The role of hypovolemic phlebotomy to maintained low CVP and minimized blood loss and blood transfusion during open liver resection. Hypovolemic phlebotomy,
Conditions
Interventions
Hypovolemic phlebotomy: . The whole blood will be collected 7-
10 ml/kg of patient body weight to achieve low CVP (CVP < 5 mmHg) without intravenous fluid replacement. Whole blood collecting bags were provided by the blood bank,
containing citrate-
phosphate-
dextrose-
adenine solution. ,Non-
hypovolemic phlebotomy: Anesthesiologist will be performed the
methods to achieve low CVP (CVP < 5 mmHg) by adopting Reverse Trendelenburg’s position (head-
up tilt 10°),
intraoperative volume restriction (2 – 4 ml/kg/hr) and intravenously nitroglycerine administration (0.5-
3 mcg/kg/minute) before parenchymal resection 30 minutes.
Experimental Procedure/Surgery,Active Comparator Procedure/Surgery
Hypovolemic Phlebotomy,Non-
Sponsors
none
Eligibility
Sex/Gender
All
Age
18 Years to 70 Years
Inclusion criteria
Inclusion criteria: 1. All genders, age 18 to 70 years old 2. American Society of Anesthesiologists (ASA) physical status classification of I-III 3. The patients who scheduled in elective open liver resection and diagnosed Hepatocellular Carcinoma, Cholangiocarcinoma, Liver metastasis, and Benign malignant tumor.
Exclusion criteria
Exclusion criteria: 1. Pregnancy 2. Refusal of blood and blood products transfusion 3. Anemia (Hb 1.8 mg/dL) 10. Abnormal coagulation parameters (INR >1.5 not on warfarin and/or platelet count 2 mg/dL or ALT >75 U/L) 12. Preoperative autologous blood donation 13. Presence of active infection (Evidence of positive hemoculture) 14. Tumor size > 10 cm. Withdrawal criteria: 1. Unresectable tumor 2. Persistent intraoperative hypotension that cannot be corrected with vasopressors. 3. Cardiac arrest during operation 4. Low central venous pressure (< 5 mmHg) cannot be achieved before and during parenchymal resection. 5. Massive bleeding due to major vascular injury
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Intraoperative blood loss Intraoperative period the measured volume of suctioned blood, gauze and swab | — |
Secondary
| Measure | Time frame |
|---|---|
| Intraoperative transfusion Perioperative periods- 30 days postoperatively Observation,Intraoperative blood transfusion Intraoperative period Observation ,Surgical field bleeding Intraoperative period using the bleeding score of the hepatic surgical field,Postoperative major complications Postoperative period Clavien-Dindo classification,Postoperative major complications Postoperative period Clavien-Dindo classification,Postoperative Acute kidney injury Postoperative period Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines,Reoperation Postoperative period observation ,Length of ICU and hospital stay Postoperative period Observation ,Length of ICU and hospital stay Postoperative period Observation ,Length of ICU and hospital stay Postoperative period Observation ,Length of ICU and hospital stay Postoperative period Observation ,Hospital mortality Postoperative period Observation ,Hospital mortality Postoperative period Observation ,Hospital mortality Postoperative period Observation ,30-day readmission 30-day postoperatively Observation ,30-day readmission 30-day postoperatively Observation ,30-day readmission 30-day postoperatively Observation ,Postoperative 30 days mortality 30-day postoperatively Observation | — |
Contacts
Public ContactWarangkana Lapisatepun
Faculty of Medicine Chiang Mai University
Outcome results
None listed