Blood lactate and pyruvate levels in the perioperative period of liver resection with Pringle maneuver.
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.
Pietsch
Uta-Carolin
UC
Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Faculty, Germany. Uta-Carolin.Pietsch@medizin.uni-leipzig.de
Herrmann
Marie-Luise
ML
Uhlmann
Dirk
D
Busch
Thilo
T
Hokema
Frank
F
Kaisers
Udo X
UX
Schaffranietz
Lutz
L
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*
D019344:Lactic Acid; D019289:Pyruvic Acid; D010100:Oxygen