Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: Blood loss, blood transfusion, and the risk of postoperative renal dysfunction Journal Article


Authors: Melendez, J. A.; Arslan, V.; Fischer, M. E.; Wuest, D.; Jarnagin, W. R.; Fong, Y.; Blumgart, L. H.
Article Title: Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: Blood loss, blood transfusion, and the risk of postoperative renal dysfunction
Abstract: Background: We have previously demonstrated that maintenance of a low central venous pressure (LCVP) combined with extrahepatic control of venous outflow reduced the overall blood loss during major hepatic resections. This study examined the overall outcomes and, in particular, renal morbidity associated with a large series of consecutive major liver resections performed with this approach. In addition, the rationale for the anesthetic management to maintain LCVP was carefully reviewed. Study Design: All major hepatectomies performed between December 1991 and April 1997 were reviewed. The prospective Hepatobiliary Surgical Service database was merged with the Memorial Hospital Laboratory and Blood Bank databases to yield the nature of the operation, blood loss, blood product transfusions, outcomes, and levels of preoperative, postoperative, and discharge serum creatinine and blood urea nitrogen. Results: A total of 496 LCVP-assisted major liver resections were performed, with no intraoperative deaths and an in-hospital mortality rate of 3.8%. The median blood loss was 645 mL. Sixty-seven percent of the patients did not require perioperative blood transfusion during surgery and the immediate 12 hours after surgery. The median number of blood transfusions was 2. Only 3% of the patients experienced a persistent and clinically significant increase in serum creatinine possibly attributable to the anesthetic technique. Renal failure directly attributable to the anesthetic technique did not occur. Conclusions: Major resection with LCVP allowed easy control of the hepatic veins before and during parenchymal transection. The anesthetic technique, designed to maintain LCVP during the critical stages of hepatic resection, not only helped to minimize blood loss and mortality but also preserved renal function.
Keywords: human tissue; treatment outcome; major clinical study; histopathology; mortality; liver neoplasms; prospective studies; bleeding; kidney disease; oxygen; risk factors; creatinine; kidney failure; surgical approach; risk assessment; postoperative complications; cause of death; kidney; ischemia; blood transfusion; liver resection; hepatectomy; perioperative period; morphine; blood loss, surgical; fentanyl; central venous pressure; hospital mortality; isoflurane; vecuronium; anesthesia complication; blood urea nitrogen; pancuronium; humans; human; priority journal; article; hypotension, controlled
Journal Title: Journal of the American College of Surgeons
Volume: 187
Issue: 6
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 1998-12-01
Start Page: 620
End Page: 625
Language: English
DOI: 10.1016/s1072-7515(98)00240-3
PUBMED: 9849736
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 12 December 2016 -- Source: Scopus
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MSK Authors
  1. Mary Ellen Fischer
    29 Fischer
  2. Leslie H Blumgart
    351 Blumgart
  3. David L Wuest
    34 Wuest
  4. William R Jarnagin
    741 Jarnagin
  5. Yuman Fong
    771 Fong