| Hemodynamic Effects of Hepatic Cooling and Portal Decompression during Hepatic Resection with Portal Triad Clamping. |
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Dong Gun Lim, Geun Bo Lee, Jun Woo Kim, Yoon Jin Hwang, Jin Woong Park, Byung Kwon Kim |
1Department of Anesthesiology, School of Medicine, Kyungpook National University, Taegu, Korea.
2Department of Surgery, School of Medicine, Kyungpook National University, Taegu, Korea. |
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| Abstract |
BACKGROUND
Portal triad clamping (PTC) during hepatic resection (Pringle maneuver, PM) can afford reduced intraoperative bleeding and bloodless surgical field. But inflow obstruction of blood to liver during PM can bring hemodynamic changes to the patient. This study was designed to evaluate the hemodynamic changes before, during and after PM application during hepatic resection. We also compared the hemodynamic effects of hepatic cooling before PM with/without portal decompression during PM.
METHODS
The patients were divided into three groups; PM (P group, n=9), PM after hepatic cooling with 400 ml of 4oC lactated Ringer's solution (LR) (C+P group, n=13), PM after hepatic cooling and portal decompression with portocaval shunt (C+P+S group, n=7). Systemic vascular resistance index (SVRI), cardiac index (CI) and mean arterial pressure (MAP) were measured before, during and after PM.
RESULTS
Portal pressure of C+P+S group (208.3+/-36.6 mmH2O) was lower than P (487.3+/-92.9 mmH2O) and C P (553.6+/-77.0 mmH2O) group during PM. CIs of P and C P group were decreased (15, 13% respectively) during PM. After reperfusion, CIs and SVRIs of P, C+P and C+P+S group were all increased (CI; 33, 26, 50%, SVRI; 30, 40, 50%, respectively) than end of PM.
CONCLUSION
PM itself doesn't make abrupt hemodynamic change. Hepatic cooling with 4oC LR (400 ml) before PM increases MAP because of increased SVRI. Reperfusion after PM for 50 minutes, hemodynamic depression could occur by decreased SVRI, especially in case of decompressed portal pressure with portocaval shunt during PM. |
| Key Words:
Monitoring, hemodynamics; Surgery, hepatic resection, portal triad clamping, pringle maneuver |
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