title: Continuous monitoring of central venous oxygen saturation predicts postoperative liver dysfunction after liver resection.
abstract: BACKGROUND
  We examined whether the data obtained by monitoring central venous oxygen saturation (ScvO2) and/or stroke volume variation (SVV) during hepatectomy, as measured with the FloTrac/Vigileo system, can predict postoperative liver dysfunction.
  
  
  METHODS
  This study included 33 patients with normal liver function who underwent hepatectomy between December 2007 and August 2010. Baseline ScvO2 and baseline SVV, as control values, were defined as the mean of ScvO2 and SVV, respectively, measured with the FloTrac/Vigileo system before hepatectomy. ScvO2 decrease (ΔScvO2) was defined as the difference between the baseline ScvO2 and the lowest intraoperative ScvO2 and SVV increase (ΔSVV) was defined as the difference between the baseline SVV and the highest intraoperative SVV. Moreover, mean ScvO2 and mean SVV were defined as the means of all ScvO2 and SVV values measured during surgery, respectively. We examined correlations of the new parameters with the highest postoperative values of total bilirubin (T. Bil).
  
  
  RESULTS
  The cutoff values for ΔScvO2 and mean SVV for predicting the highest postoperative T. Bil level to be ≥ 3.0 mg/dL with the highest sensitivity and specificity were found to be 10.2% and 13.6%, respectively. The areas under curve in receiver-operating-characteristic analysis of ΔScvO2 and mean SVV were 0.797 and 0.757, respectively, showing significant differences.
  
  
  CONCLUSIONS
  Our results suggest that ΔScvO2 and mean SVV can predict postoperative liver dysfunction. When ΔScvO2 and mean SVV exceed 10.2% and 13.6%, respectively, we advocate that adequate attention be paid to postoperative liver dysfunction, and that early intraoperative general circulatory management measures be implemented as needed.
authors.affiliation: Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Hokkaido, Japan. meguro@sapmed.ac.jp
authors.forename: Makoto
authors.initials: M
authors.lastname: Meguro
authors.forename: Toru
authors.initials: T
authors.lastname: Mizuguchi
authors.forename: Masaki
authors.initials: M
authors.lastname: Kawamoto
authors.forename: Yukio
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Shigenori
authors.initials: S
authors.lastname: Ota
authors.forename: Kazuharu
authors.initials: K
authors.lastname: Kukita
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ishii
authors.forename: Hiroomi
authors.initials: H
authors.lastname: Tatsumi
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008107:Liver Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis*; D013318:Stroke Volume; D014680:Veins / Q000378:metabolism
chemical_list: D019344:Lactic Acid; D010100:Oxygen