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Fluid therapy optimization in the perioperative period has been considered as major contributor to improve oxygen delivery. A recent, noninvasive approach to estimate fluid requirements in the anesthetized patient with arterial line is the assessment of difference in pulse pressure (dPP). Intraoperative fluid management by dPP is a goal-directed fluid management approach to avoid both hypervolemia and hypovolemia. However, several clinical factors may impede dPP measurements. Surgical manipulations in abdominal procedures may interfere with hemodynamic stability due to obstruction of the caval vein. Physiological considerations make us hypothesize that only intense pressure impedes caval blood flow and thus hemodynamics and dPP. Therefore, the investigators want to assess those changes after standardized application of three different pressure levels (2 N, 5 N, 10 N) on the caval vein.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Changes of difference in pulse pressure and plethysmography after applying various pressure levels on the caval vein | Other | Following hepatic resection, a fitting area for pressure application on the caval vein will be identified by the attending surgeon. Baseline assessments of hemodynamic and heart-lung interaction parameters will be taken. Thereafter the surgeon will apply three different pressure levels (2 N, 5 N, 10 N) at random with a force gauge (Fa. ATP Messtechnik, Ettenheim, Germany). Assessment of the parameters will be performed after 2 minutes of pressure application by an investigator, unaware of the pressure applied. After each pressure application 5 minutes will be waited to assure hemodynamic recovery. |
| Measure | Description | Time Frame |
|---|---|---|
| Change of dPP from start of intervention to 2 minutes after start of the intervention | Application of pressure for 2 minutes |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Lydia T. Strys, MD | Universitaetsmedizin - Johannes Gutenberg University Mainz (Department of Anesthesiology) | Principal Investigator |
| Dorothea Closhen, MD, PhD | Universitaetsmedizin - Johannes Gutenberg University Mainz (Department of Anesthesiology) | Principal Investigator |
| Gunther Pestel, MD, PhD | Universitaetsmedizin - Johannes Gutenberg University Mainz (Department of Anesthesiology) | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Universitaetsmedizin - Johannes Gutenberg University Mainz (Department of Anesthesiology) | Mainz | 55131 | Germany |
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| ID | Term |
|---|---|
| D001794 | Blood Pressure |
| ID | Term |
|---|---|
| D055986 | Vital Signs |
| D010808 | Physical Examination |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
| D006439 | Hemodynamics |
| D002320 | Cardiovascular Physiological Phenomena |
| D002943 | Circulatory and Respiratory Physiological Phenomena |
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