Beneficial effect of fluid warming in elderly patients with bladder cancer undergoing Da Vinci robotic-assisted laparoscopic radical cystectomy

OBJECTIVES: The enhanced recovery after surgery (ERAS) protocol recommends prevention of intraoperative hypothermia. However, the beneficial effect of maintaining normothermia after radical cystectomy has not been evaluated. This study aimed to investigate the efficacy of fluid warming nursing in elderly patients undergoing Da Vinci robotic-assisted laparoscopic radical cystectomy. METHODS: A total of 108 patients with bladder cancer scheduled to undergo DaVinci robotic-assisted laparoscopic radical cystectomy were recruited and randomly divided into the control group (n=55), which received a warming blanket (43°C) during the intraoperative period and the warming group (n=53), in which all intraoperative fluids were administered via a fluid warmer (41°C). The surgical data, body temperature, coagulation function indexes, and postoperative complications were compared between the two groups. RESULTS: Compared to the control group, the warming group had significantly less intraoperative transfusion (p=0.028) and shorter hospitalization days (p<0.05). During the entire intraoperative period (from 1 to 6h), body temperature was significantly higher in the warming group than in the control group. There were significant differences in preoperative fibrinogen level, white blood cell count, total bilirubin level, intraoperative lactose level, postoperative thrombin time (TT), and platelet count between the control and warming groups. Multivariate linear regression analysis demonstrated that TT was the only significant factor, suggesting that the warming group had a lower TT than the control group. CONCLUSION: Fluid warming nursing can effectively reduce transfusion requirement and hospitalization days, maintain intraoperative normothermia, and promote postoperative coagulation function in elderly patients undergoing Da Vinci robotic-assisted laparoscopic radical cystectomy.

Effects of forced-air prewarming combined with fluid warmingon body temperature and thermal comfort in patients undergoing lobectomy / 基础医学与临床

Objective To investigate the effects of forced-air prewarming combined with fluid warming on body temperature and thermal comfort in patients undergoing lobectomy.Methods Forty six patients scheduled for video-assisted thoracoscopic surgery (VATS) of lobectomy were randomized into two groups (n=23 each):warming group (group T) and the control group (group C).Forced-air prewarming combined with infusion heating was applied in the warming group,while only conventional passive warming was used in control group.The tympanic membrane temperatures were recorded before prewarming,after prewarming, during the anesthesia, the end of operation, the moment in and out of the postanesthesia care unit (PACU).Incidence of postoperative shivering, thermal comfort and the time in the PACU were recorded.Results The warming group had a slower temperature decrease at 1,2, 3 hours after operation and end of operation(P< 0.01), warming group had significantly lower incidence of hypothermia and shivering than control group(8.7% vs 56.5%, 4.3% vs 34.8%,P<0.05),and the thermalcomfort score was higher in warming group than in control group(8.52±0.94 vs 7.65±0.83,P<0.05).Conclusions Forced-air prewarming combined with fluid warming has significant clinical effects to stabilize patients` body temperature during operations,to reduce the incidence of hypothermia and shivering and to improve the thermal comfort, which provides a simple and effective temperature protection strategy for patients undergoing lobectomy.

Clinical evaluation of a newly designed fluid warming kit on fluid warming and hypothermia during spinal surgery / 대한마취과학회지

BACKGROUND: The Mega Acer Kit(R) (MAK) is a newly designed heated and humidified breathing circuit that warms fluid passing through the circuit lumen. In this study, we investigated the system's efficacy for the perioperative prevention of hypothermia and fluid warming. METHODS: Ninety patients undergoing spinal surgery were enrolled in this study and randomly assigned to 3 groups based on the fluid warming device used: no fluid warming system (Group C, n = 30), via a Standard Ranger (Group R, n = 30), or via the MAK (Group M, n = 30). Distal esophageal temperatures (Teso) and infusion fluid temperature (TF) were recorded at 15 min intervals for duration of 180 min during surgery. If Teso was < 35.0degrees C, a forced-air convective warming device was used. RESULTS: Final Teso values were 34.8 +/- 0.3degrees C, 35.1 +/- 0.1degrees C, and 35.8 +/- 0.3degrees C in groups C, R, and M, respectively (P < 0.01). Teso was significantly higher in group M when compared with that in groups C and R throughout the study period (P < 0.05). The number of patients requiring a forced-air convective warming device was significantly lower in group M (n = 0) when compared with that in groups R (n = 17) and C (n = 30) (P < 0.05). The final infusion fluid temperature was higher in group M when compared with that in groups C and R throughout the study period (35.4 +/- 1.0 vs. 23.0 +/- 0.3 and 32.8 +/- 0.6degrees C; P < 0.01). CONCLUSIONS: The MAK is more effective for preventing hypothermia and for warming fluid than the Standard Ranger.

The Effects of Temperature Monitoring Methods and Thermal Management Methods during Spinal Surgery / 대한마취과학회지

BACKGROUND: The precise measurement of body temperature during anesthesia is important to prevent hypothermia.The aim of this study was to compare the urinary bladder temperature to the esophageal, nasopharyngeal, rectal and skin temperatures, and to compare three heating methods during spine surgery. METHODS: Forty-two patients with ASA physical status I-II, who were scheduled to undergo spine surgery in the prone position, were included in this study.The patients were randomly divided into 4 groups:Group I was treated without any heating methods; group 2, with fluid-warmers; group 3, with forced air-warmers; and group 4, with a combination of both heating methods.After the induction of anesthesia, the esophageal, nasopharyngeal, rectal, urinary bladder and skin temperature was monitored every 15 minute for 3 hours.The urinary bladder temperature was compared to the esophageal, nasopharyngeal, rectal and skin temperatures. RESULTS: The urinary bladder temperature was found to be higher than the esophageal and the nasopharyngeal temperatures (P < 0.01).The urinary bladder temperature of group 3 was higher than that of group 1 at 180 minutes after induction of anesthesia (P < 0.05).The urinary bladder temperature of group 4 was higher than that of group 1 at 150 minutes (P < 0.05), as well as at 165 and 180 minutes (P < 0.05).The skin temperatures of groups 3 and 4 were higher than group 1 (P < 0.001). CONCLUSIONS: The urinary bladder temperature was higher than the esophageal temperature and correlated with the esophageal, nasopharyngeal and rectal temperatures.During spine surgery in the prone position, a forced air-warmer was found to be the most effective but a combination of all the methods tested was found to be even more effective.