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Imai, Eriya; Morohashi, Yoshihito; Mishima, Kohei; Ozaki, Takahiro; Igarashi, Kazuharu; Wakabayashi, Go
Surgery today (Tokyo, Japan), 09/2022, Volume: 52, Issue: 9Journal Article
Purpose Postoperative acute kidney injury (AKI) remains a serious complication of liver resection with restrictive fluid therapy. However, unlike open hepatectomy, laparoscopic liver resection (LLR) does not have established anesthesia management strategies. We compared our goal-directed therapy (GDT) protocol for LLR with/without carperitide and the conventional restrictive method regarding AKI prevention. Methods The GDT thresholds in this retrospective observational cohort study were as follows: stroke volume variation, ≤ 15%; pulse pressure variation, ≤ 13%; oxygen delivery index, ≥ 600 mL/min/m 2 ; and mean arterial pressure (MAP), ≥ 55 mmHg. If the thresholds were not achieved, a 250 mL infusion fluid bolus was administered. The MAP target was changed to > 65 mmHg if the urine output was < 0.3 mL/kg/h. Postoperative AKI within 48 h and perioperative outcomes within 90 days were analyzed. Results Forty-seven propensity score-matched pairs from 127 patients were investigated. We adjusted for AKI risk factors and surgical difficulty; 46.8% of the GDT group received carperitide. The GDT group had a lower postoperative AKI rate (10.6% vs. 27.7%, P = 0.04) and shorter overall ( P = 0.04) and postoperative ( P < 0.01) hospital stays than the conventional group. Furthermore, the GDT group received more intraoperative fluid ( P = 0.001) and phenylephrine ( P = 0.02), without significant increases in blood loss and transfusion volume, than the conventional group. Conclusions GDT reduced the AKI rates post-LLR.
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