Liver surgery has become simpler

Franco, Dominique

doi:10.1017/s0265021502001254

Cited by 9 publications

(13 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For healthy patients, routine monitoring is used. Monitoring can even be limited to just peripheral vein catheters [29]. Invasive monitoring provided by a central venous line or pulmonary catheterization is reserved for patients with poor cardiovascular status or when prolonged vascular occlusions are performed.…”

Section: Resultsmentioning

confidence: 99%

Anesthetic Considerations in Hepatectomies under Hepatic Vascular Control

et al. 2012

View full text Add to dashboard Cite

Background. Hazards of liver surgery have been attenuated by the evolution in methods of hepatic vascular control and the anesthetic management. In this paper, the anesthetic considerations during hepatic vascular occlusion techniques were reviewed. Methods. A Medline literature search using the terms “anesthetic,” “anesthesia,” “liver,” “hepatectomy,” “inflow,” “outflow occlusion,” “Pringle,” “hemodynamic,” “air embolism,” “blood loss,” “transfusion,” “ischemia-reperfusion,” “preconditioning,” was performed. Results. Task-orientated anesthetic management, according to the performed method of hepatic vascular occlusion, ameliorates the surgical outcome and improves the morbidity and mortality rates, following liver surgery. Conclusions. Hepatic vascular occlusion techniques share common anesthetic considerations in terms of preoperative assessment, monitoring, induction, and maintenance of anesthesia. On the other hand, the hemodynamic management, the prevention of vascular air embolism, blood transfusion, and liver injury are plausible when the anesthetic plan is scheduled according to the method of hepatic vascular occlusion performed.

show abstract

Section: Resultsmentioning

confidence: 99%

Anesthetic Considerations in Hepatectomies under Hepatic Vascular Control

et al. 2012

View full text Add to dashboard Cite

show abstract

“…4 Furthermore, liver resection has become safer and associated with low intraoperative bleeding mainly because of improved surgical skill and techniques. 5 The evidence that lowering CVP per se decreases blood loss and therefore improves outcome is strong but still circumstantial. 2,6 To our knowledge, blood loss was demonstrated to be reduced by a low CVP in only one prospective, randomized study of 50 patients.…”

mentioning

confidence: 99%

Awake laryngeal mask insertion followed by induction of anesthesia in infants with the Pierre Robin sequence

Stricker¹,

Budac²,

Fiadjoe³

et al. 2008

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Recalling some fundamental concepts would be interesting for the discussion. The basic concept of measuring CVP intraoperatively by inserting a CVC is still a hypothesis. 2 Some published studies to date show an appealing association between a low CVP, a low blood loss and a better outcome in patients undergoing elective liver resection. 2 This finding was contradicted in some other studies in which CVP monitoring did not appear to reduce blood loss in elective liver resection. 3 Globally, the intraoperative clinical value of CVP is questionable. 4 Intraoperative changes of transthoracic pressure by both mechanical ventilation and the pressure of surgical retractors on the thorax and right atrium are likely to alter the CVP interpretation. 4 Ascites in a cirrhotic patient is also likely to increase transthoracic pressure hence altering CVP. 4 Furthermore, liver resection has become safer and associated with low intraoperative bleeding mainly because of improved surgical skill and techniques. 5 The evidence that lowering CVP per se decreases blood loss and therefore improves outcome is strong but still circumstantial. 2,6 To our knowledge, blood loss was demonstrated to be reduced by a low CVP in only one prospective, randomized study of 50 patients. 6 In this study, mean intraoperative blood loss was 2329 ml, a value far above usual blood loss recorded in recent similar series, thus questioning the relevance for the present practice. 6 Furthermore, the causal link between reduced blood loss and improved outcome remains speculative in liver resection similarly as in other surgical fields. 7 Finally, pharmacologic intervention likely to decrease CVP may result in relative hypovolemia, decrease in weak organ vascularization, which has never been convincingly demonstrated to be safe. Many patients undergoing liver resection are old, have coexisting diseases and are likely to have pre-existing organ dysfunction. 7 In this respect, assessing the safety of such practices remains mandatory.In conclusion, a CVC was not contributive in most patients undergoing liver resection in Stephan's series. 1 However, the clinical contributive value of a low CVP in patients undergoing elective liver resection remains unanswered. N. Mansour C. Lentschener Y. Ozier References 1. Stephan F, Bezaiguia-Delclaux S. Usefulness of central venous catheter during hepatic surgery. Acta Anesthesiol Scand 2008; 52: 388-96. 2. Melendez J, Arslan V, Fische ME, Wuest D, Jarnagin WR, Fong Y, Blumgart LH. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg 1998; 187: 620-5. 3. Niemann CU, Feiner J, Behrends M, Eilers H, Ascher NL, Roberts JP. Central venous pressure monitoring during living right donor hepatectomy. Liver Transpl 2007; 13: 266-71. 4. Gelman S. Venous function and central venous pressure. A physiologic story. Anesthesiology 2008; 108: 735-48. 5. Franco D. Liver surgery has become simpler. Eur J Anae...

show abstract

“…S urgical approaches for liver resection have evolved during the last decade (1–4). Laparoscopic surgery is now a feasible and safe alternative approach to the classic open procedure for selected cases of liver resections (3).…”

mentioning

confidence: 99%