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Published on: June 16, 2023
High Stroke Volume Variation Method by Mannitol Administration Can Decrease Blood Loss During Donor Hepatectomy.
Hyungseok Seo1, In-Gu Jun, Tae-Yong Ha
1From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital (HS); Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine (I-GJ, Y-KK); and Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (T-YH, SH, S-GL).
High stroke volume variation (SVV) guided by mannitol administration significantly reduces blood loss during donor hepatectomy. This method enhances surgeon satisfaction without increasing adverse postoperative outcomes, proving effective and safe.
Area of Science:
- Transplantation Surgery
- Anesthesiology
- Nephrology
Background:
- Optimizing fluid management is crucial for donor safety during hepatectomy, aiming to minimize blood loss.
- Mannitol's osmotic diuretic properties can help prevent excessive intravascular volume.
- Evaluating advanced fluid management strategies like high stroke volume variation (SVV) is essential.
Purpose of the Study:
- To assess the efficacy of maintaining high stroke volume variation (SVV) using mannitol and fluid restriction in reducing blood loss during donor hepatectomy.
- To compare intraoperative blood loss, surgeon satisfaction, and postoperative outcomes between two fluid management strategies.
Main Methods:
- A prospective study involving 64 donor hepatectomy patients, divided into two groups.
- Group A: SVV maintained at 10%–20% with mannitol and fluid restriction (2–4 mL/kg/h).
- Group B: SVV maintained <10% with higher fluid administration (6–10 mL/kg/h) without diuretics.
Main Results:
- Group A exhibited significantly higher SVV (11.0 ± 1.7% vs. 6.5 ± 1.1%, P < 0.001) and lower red cell mass loss (145.4 ± 107.6 mL vs. 307.9 ± 110.7 mL, P < 0.001).
- Surgeon satisfaction scores were significantly higher in Group A (2.8 ± 0.5 vs. 2.0 ± 0.6, P < 0.001).
- No significant differences were observed in acute kidney injury, chest radiographic findings, or hospital stay duration between groups.
Conclusions:
- Maintaining high SVV through mannitol administration and fluid restriction is an effective and safe strategy for reducing intraoperative blood loss in donor hepatectomy.
- This approach improves surgeon satisfaction without compromising key postoperative patient outcomes.
