Effectiveness of Continuing Low Central Venous Pres- sure during Major Hepatic Resection

Effectiveness of Continuing Low Central Venous Pres- sure during Major Hepatic Resection

Sunhwi Hwang, M.D., Kihun Kim, M.D.¹, Yeogoo Chang, M.D., Seongwoo Hong, M.D., Inwook Paik, M.D. and Hyucksang Lee, M.D.

Department of Surgery, University of Inje College of Medicine, Seoul Paik Hospital, ¹Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

Background/Aims: Blood loss and blood transfusion are ex- tremely important determinants of morbidity and mortality fol- lowing hepatic resection. This is attributed to increased risks of coagulopathy, acute respiratory distress syndrome and multiorgan failure. The hypothesis is that a low pressure in the central veins would be accompanied by a low pressure in the hepatic veins and sinusoids, thereby decreasing blood loss during hepatic resection. This study evaluates the effec- tiveness of continuing low central venous pressure comparing with high central venous pressure during major hepatic resec- tion.

Methods: 20 consecutive major hepatic resections between March 2000 and August 2000 were studied prospectively con- cerning central venous pressure which was analysed for 10 cases with a central venous pressure less than 10 mmHg,

and greater than or equal to 10 mmHg. The central venous pressure was monitored continuously using a Narkomed An- aesthetic Component Monitoring System (Dräger Inc., USA).

Results: Low central venous pressure allowed a smaller intraoperative blood loss ( 10 mmHg: 1010±465.3 ml vs.

10 mmHg: 1770±916.5 ml, p 0.05), a smaller periopera- tive transfusion ( 10 mmHg: 139±276.2 ml vs. 10 mmHg: 807±799.2 ml, p 0.05), a lower postoperative peak AST ( 10 mmHg: 167.4±53.2 IU/L vs. 10 mmHg: 293.0

±123.2 IU/L, p 0.05), a lower postoperative peak ALT ( 10 mmHg: 96.1±55.3 IU/L vs. 10 mmHg: 193.2±103.5 IU/L, p 0.05), and a earlier resumption of a normal hepatic enzyme ( 10 mmHg: 6.4±0.9 days vs. 10 mmHg: 8.7±

1.6 days, p 0.05) in comparison to high central venous pressure. There was no postoperative mortality in both group.

Conclusions: Maintaining a low central venous pressure throughout major hepatic resection reduced blood loss, blood transfusion requirements and enzyme recovery periods. Low- ering the central venous pressure is a simple and effective way during hepatic resection. (Korean J HBP Surg 2002;

6:48-52)

Key Words: Low central venous pressure, High central ve- nous pressure, Major hepatic resection

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