This randomized controlled study's objective is to find a safer mechanical ventilation strategy to reduce intraoperative bleeding in liver cancer patients undergoing laparoscopic major liver resection. The hypothesis is that low tidal volume ventilation in laparoscopic major hepatectomy results in less bleeding.
Patients are randomized into the conventional tidal volume (tidal volume \[ml\]= ideal body weight \[kg\]\* 10\~12) group and low tidal (tidal volume \[ml\]= ideal body weight \[kg\] \* 6\~8) volume group and ventilated accordingly throughout the surgery. All patients undergo general anesthesia with propofol, remifentanil, and rocuronium and are intubated with an endotracheal tube (ID 7.0 for females, ID 7.5 for males). Anesthesia is maintained with sevoflurane, end tidal CO2 is targeted between 30-35mmHg. The radial artery is cannulated and connected to the Flotrac sensor and goal directed fluid therapy is done. The estimated blood loss is checked as the primary outcome. In addition postoperative complications, transfusion amounts, operation time, satisfaction of the surgeon and participants are also recorded.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
58
In the conventional tidal volume group, patients are ventilated with a tidal volume \[ml\]= ideal body weight \[kg\]\* 10\~12.
In the low tidal volume group, patients are ventilated with a tidal volume \[ml\]= ideal body weight \[kg\]\* 6\~8.
Seoul National University Hospital
Seoul, South Korea
Intraoperative blood loss
amount drained from peritoneal cavity - irrigation fluid
Time frame: during surgery
postoperative lung complications
atelectasis, pneumonia
Time frame: op end ~ postoperative 2 weeks
transfusion amount
RBC, FFP, platelet
Time frame: op. end ~ postoperative day 3
postoperative hemoglobin level
postoperative hemoglobin
Time frame: op. end ~ postoperative day 3
postoperative total bilirubin level
postoperative total bilirubin level
Time frame: op. end ~ postoperative day 3
postoperative PT INR level
postoperative PT INR level
Time frame: op. end ~ postoperative day 3
postoperative aspartate aminotransferase level
postoperative aspartate aminotransferase level
Time frame: op. end ~ postoperative day 3
postoperative alanine aminotransferase level
postoperative alanine aminotransferase level
Time frame: op. end ~ postoperative day 3
postoperative serum creatinine level
postoperative serum creatinine level
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Time frame: op. end ~ postoperative day 3
operation time
operation time
Time frame: during surgery
amount of crystalloids infused
amount of crystalloids infused
Time frame: during surgery
Satisfaction scale of the operator and participants
easy 0 - 10 difficult
Time frame: during surgery