Abstract

Hemodynamic monitoring during normothermic vascular exclusion of the liver, with or without clamping of the upper part of the abdominal aorta appears mandatory, based upon an experience with ten patients. Nine patients underwent extensive liver resection for major tumors unsuitable for conventional surgical procedures. No operative accidents were observed. Permanent monitoring during the procedure included pulmonary artery pressures, radial artery pressures, heart rate and cardiac output, measured by the thermodilution method. Hemodynamic changes after short isolated venous or aortic and combined clampings were also studied. With this procedure, the most critical period occurred immediately after the release of the clamps, with a major rise in the pulmonary artery pressures, which led to hemodynamic pulmonary edema level. The acute modifications of circulating blood volume actually carried a high risk of vascular overloading, and the most reliable method to avoid this was the permanent control of the pulmonary artery pressures. Blood volume replacement was, at its best, adjusted with the use of such a parameter, especially when hemorrhage was important. Combined aortic clamping reduced blood losses and minimized pooling in the splanchnic area and the lower extremities.