| [PMID]: | 28632543 |
| [Au] Autor: | Lee J; Kim WH; Ryu HG; Lee HC; Chung EJ; Yang SM; Jung CW |
| [Ad] Endereço: | From the *Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine; and †Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea. |
| [Ti] Título: | Stroke Volume Variation-Guided Versus Central Venous Pressure-Guided Low Central Venous Pressure With Milrinone During Living Donor Hepatectomy: A Randomized Double-Blinded Clinical Trial. |
| [So] Source: | Anesth Analg;125(2):423-430, 2017 Aug. |
| [Is] ISSN: | 1526-7598 |
| [Cp] País de publicação: | United States |
| [La] Idioma: | eng |
| [Ab] Resumo: | BACKGROUND: We previously demonstrated the usefulness of milrinone for living donor hepatectomy. However, a less-invasive alternative to central venous catheterization and perioperative contributors to good surgical outcomes remain undetermined. The current study evaluated whether the stroke volume variation (SVV)-guided method can substitute central venous catheterization during milrinone-induced profound vasodilation. METHODS: We randomly assigned 42 living liver donors to receive either SVV guidance or central venous pressure (CVP) guidance to obtain milrinone-induced low CVP. Target SVV of 9% was used as a substitute for CVP of 5 mm Hg. The surgical field grade evaluated by 2 attending surgeons on a 4-point scale was compared between the CVP- and SVV-guided groups (n = 19, total number of scores = 38 per group) as a primary outcome variable. Multivariable analysis was performed to identify independent factors associated with the best surgical field as a post hoc analysis. RESULTS: Surgical field grades, which were either 1 or 2, were not found to be different between the 2 groups via Mann-Whitney U test (P = .358). There was a very weak correlation between SVV and CVP during profound vasodilation such as CVP ≤ 5 mm Hg (R = -0.06; 95% confidence interval, -0.09 to -0.04; P < .001). Additional post hoc analysis suggested that younger age, lower baseline CVP, and longer duration of milrinone infusion might be helpful in providing the best surgical field. CONCLUSIONS: Milrinone-induced vasodilation resulted in favorable surgical environment regardless of guidance methods of low CVP during living donor hepatectomy. However, SVV was not a useful indicator of low CVP because of very weak correlation between SVV and CVP during profound vasodilation. In addition, factors contributing to the best surgical field such as donor age, proactive fasting, and proper dosing of milrinone need to be investigated further, ideally through prospective studies. |
| [Mh] Termos MeSH primário: |
Pressão Venosa Central/efeitos dos fármacos
Hepatectomia
Doadores Vivos
Milrinona/administração & dosagem
Volume Sistólico/efeitos dos fármacos
|
| [Mh] Termos MeSH secundário: |
Adulto
Cateterismo
Cateterismo Venoso Central
Método Duplo-Cego
Feminino
Seres Humanos
Modelos Lineares
Fígado/efeitos dos fármacos
Masculino
Meia-Idade
Monitorização Intraoperatória/métodos
Análise Multivariada
Inibidores da Agregação de Plaquetas/administração & dosagem
Estudos Prospectivos
Tamanho da Amostra
|
| [Pt] Tipo de publicação: | JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL |
[Nm] Nome de substância:
| 0 (Platelet Aggregation Inhibitors); JU9YAX04C7 (Milrinone) |
| [Em] Mês de entrada: | 1708 |
| [Cu] Atualização por classe: | 170814 |
[Lr] Data última revisão:
| 170814 |
| [Sb] Subgrupo de revista: | AIM; IM |
| [Da] Data de entrada para processamento: | 170621 |
| [St] Status: | MEDLINE |
| [do] DOI: | 10.1213/ANE.0000000000002197 |
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