A retrospective analysis of liver resection performed without central venous pressure monitoring.
BACKGROUND
Studies have suggested that blood loss can be reduced during liver resection by monitoring and maintaining low central venous pressure (CVP) through fluid restriction or other means, but such a strategy carries risks to the patient including those inherent to central venous catheterization. We sought to characterize fluid management and blood loss during liver resections done without CVP monitoring.


METHODS
Retrospective data were extracted from electronic anesthesia records for 993 liver resections. For 135 resections, between 2011 through 2013, where a documentation template was used that recorded fluid administration prior to hepatic inflow occlusion, multivariate analysis was performed to test for an association between pre-clamp fluid volumes administered and blood loss and other adverse outcomes.


RESULTS
The median estimated blood loss was 300 mL and overall rate of transfusion was 8.6%. There was no statistically significant association between crystalloid volume administered prior to inflow clamping (median 900 mL) and blood loss, mortality or length of stay in the subset of patients with supplemental fluid data.


CONCLUSIONS
Liver resection can be performed safely without either CVP monitoring or non-invasive continuous cardiac output monitoring. Additionally, there was no disadvantage to a practical approach to fluid administration prior to inflow clamping during liver resections in the absence of CVP monitoring with regard to blood loss or short-term outcomes.
Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY, USA.
D B
DB
Wax
Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY, USA. Electronic address: jeron.zerillo@mountsinai.org.
J
J
Zerillo
Mount Sinai Liver Cancer Program, Mount Sinai Medical Center, New York, NY, USA.
P
P
Tabrizian
Mount Sinai Liver Cancer Program, Mount Sinai Medical Center, New York, NY, USA.
M
M
Schwartz
Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY, USA.
B
B
Hill
Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY, USA.
H-M
HM
Lin
Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY, USA.
S
S
DeMaria
D000368:Aged; D002496:Central Venous Pressure; D005440:Fluid Therapy; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008107:Liver Diseases / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012189:Retrospective Studies
Fluid management; Hepatectomy; Liver resection