Fluid optimization in liver surgery

Abstract Study's purposes: to reduce bleeding, hepatectomies are usually performed mantaining low central pressure(CVP) combined with extraepatic control flow and this management can lead hemodynamic instability and reduction of in oxygen delivery. This study analyses hemodynamic changes and so the derived fluid management in patients undergoing liver resection , through the Vigileo/flow Trac system. Basic procedures Seventeen patients were included. Low CVP, below 4 mmHg, was reached by loop diuretics. Hemodynamic parameters were recorded and blood gas analysis was also performed. At the end of resection, fluid replacement was carried out with 500 ml of crystalloid solution in 20 minutes evaluating changes in CVP, cardiac index(CI) and stroke volume variation (SVV). Main findings: during Pringle maneuver, cardiac index resulted stable trough a modification of hert rate and vascular resitence (p< 0.01): Only SVV significantly changed during Pringle maneuver (p=0.03) and not CVP(p=0.8). In all patients the oxygen delivery was maintained upper 600 ml/min/ m2. Fluid optimization was performed with 1917 +/- 1161 of crystalloid solution with a significant reduction in SVV (p>0.01) about 7% despite a CVP of 5 mmHg. Conclusion: We suppose that SVV can replace CVP in major hepatectomy management. Regarded results we can conclude that a good peripheral perfusion can be reached also with a fluid restrictive regimen avoiding overload and postoperative edema.