Effects of controlled low central venous pressure combined with dexmedetomidine on the blood loss, renal function and cognitive function in patients undergoing laparoscopic hepatectomy
1Department of Anesthesiology, The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, 223300 Huai’an, Jiangsu, China
2Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, 223300 Huai’an, Jiangsu, China
DOI: 10.22514/sv.2023.032 Vol.19,Issue 3,May 2023 pp.182-187
Submitted: 23 November 2022 Accepted: 04 January 2023
Published: 08 May 2023
This study aims to investigate the effects of controlled low central venous pressure combined with dexmedetomidine on the blood loss, renal function and cognitive function in patients undergoing laparoscopic hepatectomy. From January 2021 to October 2022, 90 patients treated with laparoscopic hepatectomy in Huai’an First People’s Hospital were selected as subject objects and equally divided into the study group and control group in a random method. The blood loss, surgical duration, duration of hepatic portal occlusion, serum bilirubin, creatinine, urea nitrogen, hemoglobin, plasma albumin, interleukin (IL)-6 and cognitive function in the two groups were compared. Patients in the study group receiving the combination of controlled low central venous pressure and dexmedetomidine showed less blood loss and shorter time of hepatic portal occlusion as compared to the control group. The levels of serum bilirubin, creatinine and urea nitrogen were significantly increased at postoperative 3 days compared with preoperation in the study and control groups. In particular, these factors were higher in control group than that in the control group at postoperative 3 days, indicating better liver function and renal function of patients in the study group than those in the control group. The levels of hemoglobin and plasma albumin observed in study group 3 days after surgery were higher than those in the control group. At 1 day after surgery, the level of IL-6 was significantly lower in the study group than that in the control group. Patients in the study group achieved significantly higher mini-mental state examination (MMES) scores than those in the control group at postoperative 1 day, 3 days and 7 days. The controlled low central venous pressure combined with dexmedetomidine is a promising clinical practice in decreasing blood loss, improving the liver and kidney function, and protecting the cognitive function of patients during laparoscopic hepatectomy.
Controlled low central venous pressure; Dexmedetomidine; Laparoscopic hepatectomy; Cognitive function
Yang Zhang,Lin Li,Jianbo Xu,Wei Cheng. Effects of controlled low central venous pressure combined with dexmedetomidine on the blood loss, renal function and cognitive function in patients undergoing laparoscopic hepatectomy. Signa Vitae. 2023. 19(3);182-187.
 Junrungsee S, Suwannikom K, Tiyaprasertkul W, Lapisatepun W, Chotirosniramit A, Sandhu T, et al. Efficacy and safety of infrahepatic inferior vena cava clamping under controlled central venous pressure for reducing blood loss during hepatectomy: a randomized controlled trial. Journal of Hepato-Biliary-Pancreatic Sciences. 2021; 28: 604–616.
 Bodur MS, Tomas K, Topaloğlu S, Oğuz Ş, Küçükaslan H, Dohman D, et al. Effects of intraoperative blood loss during liver resection on patients’ outcome: a single- center experience. Turkish Journal of Medical Sciences. 2021; 51: 1388–1395.
 Cloyd JM, Wiseman JT, Pawlik TM. Surgical management of pancreatic neuroendocrine liver metastases. Journal of Gastrointestinal Oncology. 2020; 11: 590–600.
 Wang F, Sun D, Zhang N, Chen Z. The efficacy and safety of controlled low central venous pressure for liver resection: a systematic review and meta-analysis. Gland Surgery. 2020; 9: 311–320.
 Yu L, Sun H, Jin H, Tan H. The effect of low central venous pressure on hepatic surgical field bleeding and serum lactate in patients undergoing partial hepatectomy: a prospective randomized controlled trial. BMC Surgery. 2020; 20: 25.
 Yokota Y, Noda T, Kobayashi S, Matsumoto K, Sakano Y, Iwagami Y, et al. A case report of Fontan procedure-related hepatocellular carcinoma: pure laparoscopic approach by low and stable pneumoperitoneum. BMC Surgery. 2020; 20: 80.
 Xiao N, Li X, Zhu X, Huang C, Shen Y, Zhou J, et al. Increase of portal vein pressure gradient after hepatectomy predicts post-operative liver dysfunction. Surgical Innovation. 2022; 29: 145–153.
 Hou W, Zhong J, Pan B, Huang J, Wang B, Sun Z, et al. Paradoxical carbon dioxide embolism during laparoscopic surgery without intracardiac right-to-left shunt: two case reports and a brief review of the literature. Journal of International Medical Research. 2020; 48: 300060520933816.
 Kim T, Kim KR, Jung WH, Choi HJ, Park J, Hong SH, et al. Clinical implications of a persistent left superior vena cava in a patient with right superior vena cava thrombosis undergoing emergency deceased donor liver transplantation: a case report. Transplantation Proceedings. 2022; 54: 1648–1653.
 Yoshikawa T, Hokuto D, Yasuda S, Kamitani N, Matsuo Y, Sho M. Restrictive pulmonary dysfunction may increase blood loss during liver resection. The American Surgeon. 2021; 87: 1886–1892.
 Lee EK, Bang YJ, Kwon J, Park J, Ahn JH, Ko JS, et al. Change of anesthetic management from open to laparoscopic living donor right hepatectomy after learning curve. Transplantation Proceedings. 2022; 54: 406–408.
 Yang P, Gao S, Chen X, Xiong W, Hai B, Huang X. Milrinone is better choice for controlled low central venous pressure during hepatectomy: a randomized, controlled trial comparing with nitroglycerin. International Journal of Surgery. 2021; 94: 106080.
 Hu W, Li Z, Hu Z. A commentary on “Milrinone is better choice for controlled low central venous pressure during hepatectomy: a randomized, controlled trial comparing with nitroglycerin” [Int. J. Surg.(2021) 94: 106080]. International Journal of Surgery. 2021; 94: 106130.
 Liu T, Shen Q, Zhou X, Shen X, Lai L, Hou X, et al. Application of controlled low central venous pressure during hepatectomy: a systematic review and meta-analysis. Journal of Clinical Anesthesia. 2021; 75: 110467.
 Al Khaldi M, Gryspeerdt F, Carrier FM, Bouchard C, Simoneau È, Rong Z, et al. Effect of intraoperative hypovolemic phlebotomy on transfusion and clinical outcomes in patients undergoing hepatectomy: a retrospective cohort study. Canadian Journal of Anesthesia. 2021; 68: 980–990.
 Pan Y, Wang J, Lu X, Chen J, He W, Chen J, et al. Intention to control low central venous pressure reduced blood loss during laparoscopic hepatectomy: a double-blind randomized clinical trial. Surgery. 2020; 167: 933–941.
 Vega EA, Nicolaescu DC, Salehi O, Kozyreva O, Vellayappan U, Ricklan D, et al. Laparoscopic segment 1 with partial IVC resection in advanced cirrhosis: how to do it safely. Annals of Surgical Oncology. 2020; 27: 1143–1144.
 Nomi T, Hokuto D, Yoshikawa T, Kamitani N, Matsuo Y, Sho M. Clamp-crush technique for laparoscopic liver resection. Annals of Surgical Oncology. 2021; 28: 866.
 Wallace H, Miller T, Angus W, Stott M. Intra-operative anaesthetic management of older patients undergoing liver surgery. European Journal of Surgical Oncology. 2021; 47: 545–550.
 Huang YQ, Wen RT, Li XT, Zhang J, Yu ZY, Feng YF. The protective effect of dexmedetomidine against ischemia-reperfusion injury after hepatectomy: a meta-analysis of randomized controlled trials. Frontiers in Pharmacology. 2021; 12: 747911.
 Zhou X, Liu J, Xu Z, Fu Q, Wang P, Wang J, et al. Dexmedetomidine ameliorates postoperative cognitive dysfunction by inhibiting toll-like receptor 4 signaling in aged mice. The Kaohsiung Journal of Medical Sciences. 2020; 36: 721–731.
 Wu G, Chen T, Chen Z. Effect of controlled low central venous pressure technique on postoperative hepatic insufficiency in patients undergoing a major hepatic resection. American Journal of Translational Research. 2021; 13: 8286–8293.
 Park L, Gilbert R, Baker L, Shorr R, Workneh A, Turcotte S, et al. The safety and efficacy of hypovolemic phlebotomy on blood loss and transfusion in liver surgery: a systematic review and meta-analysis. HPB. 2020; 22: 340–350.
 O’Connor DC, Seier K, Gonen M, McCormick PJ, Correa-Gallego C, Parker B, et al. Invasive central venous monitoring during hepatic resection: unnecessary for most patients. HPB. 2020; 22: 1732–1737.
 Li J, Li X, Zhang X, Wang H, Li K, He Y, et al. Indocyanine green fluorescence imaging-guided laparoscopic right posterior hepatectomy. Surgical Endoscopy. 2022; 36: 1293–1301.
 Tseng W, Lin W, Lai H, Chen T, Chiu Y, Chen P, et al. Adjunctive dexmedetomidine infusion in open living donor hepatectomy: a way to enhance postoperative analgesia and recovery. International Journal of Clinical Practice. 2021; 75: e14002
 Zhang Y, Liu M, Yang Y, Cao J, Mi W. Dexmedetomidine exerts a protective effect on ischemia-reperfusion injury after hepatectomy: a prospective, randomized, controlled study. Journal of Clinical Anesthesia. 2020; 61: 109631.
 Sakamoto K, Ogawa K, Matsui T, Utsunomiya T, Honjo M, Ueno Y, et al. Vertical interval between hepatic segment of inferior vena cava and right atrium predicts intraoperative blood loss during hemi-hepatectomy. Journal of Hepato-Biliary-Pancreatic Sciences. 2020; 27: 90–100.
 Xiao L, Huang P, Wu K, Xiang J, Fu X, Zheng M, et al. Effect of infrahepatic inferior vena cava partial clamping on central venous pressure and intraoperative blood loss during laparoscopic hepatectomy. Surgical Endoscopy. 2021; 35: 2773–2780.
 Birgin E, Mehrabi A, Sturm D, Reißfelder C, Weitz J, Rahbari NN. Infrahepatic inferior vena cava clamping does not increase the risk of pulmonary embolism following hepatic resection. World Journal of Surgery. 2021; 45: 2911–2923.
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