Central venous pressure monitoring during living right donor hepatectomy.
Low central venous pressure (CVP) has been advocated during liver resection to reduce blood loss and transfusion requirements. As a consequence, CVP catheter placement has been considered essential for hepatic surgery, including living donor hepatectomies. We retrospectively analyzed whether intraoperative management without CVP monitoring influenced fluid administration, blood loss, and patient outcome. Medical charts and hospital data system of 50 adult to adult living liver donors were retrospectively reviewed. Data collection included patient demographics, intraoperative variables such as fluid management, blood loss, urine output, and operating room time. Postoperative variables were collected during the postanesthesia care unit stay and for the first 24 hours after surgery. Patients were then grouped on the basis of the presence or absence of a CVP catheter. Data were reanalyzed and groups compared. Patient groups did not differ in terms of demographics at baseline. When divided into groups with CVP and without CVP, the presence of CVP did not result in decreased intraoperative fluid administration. All patients were hemodynamically stable, and renal function was not different between groups throughout hospitalization. Length of postanesthesia care unit and hospital stay was the same. There was no difference in the frequency of complications during the hospital stay and at 3 months' follow-up. CVP monitoring did not appear to reduce blood loss when compared with patients without CVP monitoring. In centers with extensive experience, CVP monitoring may not be necessary in this highly selective patient population.
Niemann
Claus U
CU
Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143-0648, USA. niemannc@anesthesia.ucsf.edu
Feiner
John
J
Behrends
Matthias
M
Eilers
Helge
H
Ascher
Nancy L
NL
Roberts
John P
JP
D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001795:Blood Pressure Determination; D002496:Central Venous Pressure; D005260:Female; D006498:Hepatectomy; D006801:Humans; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D020858:Tissue and Organ Harvesting