GUIDA ALLA FLUIDOTERAPIA IN CHIRURGIA EPATICA. STROKE VOLUME VARIATION VERSUS DIAMETRO VENA CAVA INFERIORE

Translated title of the contribution: [Autom. eng. transl.] GUIDE TO FLUID THERAPY IN HEPATIC SURGERY. STROKE VOLUME VARIATION VERSUS LOWER QUARRY VEIN DIAMETER

Enrica Adducci, Antonio Mascia, Elisabetta Gualtieri, Paolo Primieri, Tiziana Iacobucci, Enzo Picconi

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

[Autom. eng. transl.] GUIDE TO FLUIDOTHERAPY IN LIVER SURGERY. STROKE VOLUME VARIATION VERSUS DIAMETER VENA CAVA LOWER E. Adducci, A. Mascia, E. Gualtieri, T. Iacobucci, E. Picconi, P. Primieri Catholic University of the Sacred Heart UCSC, Rome, Italy Introduction. Bleeding control and hemodynamic optimization are the priority objectives in anesthetic management in hepatobiliary surgery. The use of low Central Venous Pressure values has long been the fulcrum of anesthesiological conduct, but currently the use of reliable and dynamic hemodynamic parameters based on pressure wave analysis, through mini-invasive monitoring systems, seems to provide a valid alternative. The aim of this pilot study was to analyze the relationship between the Stroke Volume Variation (SVV) (Flo-Trac / Vigileo) and the caval diameter, measured ultrasonographically during liver surgery, as a guide to fluid therapy. Materials and methods. A study was conducted in 8 candidate patients for major elective liver surgery (> 3 segments). Patients underwent general anesthesia. Haemodynamic monitoring was performed using Flo Trac catheter positioned in the left radial artery. The following haemodynamic parameters were monitored: Arterial Pressure, Heart Rate, SVV, Cardiac Index, Stroke Volume in the following times: open abdomen, after the 1st Pringle clamping, after decamping, after the 2nd clamping and decongulation, after hepatic resection. At the same time, the surgeon performed the measurement of the caval diameter and the right hepatic vein. The Spearman correlation test for statistical analysis was used. Results. All the patients examined had oncological pathology (M / F = 5/3), average age = 58 ± 7, ASA: 2/3 = 6/2. SVV was between 10-13%, fluid therapy was 3 ± 0.8ml / kg / h. The urinary output was in all cases> 0.5ml / kg / h. One patient received infusion norepinephrine. In no case has the use of blood products been used. No intraoperative adverse events occurred. Statistical analysis showed SVV correlated to vena cava diameter (r = -0.637 p = 0.001) while a poor correlation between SVV and suprahepatic vein diameter was highlighted (r = -0.187 p = 0.381). Discussion. With the refinement of surgical techniques, hepatobiliary surgery has become progressively safer also thanks to the perioperative optimization of the patient who uses techniques aimed at reducing bleeding, an important risk factor for morbidity and mortality in these patients. The use of monitoring techniques that are minimally invasive is certainly to be preferred, especially if the reduction of risks for the patient is accompanied by better perioperative management. The use of monitoring by Flo Trac / Vigileo allowed a good intra-operative management of the patient, indicating how to manage fluid therapy or resort to vasopressors based on the detected hemodynamic parameters. The most relevant data of the study was the relationship between SVV and inferior vena cava diameter, significantly correlated with each other, confirming that a restrictive fluid therapy is accompanied by a reduction in the caval caliber. The not inconsiderable fact that the diameter of the inferior quarry accurately reflects the extent of the vascular volume leads us to investigate this issue with a wider and more significant series. Bibliography: Pathak S., Hakeem A., Pike T., et al. Anesthetic and pharmacological techniques to decrease blood loss in liver surgery: a systematic review. Anz J Surg 85 (2015) 923-930.
Translated title of the contribution[Autom. eng. transl.] GUIDE TO FLUID THERAPY IN HEPATIC SURGERY. STROKE VOLUME VARIATION VERSUS LOWER QUARRY VEIN DIAMETER
Original languageItalian
Title of host publicationLibro degli atti 70 Congresso Nazionale SIAARTI – Napoli 26/29Ottobre 2016
Pages157-158
Number of pages2
Publication statusPublished - 2016
Event70 Congresso Nazionale SIAARTI - NAPOLI -- ITA
Duration: 26 Oct 201629 Oct 2016

Conference

Conference70 Congresso Nazionale SIAARTI
CityNAPOLI -- ITA
Period26/10/1629/10/16

Keywords

  • Chirurgia Epatica
  • Diametro Vena Cava Inferiore
  • Fluidoterapia
  • Stroke Volume Variation

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