Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands; Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, the Netherlands.
Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, the Netherlands.
Surgery. 2019 Feb;165(2):337-344. doi: 10.1016/j.surg.2018.08.013. Epub 2018 Oct 9.
Fluid and pain management during liver surgery (eg, low central venous pressure) is a classic topic of controversy between anesthesiologists and surgeons. Little is known about practices worldwide. The aim of this study was to assess perioperative practices in liver surgery among and between surgeons and anesthesiologists worldwide that could guide the design of future international studies.
An online questionnaire was sent to 22 societies, including 4 international hepatopancreatobiliary societies, the American Society of Anesthesiologists, and 17 other (inter-)national societies.
A total of 913 participants (495 surgeons and 418 anesthesiologists) from 66 countries were surveyed. A large heterogeneity in fluid management practices was identified, with 66% using low central venous pressure, 22% goal-directed fluid therapy, and 6% normovolemia. In addition, large heterogeneity was found regarding pain management practices, with 49% using epidural analgesia, 25% patient-controlled analgesia with opioids, and 12% regional techniques. Most participants assume that there is a relation between perioperative pain management and morbidity and mortality (78% of surgeons vs 89% of anesthesiologists; P < .001). Both surgeons and anesthesiologists have the highest expectations for minimally invasive surgery and enhanced recovery pathways for improving outcomes in liver surgery. No clear differences between continents were found.
Worldwide there is a large heterogeneity in fluid and pain management practices in liver surgery. This survey identified several areas of interest for future international studies aiming to improve outcomes in liver surgery.
肝脏手术期间的液体和疼痛管理（例如，低中心静脉压）是麻醉师和外科医生之间经典的争议话题。目前对全球的实践情况知之甚少。本研究旨在评估全球外科医生和麻醉师在肝脏手术中的围手术期实践，以便为未来的国际研究提供指导。
向 22 个协会（包括 4 个国际肝胆胰协会、美国麻醉师协会和 17 个其他（国际）协会）发送了在线问卷。
共有来自 66 个国家的 913 名参与者（495 名外科医生和 418 名麻醉师）接受了调查。发现液体管理实践存在很大的异质性，66%的人使用低中心静脉压，22%的人使用目标导向液体治疗，6%的人使用正常血容量。此外，在疼痛管理实践方面也存在很大的异质性，49%的人使用硬膜外镇痛，25%的人使用阿片类药物的患者自控镇痛，12%的人使用区域技术。大多数参与者认为围手术期疼痛管理与发病率和死亡率之间存在关联（外科医生中 78%，麻醉师中 89%；P <.001）。外科医生和麻醉师都对微创手术和增强康复途径寄予厚望，以期改善肝脏手术的结果。没有发现各大陆之间存在明显差异。
全球范围内，肝脏手术中的液体和疼痛管理实践存在很大的异质性。本调查确定了几个未来国际研究的重点领域，旨在改善肝脏手术的结果。
