الفهرس 
LIBERAL FLUID THERAPYOnly 14 pages are availabe for public view
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Abstract
In Egypt, hepatic resection is increasingly performed for liver cell malignancy mainly due to hepatitis C, while few are due to metastatic lesions in contrast to the western countries. Lowering the central venous pressure (CVP) during liver dissection is the traditional practice for decades to reduce hepatic congestion and blood loss. CVP is affected by several factors besides its known morbidity risks as an invasive approach. The need to improve the technology of noninvasive or minimal invasive monitoring is essential to coup with the current developments in laparoscopic and robotic surgery.
The primary goal is to compare Trans esophageal Doppler (TED) corrected flow time (FTc, msec) vs. Pleth variability index (PVI, %) for guiding intraoperative fluids during liver resection. Secondary to study correlations, agreements, complications, Intensive care unit (ICU) stay and ability to discriminate patients with increased blood loss.
Forty-seven adults, hepatitis C cirrhosis (Child A) scheduled for elective open liver resection, randomized into TED (n=20) or PVI (n=20). PVI is blinded to the Anesthetist in TED and vice versa. Prior and during dissection crystalloids are restricted to keep FTc <330 msec or PVI >14%. Following resection hydroxyethyl starch (HES) is infused if FTc <330 msec or PVI >14% despite 6 ml/kg/h crystalloids.