title: Blood lactate and pyruvate levels in the perioperative period of liver resection with Pringle maneuver.
abstract: BACKGROUND
  Bleeding during liver surgery is often routinely controlled by the Pringle maneuver consisting in the temporary clamping of hepatic artery, portal vein, and bile duct. This study aimed at investigating a possible influence of the Pringle maneuver on tissue hypoxia during liver resection.
  
  
  METHODS
  Twenty-five consecutive patients undergoing elective liver resection were prospectively randomized either to be treated with the Pringle maneuver (Pringle group, n = 14) or without clamping (Controls, n = 11). Blood lactate levels, pyruvate levels, and hepatic vein oxygen saturation were monitored perioperatively.
  
  
  RESULTS
  Patients were comparable with respect to resection time, intraoperative blood loss, and duration of surgery. The Pringle maneuver induced a significant increase in arterial lactate levels during liver resection when compared to Controls (2.6 +/- 0.3 vs 1.8 +/- 0.2 mmol/l; p < 0.05). Further, the Pringle maneuver significantly increased hepatic venous lactate (3.3 +/- 0.3 vs 1.6 +/- 0.3 mmol/l; p < 0.05) and lactate/pyruvate ratio in hepatic venous blood (43 +/- 8 vs 21 +/- 5; p < 0.05) during surgery. This was paralleled by a temporal decrease in hepatic venous oxygen saturation in the Pringle group (61 +/- 4 vs 73 +/- 4%; p < 0.05).
  
  
  CONCLUSIONS
  Our findings demonstrate that liver metabolism and tissue oxygenation were markedly affected by occlusion of the liver hilus. Restricting the use of the Pringle maneuver to cases with severe bleeding might therefore be beneficial in patients undergoing liver resection.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Faculty, Germany. Uta-Carolin.Pietsch@medizin.uni-leipzig.de
authors.forename: Uta-Carolin
authors.initials: UC
authors.lastname: Pietsch
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Herrmann
authors.forename: Dirk
authors.initials: D
authors.lastname: Uhlmann
authors.forename: Thilo
authors.initials: T
authors.lastname: Busch
authors.forename: Frank
authors.initials: F
authors.lastname: Hokema
authors.forename: Udo X
authors.initials: UX
authors.lastname: Kaisers
authors.forename: Lutz
authors.initials: L
authors.lastname: Schaffranietz
mesh_terms: D001652:Bile Ducts / Q000601:surgery; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003250:Constriction; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D000860:Hypoxia / Q000209:etiology* / Q000503:physiopathology; D007432:Intraoperative Period; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011169:Portal Vein / Q000601:surgery; D019289:Pyruvic Acid / Q000097:blood*
chemical_list: D019344:Lactic Acid; D019289:Pyruvic Acid; D010100:Oxygen