الفهرس 
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Abstract
Major hepatic Resections have been associated with increased intraoperative blood loss. Most reported series describe transfusion rates of 40% 100% among patients undergoing this type of surgery. Any strategy that reduces blood loss during liver resection would benefit both the patient and the surgeon. Forty patients of either sex aging from (2070) years were admitted to gastroenterology surgical center in Mansoura University for liver resection. All patients received oral midazolam 7mg tablet at the night of operation. Premedication with (Atropine 0.04 mg/kg & Fentanyl 1<U+00B5>g /kg & midazolam 0.07 mg/kg). Patients were randomly divided into two groups (each of 20) according to the use of hypotensive technique or not. All patients were anaesthetised by the same anaesthetic technique. Anaesthesia was induced with Thiopentone sodium (5mg /kg) and intubation facilitated by using Suxamethonium (1 mg /kg). Anaesthesia was Maintained with 50% N2O in O2 and Sevoflurane and atracurium (0.5mg/kg). Ventilation was adjusted to maintain end tidal carbon dioxide around 30 mmHg. When steady state of anaesthesia (No changes in haemodynamic variables took place for at least ten minutes) was obtained, the mean blood pressure was reduced in steps of approximately 5mmHg by nitroglycerine loading dose(1<U+00B5>g/kg) over 12 minutes followed by infusion of 0.5 2 <U+00B5>g/kg /minute and adjusted to maintain mean blood pressure around 60mmHg. At the end of resection, infusion of nitroglycerine was stopped and arterial pressure returned towards normal values to allow surgical heamostasis to be achieved. The same surgeon performed all the operations. Haemodynamics and blood gasometric parameters were recorded at preinduction, postinduction every 30 minutes intraoperatively, postextubation by 30 minute and postoperatively in the second and third days. Biochemical parameters recorded at the preoperative period (basal), first, third and seventh days postoperatively. The blood loss was measured at the end of operation by the sum of three variables, volume of blood in the return bottle of the ultrasonic aspirator, volume of blood in the suction bottles and volume of blood in the wet swabs. Our results shows that there is an altration in liver function tests in the studied groups and this altration improved gradually postoperatively at the 7th day. Threre is decrease in blood loss, transfusion requirments and mean operative time in the hypotensive group in comparison to the control one. Liver resection can be carried out without blood transfusion. However we cannot deny the role of surgeon. In this work surgical experience is a major factor contributing to the very low mortality rate that are now achieved.