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Control of the inflow and outflow system during liver resection
Author(s) -
Otsubo Takehito
Publication year - 2012
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1007/s00534-011-0451-0
Subject(s) - medicine , blood loss , clamping , inferior vena cava , inflow , central venous pressure , outflow , resection , surgery , hepatectomy , anesthesia , blood pressure , occlusion , computer science , heart rate , physics , meteorology , mechanics , computer vision
Abstract Control of blood loss is a serious problem during liver resection. Bleeding from the inflow system can be controlled by the Pringle maneuver. The time limit for clamping is up to 10–15 min. A shortcoming of the Pringle maneuver is that it causes blood congestion in the portal vein. To avoid this problem other techniques have been developed including selective vascular occlusion and selective clamping of segmental branches. Bleeding from the outflow system is closely related to central venous pressure (CVP). Lowering the CVP reduces blood loss; in particular, keeping CVP <5 cmH 2 O by anesthesiological management is a simple and effective way to reduce blood loss. CVP remains high in some cases despite anesthesiological efforts, but in these circumstances other techniques are available including inferior vena cava clamping below the liver and intraoperative blood salvage.