title: Anaesthetic and pharmacological techniques to decrease blood loss in liver surgery: a systematic review.
abstract: BACKGROUND
  There is increasing evidence that perioperative blood loss and blood transfusions are associated with poorer short- and long-term outcomes in patients undergoing hepatectomy. The aim of this study was to systematically review the literature for non-surgical measures to decrease intraoperative blood loss during liver surgery.
  
  
  METHODS
  The literature search was performed using PubMed, Embase, Cochrane Library, CINAHL and Google Scholar databases. The primary outcome measures were perioperative blood loss and transfusion requirements. A secondary outcome measure was development of ischaemia-reperfusion injury.
  
  
  RESULTS
  Seventeen studies met the inclusion criteria and included 1573 patients. All were randomized controlled studies. In eight studies (n = 894), pharmacological methods, and in another nine studies (n = 679), anaesthetic methods to decrease blood loss were investigated. Anti-fibrinolytic drugs, acute normovolaemic haemodilution, autologous blood donation and use of inhalational anaesthetic agent may affect blood loss and post-operative hepatic function.
  
  
  CONCLUSIONS
  There is potential for use of non-surgical techniques to decrease perioperative bleeding. However, on the basis of this review alone, due to heterogeneity of randomized trials conducted, no particular strategy can be recommended. Future studies should be conducted looking at pathways to decrease bleeding in liver surgery.
authors.affiliation: Department of HPB and Transplant Surgery, St James's University Hospital NHS Trust, Leeds, West Yorkshire, UK.
authors.forename: Samir
authors.initials: S
authors.lastname: Pathak
authors.affiliation: Department of HPB and Transplant Surgery, St James's University Hospital NHS Trust, Leeds, West Yorkshire, UK.
authors.forename: Abdul
authors.initials: A
authors.lastname: Hakeem
authors.affiliation: Department of HPB and Transplant Surgery, St James's University Hospital NHS Trust, Leeds, West Yorkshire, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pike
authors.affiliation: Department of HPB and Transplant Surgery, St James's University Hospital NHS Trust, Leeds, West Yorkshire, UK.
authors.forename: Giles J
authors.initials: GJ
authors.lastname: Toogood
authors.affiliation: Department of Anaesthesia, St James's University Hospital NHS Trust, Leeds, West Yorkshire, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Simpson
authors.affiliation: Department of HPB and Transplant Surgery, St James's University Hospital NHS Trust, Leeds, West Yorkshire, UK.
authors.forename: K Raj
authors.initials: KR
authors.lastname: Prasad
authors.affiliation: John Goligher Colorectal Unit, St James's University Hospital NHS Trust, Leeds, West Yorkshire, UK.
authors.forename: Danilo
authors.initials: D
authors.lastname: Miskovic
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008099:Liver / Q000601:surgery*; D059035:Perioperative Period; D016032:Randomized Controlled Trials as Topic
keywords: blood loss; blood transfusion; liver surgery