Perioperative fluid management in major hepatic resection: an integrative review

Yoshino, Osamu; Perini, Marcos Vinícius; Christophi, Christopher; Weinberg, Laurence

doi:10.1016/s1499-3872(17)60055-9

Cited by 12 publications

(6 citation statements)

References 94 publications

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“…Zudem zeigt sich bei den sekundären Endpunkten (Wundinfektionen, Sepsis und Einsatz von Nierenersatzverfahren) ein Trend zu mehr Komplikationen in Mehrere andere Studien konnten Vorteile wie u. a. eine verringerte postoperative Morbidität und eine schnellere Erholung der Darmfunktion im Rahmen einer GDT zeigen [12,125,136]. Zudem gibt es erste Daten, dass eine verminderte Flüssigkeitsgabe durch GDT im Bereich der Leberchirurgie Vorteile für die Patienten hat, denn besonders in diesem Bereich sollte aufgrund der Komplexität der einzelnen Phasen immer ein individuelles Vorgehen erfolgen [33,142]. Auf Basis dieser Positivergebnisse sprechen sich französische und britische Leitlinien insbesondere bei Risikopatienten aktuell für die Verwendung einer GDT aus [96,132].…”

Section: Liberale Restriktive Bzw Nullbilanzierte Und Zielgerichtetunclassified

Perioperatives Flüssigkeitsmanagement bei großen viszeralchirurgischen Eingriffen

et al. 2020

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Zusammenfassung Die Gabe intravasaler Flüssigkeiten gehört zu den Grundpfeilern der perioperativen Therapie und nimmt insbesondere bei großen viszeralchirurgischen Eingriffen maßgeblichen Einfluss auf das chirurgische Behandlungsergebnis. Ein adäquates perioperatives Flüssigkeitsmanagement kann durch Vermeidung von Hypo- und Hypervolämie dazu beitragen, das Risiko einer unzureichenden Gewebeperfusion als Treiber postoperativer Morbidität und Letalität signifikant zu reduzieren. Der effektive Umgang mit intravasal zugeführten Flüssigkeiten setzt dabei die Kenntnis der Substanzen sowie Maßnahmen zur Therapiesteuerung voraus. Das Flüssigkeitsmanagement beginnt bereits präoperativ und sollte – unter Nutzung einer an die Bedürfnisse des Patienten angepassten und dem Eingriff entsprechenden hämodynamischen Überwachung – auch postoperativ im Aufwachraum und auf Station fortgesetzt werden. Der Kommunikation aller an der perioperativen Versorgung Beteiligten kommt im Sinne eines optimalen Flüssigkeitsmanagements eine entscheidende Bedeutung zu.

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Section: Liberale Restriktive Bzw Nullbilanzierte Und Zielgerichtetunclassified

Perioperatives Flüssigkeitsmanagement bei großen viszeralchirurgischen Eingriffen

et al. 2020

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“…The choice of the “ideal fluid” is still debated. Crystalloids are commonly used, with a preference for balanced solutions (acetate perhaps better than lactate as bicarbonate- forming substrate)[ 125 , 126 ]. However, attention should be paid to the onset of postoperative metabolic alkalosis, common after major surgery in general and after liver resections, and compensated for by respiratory acidosis (secondary to hypoventilation).…”

Section: Fluid Balance Managementmentioning

confidence: 99%

Major liver resections, perioperative issues and posthepatectomy liver failure: A comprehensive update for the anesthesiologist

De Gasperi,

Petrò,

Amici

et al. 2024

World J Crit Care Med

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Significant advances in surgical techniques and relevant medium- and long-term outcomes over the past two decades have led to a substantial expansion in the indications for major liver resections. To support these outstanding results and to reduce perioperative complications, anesthesiologists must address and master key perioperative issues (preoperative assessment, proactive intraoperative anesthesia strategies, and implementation of the Enhanced Recovery After Surgery approach). Intensive care unit monitoring immediately following liver surgery remains a subject of active and often unresolved debate. Among postoperative complications, posthepatectomy liver failure (PHLF) occurs in different grades of severity (A-C) and frequency (9%-30%), and it is the main cause of 90-d postoperative mortality. PHLF, recently redefined with pragmatic clinical criteria and perioperative scores, can be predicted, prevented, or anticipated. This review highlights: (1) The systemic consequences of surgical manipulations anesthesiologists must respond to or prevent, to positively impact PHLF (a proactive approach); and (2) the maximal intensive treatment of PHLF, including artificial options, mainly based, so far, on Acute Liver Failure treatment(s), to buy time waiting for the recovery of the native liver or, when appropriate and in very selected cases, toward liver transplant. Such a clinical context requires a strong commitment to surgeons, anesthesiologists, and intensivists to work together, for a fruitful collaboration in a mandatory clinical continuum.

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“…Fluid management strategies during LT have been extrapolated from those used for major open abdominal surgery. 134 A restrictive fluid strategy has been shown to decrease intraoperative blood loss and transfusion requirements. 135 In animal studies, a 1:1 blood loss replacement led to a 20% increase in portal venous pressure (PVP), increased intraoperative bleeding, and worse outcomes.…”

Section: Administrationmentioning

confidence: 99%

Hemodynamic Instability During Liver Transplantation in Patients With End-stage Liver Disease: A Consensus Document from ILTS, LICAGE, and SATA

et al. 2021

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Hemodynamic instability (HDI) during liver transplantation (LT) can be difficult to manage and increases postoperative morbidity and mortality. In addition to surgical causes of HDI, patient-and graft-related factors are also important. Nitric oxide-mediated vasodilatation is a common denominator associated with end-stage liver disease related to HDI. Despite intense investigation, optimal management strategies remain elusive.In this consensus article, experts from the International Liver Transplantation Society, the Liver Intensive Care Group of Europe, and the Society for the Advancement of Transplant Anesthesia performed a rigorous review of the most current literature regarding the epidemiology, causes, and management of HDI during LT. Special attention has been paid to unique LT-associated conditions including the causes and management of vasoplegic syndrome, cardiomyopathies, LT-related arrhythmias, right and left ventricular dysfunction, and the specifics of medical and fluid management in end-stage liver disease as well as problems specifically related to portal circulation. When possible, management recommendations are made.

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Perioperative fluid management in major hepatic resection: an integrative review

Cited by 12 publications

References 94 publications

Perioperatives Flüssigkeitsmanagement bei großen viszeralchirurgischen Eingriffen

Perioperatives Flüssigkeitsmanagement bei großen viszeralchirurgischen Eingriffen

Major liver resections, perioperative issues and posthepatectomy liver failure: A comprehensive update for the anesthesiologist

Hemodynamic Instability During Liver Transplantation in Patients With End-stage Liver Disease: A Consensus Document from ILTS, LICAGE, and SATA

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