Intention to control low central venous pressure reduced blood loss during laparoscopic hepatectomy: A double-blind randomized clinical trial.
Adult
Aspartate Aminotransferases
/ blood
Blood Loss, Surgical
/ prevention & control
Central Venous Pressure
Double-Blind Method
Elective Surgical Procedures
Female
Hemoglobins
/ analysis
Hemorrhage
/ prevention & control
Hepatectomy
Humans
Intraoperative Care
Intraoperative Complications
/ prevention & control
Laparoscopy
Male
Middle Aged
Patient Positioning
Vasoconstrictor Agents
/ therapeutic use
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
09
01
2020
revised:
04
02
2020
accepted:
05
02
2020
pubmed:
29
3
2020
medline:
23
6
2020
entrez:
29
3
2020
Statut:
ppublish
Résumé
Excessive intraoperative hemorrhage is a critical factor of poor prognoses after hepatectomy. Low central venous pressure during parenchymal transection is recognized to effectively reduce intraoperative hemorrhage in open procedures. However, the role of controlled low central venous pressure in laparoscopic hepatectomy is still controversial. In the present randomized clinical trial, we set up a standard boundary of low central venous pressure according to our Pilot Study, then enrolled patients scheduled for elective laparoscopic hepatectomy and allocated them randomly to a group undergoing central venous pressure reduction by anesthesiologic interventions or a control group. The primary efficacy endpoint was total intraoperative blood loss and perioperative adverse events. Analyses were performed following the intention-to-treat principle, and patients and surgeons were blinded (ClinicalTrials.gov, Number: NCT03422913). Between January 2017 and October 2018, 146 out of 469 patients were randomized and eligible for inclusion in the final analyses. Based on the retrospective training cohort, we set a central venous pressure of 5 cm H The safety and efficacy of controlled low central venous pressure were demonstrated in complex laparoscopic hepatectomy for the first time by our study, and this technique is recommended to be applied routinely in laparoscopic hepatectomy.
Sections du résumé
BACKGROUND
Excessive intraoperative hemorrhage is a critical factor of poor prognoses after hepatectomy. Low central venous pressure during parenchymal transection is recognized to effectively reduce intraoperative hemorrhage in open procedures. However, the role of controlled low central venous pressure in laparoscopic hepatectomy is still controversial.
METHODS
In the present randomized clinical trial, we set up a standard boundary of low central venous pressure according to our Pilot Study, then enrolled patients scheduled for elective laparoscopic hepatectomy and allocated them randomly to a group undergoing central venous pressure reduction by anesthesiologic interventions or a control group. The primary efficacy endpoint was total intraoperative blood loss and perioperative adverse events. Analyses were performed following the intention-to-treat principle, and patients and surgeons were blinded (ClinicalTrials.gov, Number: NCT03422913).
RESULTS
Between January 2017 and October 2018, 146 out of 469 patients were randomized and eligible for inclusion in the final analyses. Based on the retrospective training cohort, we set a central venous pressure of 5 cm H
CONCLUSION
The safety and efficacy of controlled low central venous pressure were demonstrated in complex laparoscopic hepatectomy for the first time by our study, and this technique is recommended to be applied routinely in laparoscopic hepatectomy.
Identifiants
pubmed: 32216964
pii: S0039-6060(20)30070-2
doi: 10.1016/j.surg.2020.02.004
pii:
doi:
Substances chimiques
Hemoglobins
0
Vasoconstrictor Agents
0
Aspartate Aminotransferases
EC 2.6.1.1
Banques de données
ClinicalTrials.gov
['NCT03422913']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
933-941Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.