Central venous pressure-guided fluid management in hepatectomy under remimazolam: Impact on postoperative renal and gastrointestinal recovery.
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BACKGROUND: This study aimed to evaluate the effect of central venous pressure (CVP)-guided fluid management on postoperative renal function and gastrointestinal (GI) recovery in patients with hepatocellular carcinoma (HCC) undergoing hepatectomy under remimazolam anesthesia. METHODS: This retrospective study analyzed data from 216 patients with HCC who underwent hepatectomy with remimazolam anesthesia at our hospital from January 2022 to December 2024. Patients were stratified into a CVP group (CVP-guided fluid management [n = 108]) and a control group (conventional fluid management [n = 108]). Postoperative renal outcomes (serum creatinine, urine output, and acute kidney injury [AKI] incidence) and GI recovery (time to first flatus, defecation, and bowel sound recovery) were compared. RESULTS: Compared with the control group, the CVP group exhibited significantly lower AKI incidence (31.48% vs 14.81%, respectively; P =.004), reduced serum creatinine at 24 and 48 h, and higher urine output postoperatively (P <.001). The total postoperative complication rates were lower in the CVP group than in the control group (23.15% vs 38.89%, respectively; P =.003), although GI recovery showed no intergroup differences. Subgroup analyses confirmed consistent renal benefits in American Society of Anesthesiologists grade II and III, Child-Pugh class A and B, laparoscopic, and high blood loss (≥500 mL) cohorts. CONCLUSION: CVP-guided fluid management under remimazolam anesthesia reduces the postoperative AKI risk, improves renal outcomes, and lowers postoperative complications in patients with HCC undergoing hepatectomy, demonstrating a safe and efficacious perioperative management strategy.