title: Effects of Pringle manoeuvre and ischaemic preconditioning on haemodynamic stability in patients undergoing elective hepatectomy: a randomized trial.
abstract: BACKGROUND
  The Pringle manoeuvre and ischaemic preconditioning are applied to prevent blood loss and ischaemia-reperfusion injury, respectively, during liver surgery. In this prospective clinical trial we report on the intraoperative haemodynamic effects of the Pringle manoeuvre alone or in combination with ischaemic preconditioning.
  
  
  METHODS
  Patients (n=68) were assigned randomly to three groups: (i) resection with the Pringle manoeuvre; (ii) with ischaemic preconditioning before the Pringle manoeuvre for resection; (iii) without pedicle clamping.
  
  
  RESULTS
  Following the Pringle manoeuvre the mean arterial pressure increased transiently, but significantly decreased after unclamping as a result of peripheral vasodilation. Ischaemic preconditioning improved cardiovascular stability by lowering the need for catecholamines after liver reperfusion without affecting the blood sparing benefits of the Pringle manoeuvre. In addition, ischaemic preconditioning protected against reperfusion-induced tissue injury.
  
  
  CONCLUSIONS
  Ischaemic preconditioning provides both better intraoperative haemodynamic stability and anti-ischaemic effects thereby allowing us to take full advantage of blood loss reduction by the Pringle manoeuvre.
authors.affiliation: Clinic of Anaesthesiology, Klinikum Grosshadern, Ludwig-Maximilians-University, D-81377 Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Choukèr
authors.forename: T
authors.initials: T
authors.lastname: Schachtner
authors.forename: R
authors.initials: R
authors.lastname: Schauer
authors.forename: M
authors.initials: M
authors.lastname: Dugas
authors.forename: F
authors.initials: F
authors.lastname: Löhe
authors.forename: A
authors.initials: A
authors.lastname: Martignoni
authors.forename: B
authors.initials: B
authors.lastname: Pollwein
authors.forename: M
authors.initials: M
authors.lastname: Niklas
authors.forename: H G
authors.initials: HG
authors.lastname: Rau
authors.forename: K W
authors.initials: KW
authors.lastname: Jauch
authors.forename: K
authors.initials: K
authors.lastname: Peter
authors.forename: M
authors.initials: M
authors.lastname: Thiel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003250:Constriction; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D019194:Ischemic Preconditioning; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000517:prevention & control