Effects of 37℃ Carbon Dioxide Pneumoperitoneum on Core Body Temperature, Systolic Blood Pressure, Heart Rate and Acid-Base Balance: A Randomized Double-blind Controlled Trial

PURPOSE: The purpose of this study was to compare the effects of 21℃ CO₂ and 37℃ CO₂ pneumoperitoneum on body temperature, blood pressure, heart rate, and acid-base balance. METHODS: Data were collected at a 1300-bed university hospital in Incheon, from February through September 2012. A total of 74 patients who underwent laparoscopic colectomy under general anesthesia with desflurane were randomly allocated to either a control group or an experimental group. The control group received 21℃ CO₂ pneumoperitoneum; the experimental group received 37℃ CO₂ pneumoperitoneum. The pneumoperitoneum of the two groups was under abdominal pressure 15 mmHg. Body temperature, systolic blood pressure, heart rate and acid-base balance were assessed at 30 minutes and 90 minutes after pneumoperitoneum, and again at 30 minutes after arriving at the Post Anesthesia Care Unit. RESULTS: Body temperature in the 37℃ CO2 pneumoperitoneum group was significantly higher (F=9.43, p<.001) compared to the 21℃ CO₂ group. However, there were no statistically significant differences in systolic blood pressure (p=.895), heart rate (p=.340), pH (p=.231), PaCO₂ (p=.490) and HCO3- (p=.768) between the two groups. CONCLUSION: Pneumoperitoneum of 37℃ CO₂ is effective for the increase of body temperature compared to pneumoperitonium of 21℃ CO₂, and it does not result in a decrease of blood pressure, heart rate or acid-base imbalance.

The Effects of Active Warming on Pain, Temperature, and Thermal Discomfort in Postoperative Patients after General Anesthesia for Abdominal Surgery / 중환자간호학회지

PURPOSE: This study investigated the effects of active warming using a Warm Touch warming system or a cotton blanket in postoperative patients after general anesthesia for abdominal surgery.METHODS: This quasi-experimental study utilized two experimental groups and one control group: a cotton-blanket group (n = 25) were warmed with a cotton blanket and a sheet; a forced-air warming group (n = 24) were warmed with a Warm Touch warming system, a cotton blanket, and a sheet; and a control group (n = 25) were warmed with a sheet. Measurement variables were postoperative pain, body temperature, and thermal discomfort. Data were analyzed using a one-way ANOVA, χ2-tests, Fisher's exact test, and a repeated measures ANOVA.RESULTS: The effects of active warming using a Warm Touch warming system and a cotton blanket on postoperative patients was significant in reducing pain (F = 13.91, p < .001) and increasing body temperature (F = 12.49, p < .001).CONCLUSION: Active warming made a significant difference in pain and body temperature changes. Active warming methods may help patients' postoperative recovery and prevent complications. Further research is needed to explore the effects and side effects of active warming on recovering normothermia.

Incidence of Hypothermia and Factors Associated with Body Temperature Changes during Surgery in Burned Patients

PURPOSE: The study aimed to evaluate the changes of body temperature and to identify the factors related to changes during surgery in burned patients. METHODS: A retrospective study was conducted by reviewing the medical records of 439 adult burned patients who had a surgery under general anesthesia at the Burn Center of a university hospital. RESULTS: After surgery, body temperature of the burned patients declined from 36.6℃ to 35.2℃; 52.2% were hypothermia. There were significant differences in the changes of body temperature according to the participants' characteristics including American society of anesthesiologists physical status, type of burn injury, total burn surface area, range of exposure, operation time, anesthesia time, amount of fluid, blood transfusion, use of tourniquet, and the method of warming therapy. Factors that influence the temperature changes were total burn surface area (β=0.26), operation time (β=0.25), amount of fluid (0.20), and warming therapy including ‘Room temperature setting + Heated circuit + Hot line’(β=0.09) and ‘Room temperature setting+one of others’(β=0.08). CONCLUSION: Burned patients experienced a decrease of their body temperature during surgery despite of warming therapy. A nursing protocol is needed to provide an appropriate warming therapy based on their characteristics in burned patients.

Core Temperature Evaluation in Different Body Parts in Patients Undergoing Laparoscope Surgery under Total Intravenous Anesthesia / 기본간호학회지

PURPOSE: The trend of body temperature change during laparoscopic surgery and the most adequate site for monitoring temperature measurements have not been investigated thoroughly. In this study body temperature change during laparoscopic surgery was measured and measurements of the tympanic, esophageal, and nasopharyngeal core temperatures in surgical patients with total intravenous anesthesia were compared. METHODS: From February to October 2013, 28 laparoscopic surgical patients were recruited from a tertiary hospital in Seoul. The patients' core temperature was measured 12 times at ten minute intervals from ten minutes after the beginning of endotracheal intubation. RESULTS: Repeated measure of core temperatures indicated a significant difference according to body part (p=.033), time of measure (p<.001) and the reciprocal interaction between body part and time of measure (p<.027). The core temperatures were highest at tympany location, lowest at nasopharynx. The amount of temperature change was least for the esophagus (36.10~36.33degrees C), followed by nasopharynx and tympany. CONCLUSION: The esophageal core temperature showed the highest stability followed by nasopharyngeal and tympanic temperature. Therefore, close observations are required between 10~20minutes after the beginning of the operation.

Comparison of two fluid warming devices for maintaining body core temperature during living donor liver transplantation: Level 1 H-1000 vs. Fluid Management System 2000 / 대한마취과학회지

BACKGROUND: Rapid fluid warming has been a cardinal measure to maintain normothermia during fluid resuscitation of hypovolemic patients. A previous laboratory simulation study with different fluid infusion rates showed that a fluid warmer using magnetic induction is superior to a warmer using countercurrent heat exchange. We tested whether the simulation-based result is translated into the clinical liver transplantation. METHODS: Two hundred twenty recipients who underwent living donor liver transplantation between April 2009 and October 2011 were initially screened. Seventeen recipients given a magnetic induction warmer (FMS2000) were matched 1 : 1 with those given a countercurrent heat exchange warmer (Level-1 H-1000) based on propensity score. Matched variables included age, gender, body mass index, model for end-stage liver disease score, graft size and time under anesthesia. Core temperatures were taken at predetermined time points. RESULTS: Level-1 and FMS groups had comparable core temperature throughout the surgery from skin incision, the beginning/end of the anhepatic phase to skin closure. (P = 0.165, repeated measures ANOVA). The degree of core temperature changes within the dissection, anhepatic and postreperfusion phase were also comparable between the two groups. The minimum intraoperative core temperature was also comparable (Level 1, 35.6degrees C vs. FMS, 35.4degrees C, P = 0.122). CONCLUSIONS: A countercurrent heat exchange warmer and magnetic induction warmer displayed comparable function regarding the maintenance of core temperature and prevention of hypothermia during living donor liver transplantation. The applicability of the two devices in liver transplantation needs to be evaluated in various populations and clinical settings.

Comparison of two fluid warming devices for maintaining body core temperature during living donor liver transplantation: Level 1 H-1000 vs. Fluid Management System 2000 / 대한마취과학회지

BACKGROUND: Rapid fluid warming has been a cardinal measure to maintain normothermia during fluid resuscitation of hypovolemic patients. A previous laboratory simulation study with different fluid infusion rates showed that a fluid warmer using magnetic induction is superior to a warmer using countercurrent heat exchange. We tested whether the simulation-based result is translated into the clinical liver transplantation. METHODS: Two hundred twenty recipients who underwent living donor liver transplantation between April 2009 and October 2011 were initially screened. Seventeen recipients given a magnetic induction warmer (FMS2000) were matched 1 : 1 with those given a countercurrent heat exchange warmer (Level-1 H-1000) based on propensity score. Matched variables included age, gender, body mass index, model for end-stage liver disease score, graft size and time under anesthesia. Core temperatures were taken at predetermined time points. RESULTS: Level-1 and FMS groups had comparable core temperature throughout the surgery from skin incision, the beginning/end of the anhepatic phase to skin closure. (P = 0.165, repeated measures ANOVA). The degree of core temperature changes within the dissection, anhepatic and postreperfusion phase were also comparable between the two groups. The minimum intraoperative core temperature was also comparable (Level 1, 35.6degrees C vs. FMS, 35.4degrees C, P = 0.122). CONCLUSIONS: A countercurrent heat exchange warmer and magnetic induction warmer displayed comparable function regarding the maintenance of core temperature and prevention of hypothermia during living donor liver transplantation. The applicability of the two devices in liver transplantation needs to be evaluated in various populations and clinical settings.

[ effects of temperature and birth weight on the transition rate of hypothermia in hospitalized neonates using Markov models]

Hypothermia is an important determinant of survival in newborns, especially among low-birth-weight ones. Prolonged hypothermia leads to edema, generalized hemorrhage, jaundice and ultimately death. This study was undertaken to examine the factors affecting transition from hypothermic state in neonates. The study consisted of 439 neonates hospitalized in NICU of Valiasr in Tehran, Iran in 2005. The neonates' rectal temperature was measured immediately after birth and every 30 minutes afterwards, until neonates passed hypothermia stages. In order to estimate the rate of transition from neonatal hypothermic state, we used multistate Markov models with two covariates, birth weight and environmental temperature. We also used R package to fit the model. Estimated transition rates from severe hypothermia and mild hypothermia were 0.1192 and 0.0549 per minute, respectively. Weight had a significant effect on transition from hypothermia to normal condition [95% CI: 0.1364-0.4165, P<0.001]. Environmental temperature significantly affected the transition from hypothermia to normal stage [95% CI: 0.0439-0.4963, P<0.001]. The results of this study showed that neonates with normal weight and neonates in an environmental temperature greater than 28°C had a higher transition rate from hypothermia stages. Since birth weight at the time of delivery is not under the control of medical staff, keeping the environmental temperature in an optimum level could help neonates to pass through the hypothermia stages faster

Temperature monitoring and perioperative heat loss

To assess the temperature fall at various stages in the perioperative period and identification of contributing factors. This observational study was carried out at Blackpool Victoria Hospital, UK from August 2005-January 2006 on 32 patients undergoing major lower limb vascular surgery. Semistructured data collection form was designed to record the time and tympanic temperature at different stages in perioperative period and the warming methods used. A median fall of 0.1°C [0-0.5°C] in core temperature was recorded in ward and theatre reception area. The median fall of temperature in the anaesthetic room was 0.3°C [0-.8°C]. Patients [n=16] spending more than 0.5 hour in the anaesthetic room had a significant [p=0.002] temperature drop recorded at 0.4°C as compared to 0.2°C for those spending less than 30 minutes. During operation, a median fall of temperature by 0.8°C [0.3-2.1°C] was recorded. Operations lasting for 2.5 hours or more [n=16] resulted 2 in a 1°C temperature fall as against 0.5°C for the rest. Seven patients, in whom a warming mat was used, had a temperature drop of 0.6°C compared to 0.35°C in patients who received warm touch. In the recovery unit, 23 patients had a further drop of 0.3°C, while 9 patients who were actively warmed gained 0.6°C. Significant heat loss occurs in the anaesthetic room relevant to the length of time consumed in anaesthetising the patient. Furthermore active warming measures in the perioperative period have a positive impact on maintaining core temperature

[Post anesthetic shivering in children: incidence and causative factors]

Patients loss their body heat during the anesthetic period and postoperative shivering is occurred to compensate it. To date, most of the studies about postoperative shivering were done in adults and there are limited data in pediatric patients. The aim of this study was to investigate the incidence of shivering in children and to reveal the causative factors as well as any possible clinical implications. This cross sectional study was performed on 200 pediatric patients with age ranging from 3 months to 14 years. Demographic data, kind of anesthesia, body temperature and recovery temperature were recorded. Data were analyzed using chi 2, Spearman and Pierson tests. The incidence of shivering was 7%. Shivering was significantly more in the patients receiving inspirational anesthesia [13.6%] than in the patients receiving intervenes anesthesia [0%] [p<0.05]. Shivering was high when body temperature was below 36.4°C or when recovery temperature was below 26°C [p<0.05]. The incidence of shivering in patients who received pre-medication was lower than that of in patients who received no medication [p<0.05]. The incidence of shivering in pediatric patients was related with their body temperature, recovery temperature, pre-medication and method of anesthesia

Effect of early bathing on temperature of normal newborn infants

Nowadays there is a strong tendency for early bathing of healthy newborns but little is known about the thermal stability of newborns in response to early bathing. The aim of this study was to compare the thermal effect of bathing on healthy newborn within 1-2 h of life versus 4-6 h after birth. In this randomized comparative study 100 healthy newborns in a newborn nursery of a charity hospital in Tehran were studied. The inclusion criteria were: healthy term [>/= 37 wk] newborn over 2500 grams with rectal temperature > 36.5 °C, apgar score > 7 in 1 and 5 min after birth and lack of manifestations of any diseases like sepsis or respiratory distress syndrome .The exclusion criteria were the history of recent fever, leukocytosis, urinary tract infections and using medicines in their mothers. In the experimental group, 50 newborns were bathed within the first 1-2 h of birth; those in control group were bathed at the 4-6 h of age. Rectal temperatures were measured in four different times: before bathing and immediately as well as 30 and 60 min after bathing. Rectal temperatures as measured at four different times did not differ significantly between infants bathed within 1-2 h of birth and those bathed 4-6 h after birth .There were no significant differences between the groups in types of gender, birth weight, gestational age, parity, delivery route, interval time between rupture of membranes and delivery, apgar scores at 1 and 5 min of age. Healthy full term newborns with rectal temperature > 36.5 °C can be bathed within 1-2 h of birth without any risk of hypothermia

Polynomial regression model to estimate time since death in adults from rectal temperature in Chandigarh zone of Northwest India.

Estimation of time since death from rectal cooling with the help of polynomial regression model is the subject of discussion in the present study. Though in literature various models are available but their complex modeling structure and calculation, restricted their application for real life situations, particularly in climatic conditions where the room temperature varies between 60.33o to 91.97 o F like of Chandigarh zone of India. The present study is an attempt to provide a suitable model for estimation of time since death in such conditions. Nonetheless, with the help of polynomial regression model, time since death can be estimated with SE estimate of 0.12947 hours and 0.410277 hours in summer and winter respectively. Moreover, this model has produced smaller confidence and prediction intervals.

Alteraçäo da temperatura radicular externa durante o preparo para contençäo intra-radicular / Temperature changes on the external root during post space preparation

O objetivo deste trabalho foi comparar in vitro a alteraçäo de temperatura na superfície radicular externa durante o preparo para contençäo intra-radicular utilizando 4 técnicas de remoçäo da guta-percha: condensadores aquecidos, brocas de Peeso, Gates-Glidden e Largo, em 40 dentes pré-molares inferiores (unirradiculares) tratados endodonticamente. Experimento foi realizado em uma câmara com temperatura controlada em torno de 26ºC. Para a remoçäo da guta-percha do interior dos canais, foram calculados dois terços do comprimento da raiz, deixando em torno de 4 mm de obturaçäo apical. As mediçöes da temperatura radicular externa foram realizadas com um termopar acoplado a um multímetro e efetuadas em 3 regiöes: cervical (em torno de 3 mm abaixo da junçäo cemento-esmalte), média e apical...

Temperatura corpórea central durante e após garroteamento de membros inferiores em crianças / Central body temperature during and after tourniquet use on lower limbs of children

Justificativa e objetivos - garroeamento de membros inferiores, uni ou bilateral, durante anestesia, causa elevaçäo da temperatura corpórea em crianças, enquanto o desgarrotemento produz rápida reduçäo. No presente trabalho analisam-se comportamentos per e pós-isquêmicos da temperatura esofagiana ainda näo investigados: 1) evoluçäo durante garroteamento em crianças com paralisisa cerebral; 2) modificaçöes durante garroteamento bilateral sequencial; e 3) evoluçäo após desgarroteamento. Métodos - 66 crianças portadoras de sequelas de paralisisa cerebral, submetidas a intervençöes ortopédicas sob anestesia geral combinada à peridural sacra, foram divididas em quatro grupos: controle (I), garrote unilateral (II), bilateral simultâneo (III) e bilateral sequencial (IV). Sempre aplicou-se o garroteamento no terço superior da coxa. Temperatura corpórea (medida no esôfago inferior), foi registrada imediatamente após induçäo da anestesia e a cada 10 minutos no grupo-controle ou durante isquemia. Após o desgarroteamento foi determinada a cada dois minutos. Resultados - no grupo controle a temperatura elevou-se ligeiramente no início, mantendo-se estável. Com garroteamento elevou-se progressivamente em quase todos os pacientes, principalmente sob isquemia bilateral. Ocorreram diferenças significantes entre o grupo I e os demais grupos, entre os grupos II e III, entre grupos III e IV (1º) e IV (2º), quando considerados aos 60 minutos e 80 minutos de isquemia. Depois do desgarroteamento a temperatura corpórea central baixou rapidamente, atingindo níveis ligeiramente superiores aos pré-isquêmicos aos 20 minutos. Os resultados pós-isquêmicos obtidos nos grupos II, III e IV foram estatisticamente significantes aos 10 minutos e 20 minutos. Conclusöes - 1) garroteamento bilateral simultâneo em membros inferiores de crianças aumenta a temperatura esofagiana mais que o unilateral; 2) há rápida queda da temperatura esofagiana após o desgarroteamento; 3) crianças com garroeamento de membros devem ser aquecidas de forma cuidadosa e monitorizadas durante toda a intervençäo cirúrgica; 4) parece näo haver maior sensibilidade de crianças com sequelas de paralisia cerebral às variaçöes de temperatura central

Effects of Body Temperature Changes on Hypoxic Pulmonary Vasoconstriction in Isolated Lungs of Rabbits / 대한마취과학회지

BACKGROUND: We studied the effects of body temperature changes and repeated hypoxic stimulation on hypoxic pulmonary vasoconstriction (HPV). METHODS: We isolated lungs from 15 rabbits and perfused them at a constant flow of 30 ml/kg/min with a 3% albumin-physiologic salt solution containing autologous blood. After a 30-minute stabilization, the temperature of the perfusate was changed from 38oC to 32oC gradually. The lungs were ventilated for 15 minutes with a hyperoxic gas mixture consisting of 95% oxygen and 5% carbon dioxide and then for 5 minutes with a hypoxic gas mixture consisting of 3% oxygen and 5% carbon dioxide with the balance being nitrogen. We repeated the hypoxic stimulation 3 times at the same temperature. The mean pulmonary artery pressure changes and ventilation-related parameters were measured at each hypoxic stimulation. RESULTS: With the first hypoxic stimulation, the hypoxic pressure response at the end of the 5-minute hypoxic period decreased significantly at 32oC. With the second and the third hypoxic stimulations, the hypoxic pressure responses at the end of the 5-minute hypoxic period decreased significantly at both 34oC and 36oC. With repeated hypoxic stimulations, the hypoxic pressure responses potentiated significantly at all temperatures. The baseline mean pulmonary artery pressure increased significantly below 34oC. CONCLUSION: The HPV decreased with the reduction in body temperature and was potentiated by repeated intermittent hypoxia; also, the pulmonary vascular resistance increased with the reduction in the body temperature.

El posoperatorio inmediato en neurocirugía craneana / Initial postoperative care after cranial neurosurgery

La valoración previa del riesgo anestésico quirúrgico y la prevención de las complicaciones constituyen estrategias claves de la anestesia. La primera hora del postoperatorio neuroquirúrgico representa un período crítico en el cual pueden desarrollarse complicaciones que comprometan la vida del paciente; la falta de recuperación de la conciencia, la hipotermia, alteraciones del medio interno y la dificultad respiratoria constituyen las principales. Se analiza la prevención, diagnóstico y tratamiento de las principales complicaciones postoperatorias en el paciente neuroquirúrgico. Se describen las causas anestésicas, quirúrgicas y fisiopatológicas de retraso en el despertar.

A Study in the Comparison of Body Temperature Change between General Anesthesia and Epidural Anesthesia / 대한마취과학회지

BACKGROUND: Core hypothermia after induction of anesthesia results from an core-to-peripheral redistribution of body heat and a loss of body heat to environment. The purpose of this study is finding body temperatures during operation by either general of epidural anesthesia and evaluates content of total body heat. METHODS: We measured tympanic membrane temperature, 4 point skin temperature (mid calf, mid thigh, upper extremity, nipple). And we calculate mean skin temperature, mean body temperature, total body heat content changes based on tympanic membrane temperature and 4 point skin temperature. RESULTS: Tympanic membrane temperature of the first group decreased significantly after 10 minutes of induction (p<0.005), the second group decreased after 45 minutes of induction. Although upper extremity temperature has continuously increased as time passed, there was no significant difference in both group. Lower extremity temperature has significantly increased after 30 minutes of induction in the first group, and the second group has significantly increased after 10 minutes of induction (p<0.05). Mean skin temperature hasdecreasd temperaturily in both group after 10 minutes of induction and increased as time passed. Mean body temperature of the first group has significantly decreased after 10 minutes of induction (p<0.05) and second group has no significant changes. Total body heat content has continuously decreased after induction with no significance. CONCLUSIONS: General anesthesia reveals more significant decrease than epidural anesthesia. Both groups show significant decrease of body temperature after induction. We think that we need to close attention to temperature changes after induction for preventing possible side effects due to core hypothermia.

El uso del signo de Benjamín en el diagnóstico precoz de la endometriosis / Use of Benjamin's sign in the early diagnosis of endometriosis

Se analizan las razones que existen para usar el signo de Benjamín (persistencia de la temperatura basal del cuerpo elevada durante el período menstrual de la mujer) en el diagnóstico precoz de la endometriosis, especialmente en los grupos de menores de 25 años. En el grupo de 60 mujeres estudiado hay 40 por ciento menores de 25 años (13,4 por ciento menores de 20) y sexualmente inactivas 14, el 23,3 por ciento; 90 por ciento con dismenorrea importante y con signo de Benjamín + el 91,7 por ciento. Hubo 5 falsos negativos y 5 falsos positivos. La comprobación de la endometriosis se hizo mediante laparoscopía diagnóstico/quirúrgica pertinaz y progresiva, rebelde a tratamientos habituales con el objeto de hacer screening de candidatas a laparoscopía