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Hemodynamically adjusted infrahepatic inferior venous cava clamping can reduce postoperative deterioration in renal function: a retrospective observational study

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Abstract

Purpose

Infrahepatic inferior vena cava (IIVC) clamping is beneficial for reducing the amount of bleeding during hepatic surgery, although the associated systemic circulatory deterioration is noticeable. The relationship between changes in the degree of IIVC clamping and postoperative renal function was retrospectively evaluated.

Methods

A total of 59 patients who underwent elective hepatic surgery with surgical IIVC clamping in the two years were analyzed. In 2016, constant 80% clamping of the IIVC was performed (29 cases), and in 2017, hemodynamically adjusted IIVC clamping was performed (30 cases). Intraoperative parameters, including total blood loss and number of blood transfusions, were examined. The use of each vasoactive agents was analyzed. Renal function in the acute postoperative phase was evaluated using serum creatinine (Cr) and estimated glomerular filtration rate (eGFR) values.

Results

Comparison of the two groups showed that bolus doses of both ephedrine and phenylephrine were significantly higher in the 2016 group (P = 0.0221, 0.0017). Continuous doses of dopamine were significantly higher in the 2016 group, while those of noradrenaline were not. Postoperative serum Cr levels relative to baseline (%) were significantly higher in the 2016 group immediately after surgery and on postoperative day (POD) 1 (P = 0.0143, 0.0012). Postoperative eGFR relative to baseline (%) was significantly higher in the 2016 group immediately postoperatively and on PODs 1 and 2 (P = 0.0042, 0.0003, 0.0382).

Conclusion

Hemodynamically adjustable IIVC clamping might be superior to uniformly fixed clamping in preserving renal function without compromising the desired effect on hemostasis.

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Acknowledgements

The authors would like to thank FORTE Science Communications for editing the manuscript.

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Authors and Affiliations

  1. Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan

    Jo Ohta, Yuji Kadoi & Shigeru Saito

  2. Intensive Care Unit, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma, 371-8511, Japan

    Yukie Murooka, Hiroaki Matsuoka, Masafumi Kanamoto, Masaru Tobe & Tomonori Takazawa

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  1. Jo Ohta
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Ohta, J., Kadoi, Y., Murooka, Y. et al. Hemodynamically adjusted infrahepatic inferior venous cava clamping can reduce postoperative deterioration in renal function: a retrospective observational study. J Anesth 34, 320–329 (2020). https://doi.org/10.1007/s00540-020-02742-6

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  • DOI: https://doi.org/10.1007/s00540-020-02742-6

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