Effect of multimodal warming regimen on postoperative outcomes and cost-effectiveness in patients undergoing resection of liver cancer / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the effect of multimodal warming regimen on the postoperative outcomes and cost-effectiveness in the patients undergoing resection of liver cancer.Methods Sixty Ameri-can Society of Anesthesiologists physical status ⅠorⅡ patients of both sexes, aged 35-64 yr, with body mass index of 18-24 kg∕m2, of liver function Child-Pugh grade A, scheduled for elective resection of liver cancer, were divided into 2 groups(n=30 each)using a random number table routine warming group (group R)and multimodal warming group(group M). Quilts were covered on the body exposed before in-duction of anesthesia, and the abdominal cavity was washed with the room-temperature peritoneal lavage flu-id during operation in group R.In group M, the lower body was covered using the forced-air warming system at 30 min before induction of anesthesia, and the temperature was maintained at 38℃ until the end of oper-ation; the solution used for infusion was warmed to 42 ℃ using a fluid-warming device during operation;the abdominal cavity was washed with 0.9% sodium chloride injection which was prewarmed to 37℃ during operation.The rectal temperature was recorded after anesthesia induction and before tracheal intubation (T1), at 30, 60, 90, 120 and 150 min after anesthesia and at the end of operation(T2-7). The parame-ters of thrombelastogram were measured before induction of anesthesia(T0), at T7and at 12 h after opera-tion(T8).At T0, T7, T8and 24 and 48 h after operation(T9,10), blood samples were taken from the in-ternal jugular vein for determination of plasma interleukin-6 concentrations by enzyme-linked immunosorbent assay.The extubation time, duration of post-anesthesia care unit stay, intraoperative blood loss, blood transfusion, requirement for allogeneic blood transfusion, length of hospitalization, occurrence of postoper-ative shivering, occurrence of hypothermia, volume of drainage on 1st and 3rd days after operation, neu-trophil count, cost of general anesthesia and total cost of hospitalization were recorded.Results Compared with group R, the extubation time and duration of post-anesthesia care unit stay were significantly short-ened, the intraoperative blood loss, volume of blood transfused, and volume of drainage on 1st day after operation were reduced, length of hospitalization was shortened, the requirement for allogeneic blood trans-fusion and incidence of postoperative shivering and hypothermia were decreased, the body temperature was increased at T2-7, R and K were shortened at T7, α angle was enlarged, the neutrophil count on 1st day af-ter operation was reduced, the concentration of plasma interleukin-6 was decreased at T8and T9, the cost of anesthesia was increased, and the total cost of hospitalization was reduced in group M(P<0.05). Con-clusion Multimodal warming regimen can not only promote postoperative outcomes but also improve the cost-effectiveness in the patients undergoing resection of liver cancer.