Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: Blood loss, blood transfusion, and the risk of postoperative renal dysfunction

Background: We have previously demonstrated that maintenance of a low centr al venous pressure (LCVP) combined with extrahepatic control of venous outf low reduced the overall blood loss during major hepatic resections. This st udy examined the overall outcomes and, in particular, renal morbidity assoc iated with a large series of consecutive major liver resections performed w ith this approach. In addition, the rationale for the anesthetic management to maintain LCVP was carefully reviewed. Study Design: All major hepatectomies performed between December 1991 and A pril 1997 were reviewed. The prospective Hepatobiliary Surgical Service dat abase was merged with the Memorial Hospital Laboratory and Blood Bank datab ases to yield the nature of the operation, blood loss, blood product transf usions, outcomes, and levels of preoperative, postoperative, and discharge serum creatinine and blood urea nitrogen. Results: A total of 496 LCVP-assisted major liver resections were performed , with no intraoperative deaths and an in-hospital mortality rate of 3.8%. The median blood loss was 645 mL. Sixty-seven percent of the patients did n ot require perioperative blood transfusion during surgery and the immediate 12 hours after surgery. The median number of blood transfusions was 2. Onl y 3% of the patients experienced a persistent and clinically significant in crease in serum creatinine possibly attributable to the anesthetic techniqu e. Renal failure directly attributable to the anesthetic technique did not occur. Conclusions: Major resection with LCVP allowed easy control of the hepatic veins before and during parenchymal transection. The anesthetic technique, designed to maintain LCVP during the critical stages of hepatic resection, not only helped to minimize blood loss and mortality but also preserved ren al function. (J Am Coll Surg 1998;187:620-625. (C) 1998 by the American Col lege of Surgeons).