nach oben

Die Anaesthesiologie

Erschienen in:

10.09.2018 | Operationen an der Leber | Allgemeinanästhesie

Der zentrale Venendruck in der Leberchirurgie

Ein primäres Therapieziel oder ein hämodynamischer Mosaikstein?

verfasst von: Dr. C. R. Behem, M. F. Gräßler, C. J. C. Trepte

Erschienen in: Die Anaesthesiologie | Ausgabe 10/2018

Einloggen, um Zugang zu erhalten

Zusammenfassung

Der zentrale Venendruck (ZVD) gilt als wichtiger Parameter des anästhesiologischen Managements in der Leberchirurgie. Zur Reduktion des Blutverlustes bei Leberresektionen wird häufig eine niedriger Zielwert des ZVD propagiert. In aktuellen Metaanalysen konnte zwar ein Zusammenhang eines niedrigen ZVD mit einer Reduktion des Blutverlustes gezeigt werden, allerdings weisen die zugrunde liegenden Studien methodologische Schwächen auf und Vorteile bezüglich Morbidität und Letalität lassen sich kaum nachweisen. Die Messung des ZVD selbst ist mit zahlreichen Limitationen und Einflussfaktoren verbunden, und die Maßnahmen zur Senkung des ZVD sind in Bezug auf die hepatische Hämodynamik nur unzureichend untersucht worden. Die Definition eines allgemeingültigen Zielbereichs für den ZVD ist infrage zu stellen. Das primäre Ziel ist die Aufrechterhaltung eines adäquaten Sauerstoffangebots und einer Euvolämie. Der ZVD sollte hierbei als Mosaikstein des hämodynamischen Managements betrachtet werden.

Hughes MJ, Ventham NT, Harrison EM, Wigmore SJ (2015) Central venous pressure and liver resection: a systematic review and meta-analysis. HPB (Oxford) 17:863–871CrossRef

Katz SC, Shia J, Liau KH et al (2009) Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg 249:617–623PubMedCrossRef

Yang T, Zhang J, Lu JH, Yang GS, Wu MC, Yu WF (2011) Risk factors influencing postoperative outcomes of major hepatic resection of hepatocellular carcinoma for patients with underlying liver diseases. World J Surg 35:2073–2082PubMedCrossRef

Truong JL, Cyr DP, Lam-McCulloch J, Cleary SP, Karanicolas PJ (2014) Consensus and controversy in hepatic surgery: a survey of Canadian surgeons. J Surg Oncol 110:947–951PubMedCrossRef

Melloul E, Hubner M, Scott M et al (2016) Guidelines for perioperative care for liver surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg 40:2425–2440PubMedCrossRef

Li Z, Sun YM, Wu FX, Yang LQ, Lu ZJ, Yu WF (2014) Controlled low central venous pressure reduces blood loss and transfusion requirements in hepatectomy. World J Gastroenterol 20:303–309PubMedPubMedCentralCrossRef

Moggia E, Rouse B, Simillis C et al (2016) Methods to decrease blood loss during liver resection: a network meta-analysis. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD010683.pub3 PubMedCrossRefPubMedCentral

Zhang XL, Wang WJ, Wang WJ, Cao N (2015) Effectiveness and safety of controlled venous pressure in liver surgery: a systematic review and network meta-analysis. Biomed Res Int 2015:290234PubMedPubMedCentral

Melendez JA, Arslan V, Fischer ME et al (1998) Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg 187:620–625PubMedCrossRef

10.

Rees M, Plant G, Wells J, Bygrave S (1996) One hundred and fifty hepatic resections: evolution of technique towards bloodless surgery. Br J Surg 83:1526–1529PubMedCrossRef

11.

Wang WD, Liang LJ, Huang XQ, Yin XY (2006) Low central venous pressure reduces blood loss in hepatectomy. World J Gastroenterol 12:935–939PubMedPubMedCentralCrossRef

12.

Soonawalla ZF, Stratopoulos C, Stoneham M, Wilkinson D, Britton BJ, Friend PJ (2008) Role of the reverse-Trendelenberg patient position in maintaining low-CVP anaesthesia during liver resections. Langenbecks Arch Surg 393:195–198PubMedCrossRef

13.

Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA (2011) Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med 39:259–265PubMedCrossRef

14.

Marik PE, Baram M, Vahid B (2008) Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest 134:172–178PubMedCrossRef

15.

Ytrebo LM (2011) Stop filling patients against central venous pressure, please! Crit Care Med 39:396–397PubMedCrossRef

16.

Magder S (2006) Central venous pressure monitoring. Curr Opin Crit Care 12:219–227PubMedCrossRef

17.

Magder S (2006) Central venous pressure: a useful but not so simple measurement. Crit Care Med 34:2224–2227PubMedCrossRef

18.

Schummer W (2009) Central venous pressure. Validity, informative value and correct measurement. Anaesthesist 58:499–505PubMedCrossRef

19.

Ukere A, Meisner S, Greiwe G et al (2016) The influence of PEEP and positioning on central venous pressure and venous hepatic hemodynamics in patients undergoing liver resection. J Clin Monit Comput. https://doi.org/10.1007/s10877-016-9970-1 PubMedCrossRef

20.

Figg KK, Nemergut EC (2009) Error in central venous pressure measurement. Anesth Analg 108:1209–1211PubMedCrossRef

21.

Giordano C, Deitte LA, Gravenstein N, Rice MJ (2010) What is the preferred central venous pressure zero reference for hepatic resection? Anesth Analg 111:660–664PubMedCrossRef

22.

Johnson M, Mannar R, Wu AV (1998) Correlation between blood loss and inferior vena caval pressure during liver resection. Br J Surg 85:188–190PubMedCrossRef

23.

Palmon SC, Moore LE, Lundberg J, Toung T (1997) Venous air embolism: a review. J Clin Anesth 9:251–257PubMedCrossRef

24.

Lee SY, Choi BI, Kim JS, Park KS (2002) Paradoxical air embolism during hepatic resection. Br J Anaesth 88:136–138PubMedCrossRef

25.

Bickley LS, Szilagyi PG, Bates B (2009) Bates’ guide to physical examination and history taking, 10. Aufl. Lippincott Williams & Wilkins, Philadelphia, PA: Wolters Kluwer Health

26.

Pinsky MR, Payen D (2005) Functional Hemodynamic Monitoring. Update in intensive care and emergency medicine. Springer, Berlin, HeidelbergCrossRef

27.

de Boer MT, Molenaar IQ, Porte RJ (2007) Impact of blood loss on outcome after liver resection. Dig Surg 24:259–264PubMedCrossRef

28.

Poon RT, Fan ST, Lo CM et al (2004) Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 240:698–708PubMedPubMedCentral

29.

Stümpfle R, RIga A, Deshpande R, Mudan SS, Baikady RR (2009) Anaesthesia for metastatic liver resection surgery. Curr Anesth Crit Care 20:3–7CrossRef

30.

Jones RM, Moulton CE, Hardy KJ (1998) Central venous pressure and its effect on blood loss during liver resection. Br J Surg 85:1058–1060PubMedCrossRef

31.

Kim YK, Chin JH, Kang SJ et al (2009) Association between central venous pressure and blood loss during hepatic resection in 984 living donors. Acta Anaesthesiol Scand 53:601–606PubMedCrossRef

32.

Chhibber A, Dziak J, Kolano J, Norton JR, Lustik S (2007) Anesthesia care for adult live donor hepatectomy: our experiences with 100 cases. Liver Transplant 13:537–542CrossRef

33.

Gurusamy KS, Li J, Vaughan J, Sharma D, Davidson BR (2012) Cardiopulmonary interventions to decrease blood loss and blood transfusion requirements for liver resection. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007338.pub3 PubMedPubMedCentralCrossRef

34.

Liu Y, Cai M, Duan S et al (2008) Effect of controlled low central venous pressure on renal function in major liver resection. Chinese-German J Clin Oncol 7(1):7–9CrossRef

35.

Liu HZ, Zhou QL, Wang XH et al (2005) Application of low central venous pressure in liver resection. Zhonghua Gandan Waike Zazhi 11:461–463

36.

El-Kharboutly WS, El-Wahab MA (2004) The role of adoption of low central venous pressure in hepatic resection with pringle manoeuvre in reducing blood loss and improving operative outcome. Egyp J Anaesth 20:369–376

37.

Niemann CU, Feiner J, Behrends M, Eilers H, Ascher NL, Roberts JP (2007) Central venous pressure monitoring during living right donor hepatectomy. Liver Transpl 13:266–271PubMedCrossRef

38.

Wax DB, Zerillo J, Tabrizian P et al (2016) A retrospective analysis of liver resection performed without central venous pressure monitoring. Eur J Surg Oncol 42:1608–1613PubMedCrossRef

39.

Schroeder RA, Collins BH, Tuttle-Newhall E et al (2004) Intraoperative fluid management during orthotopic liver transplantation. J Cardiothorac Vasc Anesth 18:438–441PubMedCrossRef

40.

Shin CH, Long DR, McLean D et al (2017) Effects of intraoperative fluid management on postoperative outcomes: a hospital registry study. Ann Surg 266:545–554CrossRef

41.

Thacker JK, Mountford WK, Ernst FR, Krukas MR, Mythen MM (2016) Perioperative fluid utilization variability and association with outcomes: considerations for enhanced recovery efforts in sample US surgical populations. Ann Surg 263:502–510PubMedCrossRef

42.

Vollmar B, Menger MD (2009) The hepatic microcirculation: mechanistic contributions and therapeutic targets in liver injury and repair. Physiol Rev 89:1269–1339PubMedCrossRef

43.

Miller RD, Eriksson LI, Fleisher LA et al (2014) Miller’s anesthesia, 8. Aufl. Elsevier Saunders, Philadelphia

44.

Gelman S (2008) Venous function and central venous pressure: a physiologic story. Anesthesiology 108:735–748PubMedCrossRef

45.

Vagts DA, Iber T, Puccini M et al (2003) The effects of thoracic epidural anesthesia on hepatic perfusion and oxygenation in healthy pigs during general anesthesia and surgical stress. Anesth Analg 97:1824–1832PubMedCrossRef

46.

Gelman S, Dillard E, Bradley EL Jr. (1987) Hepatic circulation during surgical stress and anesthesia with halothane, isoflurane, or fentanyl. Anesth Analg 66:936–943PubMedCrossRef

47.

Meierhenrich R, Gauss A, Muhling B et al (2010) The effect of propofol and desflurane anaesthesia on human hepatic blood flow: a pilot study. Anaesthesia 65:1085–1093PubMedCrossRef

48.

Meierhenrich R, Wagner F, Schutz W et al (2009) The effects of thoracic epidural anesthesia on hepatic blood flow in patients under general anesthesia. Anesth Analg 108:1331–1337PubMedCrossRef

49.

Zhu T, Pang Q, McCluskey SA, Luo C (2008) Effect of propofol on hepatic blood flow and oxygen balance in rabbits. Can J Anaesth 55:364–370PubMedCrossRef

50.

Lautt WW (2007) Regulatory processes interacting to maintain hepatic blood flow constancy: vascular compliance, hepatic arterial buffer response, hepatorenal reflex, liver regeneration, escape from vasoconstriction. Hepatol Res 37:891–903PubMedPubMedCentralCrossRef

51.

Ayuse T, Mishima K, Oi K, Ureshino H, Sumikawa K (2010) Effects of nitric oxide donor on hepatic arterial buffer response in anesthetized pigs. J Invest Surg 23:183–189PubMedCrossRef

52.

Karplus G, Szold A, Serour F, Weinbroum AA (2012) The hepatorenal reflex contributes to the induction of oliguria during pneumoperitoneum in the rat. Surg Endosc 26:2477–2483PubMedCrossRef

53.

Rothe CF (1983) Reflex control of veins and vascular capacitance. Physiol Rev 63:1281–1342PubMedCrossRef

54.

Guyton AC (1955) Determination of cardiac output by equating venous return curves with cardiac response curves. Physiol Rev 35:123–129CrossRefPubMed

55.

Brienza N, Revelly JP, Ayuse T, Robotham JL (1995) Effects of PEEP on liver arterial and venous blood flows. Am J Respir Crit Care Med 152:504–510PubMedCrossRef

56.

Saner FH, Pavlakovic G, Gu Y et al (2006) Does PEEP impair the hepatic outflow in patients following liver transplantation? Intensive Care Med 32:1584–1590PubMedCrossRef

57.

Saner FH, Damink OSW, Pavlakovic G et al (2008) Positive end-expiratory pressure induces liver congestion in living donor liver transplant patients: myth or fact. Transplantation 85:1863–1866PubMedCrossRef

58.

Saner FH, Damink OSW, Pavlakovic G et al (2010) How far can we go with positive end-expiratory pressure (PEEP) in liver transplant patients? J Clin Anesth 22:104–109PubMedCrossRef

59.

Reuter DA, Felbinger TW, Schmidt C et al (2003) Trendelenburg positioning after cardiac surgery: effects on intrathoracic blood volume index and cardiac performance. Eur J Anaesthesiol 20:17–20PubMedCrossRef

60.

Sand L, Rizell M, Houltz E et al (2011) Effect of patient position and PEEP on hepatic, portal and central venous pressures during liver resection. Acta Anaesthesiol Scand 55:1106–1112PubMedCrossRef

61.

Kortgen A, Silomon M, Pape-Becker C, Buchinger H, Grundmann U, Bauer M (2009) Thoracic but not lumbar epidural anaesthesia increases liver blood flow after major abdominal surgery. Eur J Anaesthesiol 26:111–116PubMedCrossRef

62.

Sand L, Lundin S, Rizell M, Wiklund J, Stenqvist O, Houltz E (2014) Nitroglycerine and patient position effect on central, hepatic and portal venous pressures during liver surgery. Acta Anaesthesiol Scand 58:961–967PubMedCrossRef

63.

Bown LS, Ricksten SE, Houltz E et al (2016) Vasopressin-induced changes in splanchnic blood flow and hepatic and portal venous pressures in liver resection. Acta Anaesthesiol Scand 60:607–615PubMedCrossRef

64.

Raedler C, Voelckel WG, Wenzel V et al (2004) Treatment of uncontrolled hemorrhagic shock after liver trauma: fatal effects of fluid resuscitation versus improved outcome after vasopressin. Anesth Analg 98:1759–1766PubMedCrossRef

65.

Fayed N, Refaat EK, Yassein TE, Alwaraqy M (2013) Effect of perioperative terlipressin infusion on systemic, hepatic, and renal hemodynamics during living donor liver transplantation. J Crit Care 28:775–782PubMedCrossRef

66.

Zhu P, Lau WY, Chen YF et al (2012) Randomized clinical trial comparing infrahepatic inferior vena cava clamping with low central venous pressure in complex liver resections involving the Pringle manoeuvre. Br J Surg 99:781–788PubMedCrossRef

67.

Rahbari NN, Koch M, Zimmermann JB et al (2011) Infrahepatic inferior vena cava clamping for reduction of central venous pressure and blood loss during hepatic resection: a randomized controlled trial. Ann Surg 253:1102–1110PubMedCrossRef

68.

Kato M, Kubota K, Kita J, Shimoda M, Rokkaku K, Sawada T (2008) Effect of infra-hepatic inferior vena cava clamping on bleeding during hepatic dissection: a prospective, randomized, controlled study. World J Surg 32:1082–1087PubMedCrossRef

69.

AWMF (2014) S3-Leitlinine Intravasale Volumentherapie beim Erwachsenen. Leitliniendetailansicht. www.awmf.org/leitlinien/detail/ll/001-020.html. Zugegriffen: 31. Juli 2018

70.

Jozwiak M, Teboul JL, Monnet X (2015) Extravascular lung water in critical care: recent advances and clinical applications. Ann Intensive Care 5:38PubMedPubMedCentralCrossRef

Titel: Der zentrale Venendruck in der Leberchirurgie
Ein primäres Therapieziel oder ein hämodynamischer Mosaikstein?
verfasst von: Dr. C. R. Behem
M. F. Gräßler
C. J. C. Trepte
Publikationsdatum: 10.09.2018
Verlag: Springer Medizin
Schlagwörter: Operationen an der Leber
Operationen an der Leber
Leberresektion
Leberresektion
Erschienen in: Die Anaesthesiologie / Ausgabe 10/2018
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI: https://doi.org/10.1007/s00101-018-0482-x

Neu im Fachgebiet AINS

24.04.2024 | DGIM 2024 | Kongressbericht | Nachrichten

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Der zentrale Venendruck in der Leberchirurgie

Ein primäres Therapieziel oder ein hämodynamischer Mosaikstein?

Zusammenfassung

Neu im Fachgebiet AINS

Magen-Darm-Blutungen werden präklinisch oft falsch eingeschätzt

Sepsis-Verdacht: Eine Stunde, fünf essenzielle Maßnahmen

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Update AINS

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 10/2018

Perspektiven für Anästhesisten in der Krankenhaushygiene

Hohe Schmerzerwartung und Beeinträchtigung durch vorbestehende Schmerzen sind Risikofaktoren für hohe postoperative Schmerzen

Update Mallampati

Das Leid mit den Leitlinien

Algorithmen fürs Management des schwierigen Atemwegs

Landouzy-Sepsis bei einer Patientin mit Miliartuberkulose

Neu im Fachgebiet AINS

Magen-Darm-Blutungen werden präklinisch oft falsch eingeschätzt

Sepsis-Verdacht: Eine Stunde, fünf essenzielle Maßnahmen

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Update AINS