title: The effect of hepatic vascular inflow occlusion on liver tissue pH, carbon dioxide, and oxygen partial pressures: defining the optimal clamp/release regime for intermittent portal clamping.
abstract: BACKGROUND
  The optimal duration of hepatic vascular inflow occlusion (Pringle maneuver) and reperfusion during liver resection are not defined. The aim of this study was to describe the changes that occur in liver tissue pH, partial pressure of carbon dioxide (P(L)CO(2)), and partial pressure of oxygen (P(L)O(2)) and by using the P(L)CO(2) as a predictor of hepatocellular damage define the optimal clamp/release regime for intermittent portal clamping during liver resection.
  
  
  METHODS
  Continuous pH, P(L)CO(2), and P(L)O(2) measurements were obtained using a Paratrend multi-parameter sensor (Diametrics Medical Inc., Roseville, MN) in 13 patients undergoing elective partial liver resection. Patients were randomly allocated to undergo a 10-min clamp/5-min release regime (group 1) or a 20-min clamp/10-min release regime (group 2).
  
  
  RESULTS
  In group 1 (n = 6) P(L)CO(2) increased and pH decreased significantly after 10 min of clamping and returned to baseline within 5 min of reperfusion. In group 2 (n = 7) the P(L)CO(2) increased and pH decreased significantly after 10 min of clamping, with a further significant change after 20 min. Following 10 min of reperfusion, pH and P(L)CO(2) had not returned to baseline. P(L)O(2) did not change significantly with either intermittent portal clamping regime.
  
  
  CONCLUSIONS
  A reperfusion of 5 min is sufficient to restore the P(L)CO(2) and liver tissue pH to normal after 10 min of clamping, but more than 10 min of reperfusion is required after 20 min of clamping. To minimize hepatic ischemia during liver resection, a 10-min clamp/5-min release regime should be used.
authors.affiliation: Department of Surgery and Critical Care, Nottingham University NHS Trust, Queens Medical Centre, Nottingham, United Kingdom. adam@nuh.nhs.uk
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Brooks
authors.forename: John S
authors.initials: JS
authors.lastname: Hammond
authors.forename: Keith
authors.initials: K
authors.lastname: Girling
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Beckingham
mesh_terms: D000368:Aged; D002245:Carbon Dioxide / Q000097:blood*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007511:Ischemia / Q000378:metabolism*; D008099:Liver / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen