Objective: We conducted a prospective investigation of the effects of changes in surgical position on central venous pressure (CVP) and stroke volume variation (SVV) and the correlation between CVP and SVV.
Methods: Subjects were patients who underwent elective hepatectomy at the St. Marianna University School of Medicine Hospital from November 25, 2020 to December 31, 2022. The relevant measurements were taken after induction of anesthesia and prior to the surgery. After induction, measurements of blood pressure, pulse, SVV, and CVP were taken while the operating table was placed in a reverse Trendelenburg position at angles of 0°, 5°, and 10°. A Flo TracTM sensor (Edwards Lifesciences, Irvine, CA, USA) was used to measure SVV.
Results: When the patient was placed in a reverse Trendelenburg position at 10°, the CVP decreased by a mean of -1.6 (±0.7) mmHg, whereas the SVV increased by a mean of 2.9 (±1.6) %. A negative correlation was observed between the width of variation of CVP and SVV (r=-0.31, R2 value=0.10) and between the CVP and SVV values (r=-0.30, R2 value=0.09). We also noted that the mean CVP decreased by 5 mmHg at 10° among patients in whom the CVP was less than 7.5 mmHg and the SVV was greater than 10% when the patients were placed at 0°.
Conclusion: We determined that both CVP and SVV values changed when patients were moved into the reverse Trendelenburg position. Our findings also showed that the CVP and width of variation of CVP and SVV due to patient placement into the reverse Trendelenburg position were both affected by physique. These results suggest that among patients in whom the CVP was <7.5 mmHg at 0°, an adequately low CVP value can be maintained using only the reverse Trendelenburg position, thus allowing hepatectomy to be performed safely.
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