Fluid Replacement Therapy and Hepatic Venous Oxygen Saturation Monitoring in the Management of Hepato-Pancreato-Duodenectomy

Masahiko Murakami and Nobuhiro Sato

Department of surgery 1, Iwate Medical University, School of Medicine

In an attempt to prevent postoperative complications after hepato-pancreato-duodenectomy (HPD), we have employed voluminous replacement of fluid containing inotropic agents in the early postoperative period. Our basic strategy was to give fluids at a minimum target dose of 15 ml/kg/hr during surgery and 5 ml/kg/hr plus dopamine and dobutamine at 3-5 μ g/kg/min on the day after surgery. In this study, we determined the cardiopulmonary parameters and hepatic blood supply in 13 cases of HPD. The hepatic venous oxygen saturation (ShvO₂) was determined by using an optical catheter implanted in the hepatic vein for continuous monitoring. The postoperative systemic hemodynamic condition indicated hyperdynamic circulation, the oxygen delivery index was kept over 600 ml/min/m² and the oxygen consumption index was maintained over 135 ml/min/m². The arterial ketone body ratio registered minimum values of 0.53±0.06 (mean±SE) during surgery, then rapidly recoverd to over 1.0 after surgery. The total time of ShvO₂ below 60% (t-ShvO₂≤60) was 56.0±16.2 min during surgery, but it did not fall below 60% after surgery. Postoperative peak serum total bilirubin (peak-Bil) and IL-6 (peak-IL-6) were 6.2±1.8 mg/dl and 1,060±131 pg/ml, respectively. Regression analysis demonstrated a significant correlation between the t-ShvO₂≤60 and peak-Bil (r=0.740). A significant correlation also was noted between the t-ShvO₂≤60 and peak-IL-6 (r=0.938). Only one patient developed hepatic failure. There were no pulmonary complications or treatment-related deaths. These results show the importance of maintenance of the oxygen demand and supply and the usefulness of aggressive fluid replacement and ShvO₂ monitoring in HPD.

Key words
arterial ketone body ratio, hepato-pancreato-duodenectomy, hepatic venous oxygen saturation, inotropic agent

Reprint requests
Masahiko Murakami Department of Surgery 1, Iwate Medical University, School of Medicine 19-1 Uchimaru, Morioka, 020-0023 JAPAN

Accepted
October 14, 1998

To read the PDF file you will need Abobe Reader installed on your computer.