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A Randomized Controlled Trial

Kiyoshi Hasegawa, MD; Tadatoshi Takayama, MD, PhD; Ryo Orii, MD, PhD; Keiji Sano, MD; Yasuhiko Sugawara, MD, PhD; Hiroshi Imamura, MD, PhD; Keiichi Kubota, MD, PhD; Masatoshi Makuuchi, MD, PhD

Arch Surg. 2002;137:311-315.

Hypothesis  Blood loss in hepatic resection is an important determinant of operative outcome.

Objective  To clarify whether reducing the tidal volume would be effective in decreasing blood loss during liver transection.

Design  Randomized controlled trial.

Setting  University hospital.

Patients  Eighty patients scheduled to undergo hepatic resection were randomly assigned to receive liver transection under normoventilation (n = 40) or hypoventilation (n = 40).

Interventions  During liver transection, in the normoventilation group, the tidal volume was 10 mL/kg and the respiratory rate was 10/min; in the hypoventilation group, the tidal volume was reduced to 4 mL/kg and respiratory rate was increased to 15/min. Liver transection was performed under total or selective inflow occlusion.

Main Outcome Measure  Blood loss.

Results  Between the normoventilation and hypoventilation groups, no significant difference was found in total blood loss (median [range]: 630 mL [72-3600 mL] vs 630 mL [120-3520 mL]; P = .44) or blood loss per transection area (median [range]: 7.3 mL/cm² [1.2-55.4 mL/cm²] vs 9.8 mL/cm² [0.9-79.9 mL/cm²]; P = .55). During liver transection, the central venous pressure was significantly reduced in the hypoventilation group than in the normoventilation group (median [range]: –0.7 cm H₂O [–3.0 to 1.8 cm H₂O] vs –0.2 cm H₂O [–4.0 to 2.0 cm H₂O]; P = .007). The maximum end-tidal carbon dioxide level in the hypoventilation group was significantly higher than that in the normoventilation group (maximum [range]: 50 mm Hg [28-66 mm Hg] vs 37 mm Hg [27-60 mm Hg]; P<.001). Transection time, postoperative liver function, hospitalization length, morbidity, and mortality were similar in the 2 groups.

Conclusion  This randomized trial suggested no beneficial effect of reduction of tidal volume on bleeding during hepatic resection.

From the Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Departments of Surgery (Drs Hasegawa, Takayama, Sano, Sugawara, Imamura, Kubota, and Makuuchi) and Anesthesiology (Dr Orii), Faculty of Medicine, University of Tokyo, Tokyo, Japan.

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