High Stroke Volume Variation Method by Mannitol Administration Can Decrease Blood Loss During Donor Hepatectomy

Abstract

Optimal fluid management to reduce blood loss during donor hepatectomy is important for maximizing donor safety. Mannitol can induce osmotic diuresis, helping prevent increased intravascular volume status. We therefore evaluated the effect of high stroke volume variation (SVV) method by mannitol administration and fluid restriction on blood loss during donor hepatectomy.In this prospective study, 64 donors scheduled for donor right hepatectomy were included and allocated into 2 groups. In group A, the SVV value of each patient was maintained at 10% to 20% during hepatic resection with 0.5 g/kg mannitol administration and fluid restriction at a rate of 2 to 4 mL/kg/h. In group B, the SVV value was maintained at <10% by fluid administration at a rate of 6 to 10 mL/kg/h without diuretic administration during surgery. Intraoperative blood loss was estimated by the loss of red cell mass. Surgeon satisfaction scores and postoperative outcomes, including acute kidney injury, abnormal chest radiographic findings, and hospital stay duration, were also assessed.SVV during hepatectomy was significantly higher in group A than in group B (11.0 ± 1.7 vs 6.5 ± 1.1, P < 0.001). The red cell mass loss was significantly lower in group A than in group B (145.4 ± 107.6 vs 307.9 ± 110.7 mL, P < 0.001). Surgeon satisfaction scores were higher in group A than in group B (2.8 ± 0.5 vs 2.0 ± 0.6, P < 0.001). The incidence of acute kidney injury, abnormal chest radiographic findings, and duration of hospital stay did not significantly differ between the 2 groups.Maintenance of high SVV by mannitol administration is effective and safe for reducing blood loss during donor hepatectomy.

Relationship between Stroke Volume Variation and Blood Transfusion during Liver Transplantation

“… 10 , 22 , 23 Importantly, our group has previously suggested that maintaining a high SVV is a useful way to reduce blood loss during living donor right hepatectomy. 10 , 11 , 24 Additionally, a higher SVV value has been reported to correlate with a lower right ventricular end-diastolic volume index value in liver transplant recipients. 12 The maintenance of a high SVV appears to induce lower normal levels of intravascular volume and to thereby prevent vascular congestion.…”

“… 8 , 9 Recently, our group found that blood loss during living donor hepatectomy was significantly lower in donors who maintained 10-20% of stroke volume variation (SVV) compared with those who maintained <10% of SVV. 10 , 11 However, no study has yet reported the relationship between the high SVV method (i.e. maintaining 10-20% of SVV during surgery) and intraoperative blood transfusion in liver transplant recipients, who are frequently at risk for blood transfusion during liver transplantation.…”

A Comparative Study of Intraoperative Fluid Management Using Stroke Volume Variation in Liver Resection

“…1). During the period of this study, 2 reports were presented regarding high SVV management during liver transection in livingdonor right hepatectomy set at 10%-20%, 19,20 but there has been no report of management with SVV as an indicator in conventional open-liver resection for liver diseases. In this study, to achieve the target SVV, we mainly addressed fluid restriction only.…”

“…Seo et al, however, reported that administration of mannitol at 0.5 g/kg was effective in high SVV management. 20 Furthermore, some reports show that reverse Trendelenburg position leads to a reduction in CVP, 21 and that low CVP is maintained by vasodilation using isoflurane and sublingual nitroglycerine. 22 It is highly possible that these results will be applied to intraoperative management with SVV in the future.…”

Kajian Penggunaan Antihipertensi pada Pasien Strok di Instalasi Rawat Inap RSU Anutapura Palu Tahun 2017

“…Pada penelitian yang telah dilakukan sebelumnya, ditunjukkan bahwa manitol secara aman dan efektif dapat mempertahankan variasi volume strok tinggi sebesar 10-20% untuk mengurangi kehilangan darah selama donor hepatektomi hidup. 16 Selanjutnya, persentase penggunaan cairan asering lebih rendah dibandingkan dengan yang lainnya disebabkan asetat dalam larutan asering lebih banyak dimetabolisme dalam otot dan sebagian kecil dalam ginjal Volume 7, Nomor 4, Desember 2018 dan jantung, dalam hal ini pada pasien strok cenderung mengalami atrofi otot berbeda dengan laktat yang dimetabolisme di dalam hati. Selain itu, asering dapat berinteraksi dengan obat lain yang digunakan pada pasien strok seperti aspirin pada dosis 80-100 mg digunakan sebagai antikoagulan pada pasien strok.…”