Determination of blood flow of the common HA and PV was carried out simultaneously before starting PM or IP (baseline) as well as 10 min after IP (only group B), and at 15 min of reperfusion as well as before abdominal closure FTY720 162359-56-0 (group A, 32 �� 4 min; group B, 29 �� 6 min after declamping the portal triad) using the transit-time flowmeter (CardioMed CM 2005; MediStern AS, Oslo, Norway). This device measures the difference in travel time between pulses transmitted in the direction of, and against, the flow. The blood flow velocity is directly proportional to the measured difference between upstream and downstream transit times. Because the cross-sectional area of the probe/vessel was known as the probes were individually adapted to the vessel diameter, the product of that area and the flow velocity provided a measure of volumetric flow.
The calculations were easily performed by a microprocessor-based converter and displayed online on a computer during surgery. Study design The targeted endpoints were the occurrence of IP- and PM-related flow changes of the HA and PV at defined time points. Secondary endpoints were serum levels of alanine aminotransferase (ALT) on postoperative day 1 and complication rates. Operations were performed by 4 experienced abdominal surgeons in a routine clinical setting. Transection was started immediately after inducing PM which was maintained until the transection was finished. Parenchymal transection was performed using a water jet cutter (Saphir Medical, Lyon, France). The volume of the resected liver was determined by the quantity of displaced fluid in a pre-filled trough.
All anesthetic procedures were performed by the same team of experienced anesthesiologists ensuring a standardized protocol. To meet intraoperative fluid demand and to compensate for blood loss, crystalloids and colloidal solutions, respectively, were infused as described elsewhere. Adequate mean arterial pressure (MAP > 65 mmHg), central venous pressure (CVP 9-14 mm Hg), and diuresis (> 100 mL/h) were maintained throughout the operation by fluid infusion and, when necessary, by administration of vasopressors (dopamine 2-3 ��g/kg per hour and/or norepinephrine) as appropriate. Laboratory parameters of hepatocellular injury (ALT) and liver function (bilirubin) were obtained before surgery and on postoperative days 1, 2 and 7.
Transient liver failure was defined as bilirubin levels > 5 mg/dL and/or prothrombin activity < 40% for at least 3 postoperative days. Dacomitinib Fatal liver failure was defined as death from irreversible hepatic dysfunction in the absence of other causes. Statistical analysis Numerical values are presented as mean and standard deviation unless otherwise noted. All significance tests were 2-sided and a P-value < 0.05 was considered statistically significant.