower in the study group than that in the control group. Patients in the study group achieved significantly higher mini-mental state examination (MMES) scores than those in the control group at postoperative 1 day, 3 days and 7 days. The controlled low central venous pressure combined with dexmedetomidine is a promising clinical practice in decreasing blood loss, improving the liver and kidney function, and protecting the cognitive function of patients during laparoscopic hepatectomy.

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Section: Discussionmentioning

confidence: 99%

Effects of controlled low central venous pressure combined with dexmedetomidine on the blood loss, renal function and cognitive function in patients undergoing laparoscopic hepatectomy

2023

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“…were documented. Intraoperative cardiac gas embolism was recorded, and cardiac CO 2 gas embolism was graded into five classes based on the proportion of bubbles detected: class 0, no bubbles seen in multiple views; class 1, non-contiguous visible single bubbles (< 10/section); class 2, non-contiguous visible clusters of bubbles (< 10/section); class 3, continuous visible clusters of bubbles (> 20/section); and class 4, continuous clusters of bubbles (> 20/section) in the right heart system 7 .…”

Section: Methodsmentioning

confidence: 99%

The impacts of corrected left ventricular ejection time combined with dobutamine on hepatocellular carcinoma patients

Xiaochen

Sun

et al. 2022

Sci Rep

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To evaluate the clinical effect of corrected left ventricular ejection time (LVETc) combined with dobutamine on the intraoperative management of patients undergoing hepatectomy for hepatocellular carcinoma. Sixty-eight patients with elective proposed pancreaticoduodenectomy, aged 61–78 years, body mass index 19–26 kg/m2, and ASA classification II or III, were divided into two groups (n = 34) using the random number table method: the esophageal ultrasound group (S group) and the esophageal ultrasound combined with dobutamine group (D group). In both groups, an esophageal ultrasound probe was placed after induction of anesthesia, and the left ventricular ejection time (LVET) and stroke volume (SV) were measured via a long-axis section of gastric fundus to guide fluid infusion. Nitroglycerin or a combination of dobutamine and nitroglycerine were pumped intravenously from the beginning of surgery to the completion of hemostasis after partial hepatectomy, in groups S or D, respectively. Central Venous Pressure (CVP), heart rate HR, and mean arterial pressure MAP were recorded at entry (T0), immediately after induction (T1), at the beginning of the operation (T2), during hilar occlusion (T3), after partial hepatectomy (T4), and after the operation (T5). SV and LVETc were recorded between T1 and T5. At T0 and T5, blood samples from radial artery and central vein were taken to determine the concentration of blood lactic acid, and the oxygen supply index (DO2I) and oxygen uptake rate (O2ERe) were calculated by blood gas analysis. The operation time, hilar occlusion time, intraoperative urine volume, intraoperative crystalloid and colloid infusion, intraoperative blood loss and blood transfusion, and the occurrence of cardiac gas emboli during the operation were also recorded. Adverse events of cardiovascular, pulmonary, and renal function during and after operation were registered. Sixty-four patients were included in the final analysis. Compared with group S, group D had lower CVP values at T2–T3 and higher SV values at T2–T5, reduced intraoperative blood loss, significantly increased intraoperative urine output, a smaller total dose of nitroglycerin use, and lower incidences of intraoperative hypotension and cardiac gas emboli (P < 0.05). Esophageal ultrasound detection of LVETc combined with dobutamine ensures hemodynamic stability in patients undergoing partial hepatectomy while reducing the incidence of intraoperative hypotension and air embolism.

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“…74,75 However, select data including recent randomized trials have failed to support superiority of this approach over goal directed therapy or intraoperative visual or ultrasound-based assessment of volume status by the surgeon, leading to a movement away from invasive CVP monitoring without any noted consequence in meaningful clinical outcomes. [76][77][78] Alternative metrics such as stroke volume variation (SVV) can be used, particularly for minimally invasive surgery where CO 2 insufflation of the abdomen can alter cardiac preload. 79 Techniques of parenchymal transection and inflow control are important but are beyond the scope of this review.…”

Section: Intraoperative Principlesmentioning

confidence: 99%

A Review of Resection and Surgical Ablation for Primary and Secondary Liver Cancers

White,

Jensen,

Brauer

2023

Semin intervent Radiol

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The surgical management of primary and secondary liver tumors is constantly evolving. Patient selection, particularly with regard to determining resectability, is vital to the success of programs directed toward invasive treatments of liver tumors. Particular attention should be paid toward determining whether patients are best served with surgical resection or ablative therapies. A multidisciplinary approach is necessary to provide optimal care to patients with liver malignancy.

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Invasive central venous monitoring during hepatic resection: unnecessary for most patients

Cited by 4 publications

References 11 publications

Effects of controlled low central venous pressure combined with dexmedetomidine on the blood loss, renal function and cognitive function in patients undergoing laparoscopic hepatectomy

Effects of controlled low central venous pressure combined with dexmedetomidine on the blood loss, renal function and cognitive function in patients undergoing laparoscopic hepatectomy

The impacts of corrected left ventricular ejection time combined with dobutamine on hepatocellular carcinoma patients

A Review of Resection and Surgical Ablation for Primary and Secondary Liver Cancers

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