The advantages of hemodilution anesthesia for major liver resection in children

• Published in: Journal of pediatric surgery Vol. 19; no. 6; pp. 705 - 710
• Main Authors: Schaller, Robert T., Schaller, Joanne, Furman, Eric B.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.12.1984; Elsevier
• Subjects: Abdominal surgery. Urology. Gynecology. Obstetrics; Anesthesia; Anesthesia depending on type of surgery; Anesthesia, General; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Carcinoma, Hepatocellular - surgery; Child; Child, Preschool; Hamartoma - surgery; Hemodilution; Hemodilution anesthesia; Humans; Infant; Liver - surgery; Liver Neoplasms - surgery; liver tumor; Medical sciences; liver tumor; Hemodilution anesthesia; Human; Digestive system; Extensive resection; Surgery; Liver; General anesthesia; Hemodilution; Child
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/S0022-3468(84)80356-5

Since 1977, eight children have had major liver resections with the aid of normovolemic hemodilution anesthesia. Five children were 7 months of age or less; the other three were 3 1/2, 8, and 12 years old. This includes three operations for hepatoblastoma, three for hepatoma, and two for mesenchymal hamartoma. There were three right lobectomies, two trisegmentectomies, two extended left lobectomies, and one standard left lobectomy. With the use of this method, operative blood loss has been greatly reduced and operating technique significantly improved. After abdominal exploration and initial liver mobilization, whole blood is removed from the patient and simultaneously replaced with three times the volume of Ringer's lactate solution to maintain adequate intravascular volume. After the major blood loss has ceased, the patient is reinfused with his own blood and a simultaneous diuresis is induced with LASIX to remove the previously administered crystalloid solution. Metabolic demand is reduced by allowing the patient's temperature to drift down to 32 °C. Blood loss is further reduced by a Halothane-induced hypotension to a mean arterial pressure of 40 to 50 torr. The diluted blood lost during surgery has a low red blood cell volume per cc; therefore, each cc of blood lost depletes the total red cell volume by a lesser amount. This results in a nearly bloodless operative field which facilitates the ease, speed, and safety of the dissection. Use of this technique can avoid the need for massive intraoperative transfusions and the threat of cardiac arrest due to extensive blood loss during major liver resection in children. Bank blood rransfusion was necessary in only three of the eight patients and the quantity of PRBC was 125 ccs or less in each instance. Recent experience with chemotherapy for liver malignancies has emphasized the importance of gross total resection of the tumor if one is to achieve a cure. Liver tumor resection can be accomplished safely and completely with minimal blood loss using acute normovolemic hemodilution anesthesia.