Maintaining perioperative normothermia during laparoscopic and open urologic surgery.

PURPOSE The ability to maintain normothermia during surgical procedures is crucial for improvement of the quality of patient care and the outcome of the procedure. We tested the hypothesis of whether one warming protocol is able to maintain normothermic core temperatures equally well in major open and laparoscopic urologic procedures. PATIENTS AND METHODS In this prospective study, 300 patients who were scheduled for open (n=53) or laparoscopic (n=247) urologic procedures were included and received intraoperative warming using a combination of an upper and lower body forced-air warmer and a single warming blanket. Core temperature was measured at baseline, at induction of anesthesia, at the start of the operation, and at the end of the operation. RESULTS A significant improvement in core temperature during the operation was achieved in all patients (P<0.001). There was no difference in the end-of-operation core temperature between laparoscopic and open procedures: (36.29 degrees C+/-0.03 degrees C v 36.23 degrees C+/-0.06 degrees C; P=0.224). Further, 23.3% of all patients had a core temperature of lower than 36.0 degrees C at the end of the operation (laparoscopy 23.8% v open 26.6%). Linear regression analysis revealed a correlation between duration of the operation and intraoperative core temperature (P<0.001). CONCLUSION The present warming protocol is effective in maintaining perioperative normothermia during major open and laparoscopic urologic procedures.

[1]  P. Ituarte,et al.  Intraoperative thermal regulation in patients undergoing laparoscopic vs open surgical procedures , 2001, Surgical Endoscopy.

[2]  D. Sessler,et al.  Perioperative thermoregulation and temperature monitoring. , 2006, Anesthesiology clinics.

[3]  M. Goldblatt,et al.  Heating and humidifying of carbon dioxide during pneumoperitoneum is not indicated , 2005, Surgical Endoscopy And Other Interventional Techniques.

[4]  D. Farley,et al.  Double-blind, prospective, randomized study of warmed, humidified carbon dioxide insufflation vs standard carbon dioxide for patients undergoing laparoscopic cholecystectomy. , 2004, Archives of surgery.

[5]  Barbara Kabon,et al.  Effects of a Circulating-water Garment and Forced-air Warming on Body Heat Content and Core Temperature , 2004, Anesthesiology.

[6]  G. Maddern,et al.  Hypothermia induced by laparoscopic insufflation , 1995, Surgical Endoscopy.

[7]  T. Matsukawa,et al.  Warming by resistive heating maintains perioperative normothermia as well as forced air heating. , 2003, British journal of anaesthesia.

[8]  Y. Chan,et al.  A Comparative Study of Three Warming Interventions to Determine the Most Effective in Maintaining Perioperative Normothermia , 2003, Anesthesia and analgesia.

[9]  H. Winfield,et al.  Thermostasis during laparoscopic urologic surgery. , 2002, Journal of endourology.

[10]  G. Fanelli,et al.  Temperature control and recovery of bowel function after laparoscopic or laparotomic colorectal surgery in patients receiving combined epidural/general anesthesia and postoperative epidural analgesia. , 2002, Anesthesia and analgesia.

[11]  J. Hayes,et al.  Thermal efficiency of prewarmed cotton, reflective, and forced-warm-air inflatable blankets in trauma patients. , 2002, International journal of trauma nursing.

[12]  B. Wolfe,et al.  Effect of heated and humidified carbon dioxide gas on core temperature and postoperative pain , 2002, Surgical Endoscopy.

[13]  R. Stitz,et al.  Hypothermia in open and laparoscopic colorectal surgery , 1999, Diseases of the colon and rectum.

[14]  R. Moss,et al.  Preventing inadvertent hypothermia—a success story , 1999 .

[15]  L. Mettler,et al.  Measurement of CO(2) hypothermia during laparoscopy and pelviscopy: how cold it gets and how to prevent it. , 1999, The Journal of the American Association of Gynecologic Laparoscopists.

[16]  G. Maddern,et al.  Core temperature changes during open and laparoscopic colorectal surgery , 1999, Surgical Endoscopy.

[17]  J. Lincoln,et al.  Prevalence of inadvertent hypothermia during the perioperative period: a quality assurance and performance improvement study. , 1998, Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses.

[18]  G. Fanelli,et al.  Hypothermia prevention and treatment , 1998, Anaesthesia.

[19]  D. Sessler,et al.  Mild perioperative hypothermia. , 1997, The New England journal of medicine.

[20]  M. Mäkinen.  Comparison of body temperature changes during laparoscopic and open cholecystectomy , 1997, Acta anaesthesiologica Scandinavica.

[21]  Hunt Tr,et al.  Laparoscopic hypothermia: heat loss from insufflation gas flow. , 1997 .

[22]  D. Sessler.  Perioperative thermoregulation and heat balance , 1995, The Lancet.

[23]  L. Fleisher,et al.  The Catecholamine, Cortisol, and Hemodynamic Responses to Mild Perioperative Hypothermia: A Randomized Clinical Trial , 1995, Anesthesiology.

[24]  A. Kurz,et al.  Postoperative hemodynamic and thermoregulatory consequences of intraoperative core hypothermia. , 1994, Journal of clinical anesthesia.

[25]  I. Constant,et al.  Evaluation of the efficacy of a forced-air warmer (Bair Hugger) during spinal surgery in children. , 1994, Journal of clinical anesthesia.

[26]  F. Carli,et al.  Prevention of hypothermia during hip surgery: effect of passive compared with active skin surface warming. , 1994, British journal of anaesthesia.

[27]  D. Himpe,et al.  Bair hugger forced-air warming maintains normothermia more effectively than thermo-lite insulation. , 1994, Journal of clinical anesthesia.

[28]  A. Kurz,et al.  Forced-air warming maintains intraoperative normothermia better than circulating-water mattresses. , 1993, Anesthesia and analgesia.

[29]  J. Monagle,et al.  Carbon dioxide, temperature and laparoscopic cholecystectomy. , 1993, The Australian and New Zealand journal of surgery.

[30]  A. Lienhart,et al.  Prevention of Intraoperative Hypothermia by Preoperative Skin-Surface Warming , 1992, Anesthesiology.