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Nitroglycerine and patient position effect on central, hepatic and portal venous pressures during liver surgery
Author(s) -
SAND L,
LUNDIN S,
RIZELL M,
WIKLUND J,
STENQVIST O,
HOULTZ E
Publication year - 2014
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12349
Subject(s) - medicine , central venous pressure , body position , anesthesia , portal venous pressure , mean arterial pressure , blood pressure , heart rate , portal hypertension , cirrhosis , physical medicine and rehabilitation
Background To reduce blood loss during liver surgery, a low central venous pressure ( CVP ) is recommended. Nitroglycerine ( NG ) with its rapid onset and offset can be used to reduce CVP . In this study, the effect of NG on portal and hepatic venous pressures ( PVP and HVP ) in different body positions was assessed. Methods Thirteen patients undergoing liver resection were studied. Cardiac output ( CO ), mean arterial pressure ( MAP ) and CVP were measured. PVP and HVP were measured using tip manometer catheters at baseline ( BL ) in horizontal position; during NG infusion, targeting a MAP of 60 mmHg , with NG infusion and the patient placed in 10 head‐down position. Results NG infusion reduced HVP from 9.7 ± 2.4 to 7.2 ± 2.4, PVP from 12.3 ± 2.2 to 9.7 ± 3.0 and CVP from 9.8 ± 1.9 to 7.2 ± 2.1 mmHg at BL . Head‐down tilt during ongoing NG resulted in increases in HVP to 8.2 ± 2.1, PVP to 10.7 ± 3 and CVP to 11 ± 1.9 mmHg . CO at BL was 6.3 ± 1.1, which was reduced by NG to 5.8 ± 1.2. Head‐down tilt together with NG infusion restored CO to 6.3 ± 1.0 l/min. Conclusion NG infusion leads to parallel reductions in CVP , HVP and PVP at horizontal body position. Thus, CVP can be used to guide NG dosage and fluid administration at horizontal position. NG infusion can be used to reduce HVP . Head‐down tilt can be used during NG infusion to improve both blood pressure and CO without substantial increase in liver venous pressure. In head‐down tilt, CVP dissociates from HVP and PVP .