Core and Peripheral Temperature Changes with and without Wrapping the Lower Extremity during Open Abdominal Surgery under General Anesthesia / 대한마취과학회지

BACKGROUND: Core hypothermia after the induction of general anesthesia results largely from core-to- peripheral redistribution of body heat and anesthetic-induced inhibition of tonic thermoregulatory vasoconstriction. Because most metabolic heat is lost via the skin surface, covering the skin surface with an insulator is a way of minimizing heat loss. We therefore evaluated core and peripheral temperature changes with and without wrapping the lower extremity in cotton and elastic bandages during open abdominal surgery under general anesthesia. METHODS: Eighty-five patients of ASA physical status 1 or 2 who underwent open abdominal surgery under general anesthesia were investigated in this study. They were randomly assigned based on wrapping of the lower extremity in cotton and elastic bandages (group 2, n = 37) or not (group 1, n = 48). Anesthesia in both groups was induced with propofol and maintained with enflurane and 50% nitrous oxide in oxygen. The temperatures of the nasopharynx, forehead, chest, back, palm and sole were measured before and 10, 30, 60, 90, 120, 150 and 180 min after induction. RESULTS: Core temperature decreased significantly after the induction of anesthesia in both groups (P <0.05), but no significant difference was found between the groups in terms of core, palm, back and forehead skin temperature changes. However, the core and chest temperatures of group 2 at 150 and 180 min after induction were significantly lower than those of group 1 (P <0.05), and sole temperature changes were significantly different between the groups (P <0.05). CONCLUSIONS: Wrapping the lower extremity in cotton and elastic bandages during open abdominal surgery under general anesthesia was not effective at preventing the core temperature from decreasing. It is possible that wrapping the lower extremity causes peripheral vasodilation before anesthesia, stimulating the barorecepter, and shifting the body core temperature threshold for hypothermia inducing peripheral vasoconstriction to lower the body core temperature.

A Laparoscopic Cholecystectomy in a Patient with Aortic Dissection / 대한마취과학회지

We experienced a case of a laparoscopic cholecystectomy in a 64 year old woman with DeBakey type IIIb, Daily type B abdominal aortic dissection diagnosed at the emergency room. Isosorbide dinitrate and propranolol were given for control of blood pressure preoperatively. Fentanyl, propofol, atracurium, lidocaine, esmolol and isoflurane were used for smooth induction, and isoflurane in a mixture of O2, N2O (1:1) were inhaled for maintenance. Intraabdominal pressure for pneumoperitonium was kept to 10 mmHg which was lower than that of usual use. An A-line, ETCO2, pulse oximeter and thoracic bioimpedance were monitored. The patient was anesthetized safely and discharged 3 days after the operation. The hemodynamic changes during pneumoperitonium and it's correlation with aortic dissection are discussed.