Feasibility of using head up patient position in maintaining low central venous pressure and restricting the need for pharmacological agents during major hepatectomy.

Backgrounds/Aims: Head-up position is used with fluid restriction and medications to achieve low central venous pressure (LCVP). We evaluated application of head-up position for its effectiveness, safety and potential to reduce need for complex drug interventions in achieving LCVP during hepatectomy. Methods: This prospective study included 50 patients undergoing major hepatectomies from 2019 to 2024. CVP was measured in supine, 10 cm and 20 cm head-up positions during liver resection. We assessed relationship between supine CVP and head-up positions with the need for supplemental pharmacological intervention using regression analysis. Additionally, we evaluated correlation between LCVP fluctuation, blood loss, and head-up position. Results: Mean blood loss was 204.6 ± 29.2 mL, with no incidents of air embolism, hemodynamic instability, renal dysfunction, blood transfusion, or 90-day mortality. Mean CVP values were 7.370 ± 4.094 mmHg in supine, 3.360 ± 4.304 mmHg at head-up 10 cm, and -0.780 ± 4.663 mmHg at head-up 20 cm positions, demonstrating a progressive reduction with each position ( Conclusions: LCVP can be effectively achieved using a 20 cm head-up position, with the potential to limit drug usage in the majority of patients.