Skip to main content

Low CVP Hepatectomy..What is good and What is Bad?




Blood loss is affected by central venous pressure during Hepatectomy.

When central venous pressure is maintained at <5 mm Hg, blood loss is predictably lower than when central venous pressure is> 6 mm Hg.

In the original publication describing low central venous pressure approaches to hepatic resection, median blood loss was only 200 mL, with most patients in the low central venous pressure study group not requiring transfusion.

In contrast, when central venous pressure was ≥ 6 mm Hg, median blood loss was 1 L and half of the patients required transfusion.

Low central venous pressure approaches affect outcomes beyond transfusion and blood loss, as reflected in longer hospital stays for patients whose central venous pressure was >6 mm HG during hepatic resection.

Low central venous pressure anesthesia apparently is safe with respect to renal function.

Only 3% of patients experience any degree of permanent renal dysfunction after hepatic resection
using a low central venous pressure technique.

However, these favorable outcomes are predicated on maintaining good renal perfusion pressure (typically believed to be ≥ 60 mm Hg).

Obviously the risk of severe air embolism is elevated under low central venous pressure conditions, and the anesthesia team must be highly vigilant for such an event.

Reports in the surgical literature caution that extreme care must be taken during dissection of the liver so as not to make holes in the hepatic veins, which can lead to catastrophic hemorrhage or air embolism.

1. Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection.
 Br J Surg 1998;85:1058–1060.
2. Smyrniotis V, Kostopanagiotou G, Theodoraki K, et al. The role of central venous pressure and type of vascular control in blood loss during major liver resections.
Am J Surg 2004;187:398–402.
Labels:

Comments

Post a Comment

Popular posts from this blog

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients     Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...
1 comment
Read more

The pressure volume loop...

In the pressure-volume loop below, cardiac work is best represented by:   the area of the curve  the slope of the line from points C to D  the distance of the line from points C to D  the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by:  the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.
Post a Comment
Read more

Steroids In Perioperative period...The Multi-purpose Drugs

1-Steroids are not Bronchodilator ,but have well established usefulness in hyper-reactive airway. They are also said to have a permissive role for bronchodilator medication. They can be administered orally, parenterally or in aerosol form 2- Steroids have been commonly used in chemotherapy for prevention of nausea along with other anti-emetic agents . Dexamethasone was found to be highly effective when given immediately before induction rather than at the end of anesthesia . 3- Steroids do exert analgesic effects. Various routes of administration of steroids include parentral, local infiltration at operated site , as an adjuvant in nerve blocks and central-neuraxial blockade. 4 - Steroids cannot be the mainstay of therapy in anaphylaxis because of the delayed onset of action, so they are used as adjunct after initial treatment with epinephrine. 5- Steroids (Dexamethsone) are of value in reduction or prevention of cerebral edema associated with parasitic infections and neopla...
1 comment
Read more