Effect of Low Tidal Volume Ventilation Strategy Combined Goal -Directed Fluid Therapy on Intraoperative Bleeding Undergoing Laparoscopic Major Hepatectomy in Liver Cancer Patients: a Surgeon Blinded Randomized Controlled Study
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Ventilator Lung
- Sponsor
- Seoul National University Hospital
- Enrollment
- 58
- Locations
- 1
- Primary Endpoint
- Intraoperative blood loss
- Last Updated
- 3 years ago
Overview
Brief Summary
This randomized controlled study's objective is to find a safer mechanical ventilation strategy to reduce intraoperative bleeding in liver cancer patients undergoing laparoscopic major liver resection. The hypothesis is that low tidal volume ventilation in laparoscopic major hepatectomy results in less bleeding.
Detailed Description
Patients are randomized into the conventional tidal volume (tidal volume \[ml\]= ideal body weight \[kg\]\* 10\~12) group and low tidal (tidal volume \[ml\]= ideal body weight \[kg\] \* 6\~8) volume group and ventilated accordingly throughout the surgery. All patients undergo general anesthesia with propofol, remifentanil, and rocuronium and are intubated with an endotracheal tube (ID 7.0 for females, ID 7.5 for males). Anesthesia is maintained with sevoflurane, end tidal CO2 is targeted between 30-35mmHg. The radial artery is cannulated and connected to the Flotrac sensor and goal directed fluid therapy is done. The estimated blood loss is checked as the primary outcome. In addition postoperative complications, transfusion amounts, operation time, satisfaction of the surgeon and participants are also recorded.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Patients with hepatocellular carcinoma scheduled for laparoscopic major hepatectomy, defined as resection of more than 30% of non-anatomical resection or more than 3 segments
Exclusion Criteria
- •ASA class \>4
- •patients with chronic obstructive pulmonary disease
- •patients with Child-Pugh score C
- •patients with arrythmia
Outcomes
Primary Outcomes
Intraoperative blood loss
Time Frame: during surgery
amount drained from peritoneal cavity - irrigation fluid
Secondary Outcomes
- Satisfaction scale of the operator and participants(during surgery)
- transfusion amount(op. end ~ postoperative day 3)
- postoperative alanine aminotransferase level(op. end ~ postoperative day 3)
- postoperative lung complications(op end ~ postoperative 2 weeks)
- postoperative hemoglobin level(op. end ~ postoperative day 3)
- postoperative total bilirubin level(op. end ~ postoperative day 3)
- postoperative PT INR level(op. end ~ postoperative day 3)
- operation time(during surgery)
- postoperative aspartate aminotransferase level(op. end ~ postoperative day 3)
- postoperative serum creatinine level(op. end ~ postoperative day 3)
- amount of crystalloids infused(during surgery)