ABSTRACT
Hepatic resection has been widely accepted as the first choice for the treatment of colorectal metastases. Liver surgery has been recognized as a major abdominal procedure; it exposes patients to a high risk of perioperative adverse events. Decision sharing and the multimodal approach to the patients' management are the two key items for a safe outcome, even in such a high-risk surgery. This review aims at addressing the main perioperative issues (preoperative evaluation; general anesthesia and intraoperative fluid management and hemodynamic monitoring; intraoperative metabolism; administration policy for blood-derivative products; postoperative pain control; postoperative complications), in particular, from the anesthetist's point of view; however, only an alliance with the surgery team may be successful in case of adverse events to accomplish a good final outcome.
ABSTRACT
BACKGROUND: Serum lactate (sLac) concentration during liver resection with intermittent hepatic hilum clamping (i.e. Pringle maneuver, PM) was retrospectively investigated. METHODS: A total of 133 patients who underwent liver resection were enrolled. We analyzed the sLac peri-operatively. Correlations were searched between the PM and lactatemia and its variations (i.e. lactate clearance, cLac) and other factors which it might be related to. Lactatemia in triplicate intraoperatively was recorded, just after the awakening, and 1 and 2 h later. The cLac between two consecutive measurements [(sLac1 - sLac2 )/sLac1 ] was computed. RESULTS: A reliable dependence of sLac was found from the cumulative PM. More than 76 min of cumulative Pringle Time (cPT) exposed patients to a worse cLac at the end of the resection phase (P < 0.0001). We found cPT >76 min, global operation time >365 min and bleeding >225 ml to be predictors of hyperlactatemia (sLac >4 mmol/L). Normal liver resulted as a risk factor for hyperlactatemia and steatosis was not (P = 0.030 vs. P = 0.325). Finally, cLac showed a "square-root- shape, just like the mathematical operation sign. CONCLUSIONS: Lactatemia during liver resection depends on the duration of PM, bleeding and the duration of the operation. Normal liver may expose the patient to the risk of hyperlactatemia.