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.