Reliability of alternative devices for postoperative patient temperature measurement: two prospective, observational studies.

Peri-operative hypothermia is associated with significant morbidity, yet limitations exist regarding non-invasive temperature assessment in the post-anaesthesia care unit (PACU). In this prospective study of 100 patients, we aimed to determine the reliability of two commonly used temperature measurement devices, forehead temporal artery temperature and tympanic measurement, in addition to an indwelling urinary catheter with temperature probe, in comparison with the final nasopharyngeal core temperature at the end of surgery. Agreement of forehead measurement with nasopharyngeal temperature showed a mean bias (±95% limits of agreement) of 0.15 °C (±1.4 °C), with a steep slope of the relationship on the Bland-Altman plot of -0.8, indicating a tendency to normalise patient temperature readings to 36.4 °C. Only 54% of hypothermic cases were correctly detected by the forehead measurement device. Agreement of tympanic measurement with nasopharyngeal core temperature measurement was marginally improved with a mean bias of 0.13 °C (95% limits of agreement ±1.15 °C). In contrast, agreement of bladder temperature with nasopharyngeal temperature showed a mean (SD) bias of 0.19 (0.28) °C (95% limits of agreement ±0.54 °C), with a relatively flat line of best fit. We demonstrated that two commonly used temperature measurement devices, forehead temporal artery temperature and tympanic measurement, compared with nasopharyngeal core temperature, were imprecise and unreliable following major surgery. However, the indwelling catheter with temperature sensor was precise and acceptable for continuous core temperature measurement in the PACU.

Changing patterns in volatile anaesthetic agent consumption over seven years in Victorian public hospitals.

Evidence-based choices of volatile agents can increase health cost efficiencies. In this pharmaco-economic study, we evaluated the trends and costs of volatile agent use in Australian public hospitals. The total number of volatile agent (isoflurane, sevoflurane and desflurane) bottles ordered and inflation-adjusted costs were collected from 65 Victorian public hospitals from 2005 to 2011. Environmental costs were measured through the 100-year global warming potential index as carbon dioxide equivalents. During this time period, the aggregate inflation-adjusted expenditure was $39,209,878. Time series analysis showed that bottles of isoflurane ordered decreased by 419/year (99% confidence interval (CI): -603 to -235); costs decreased by $56,017/year (99% CI: -$93,243 to -$18,791). Bottles of sevoflurane increased by 1,330/year (99% CI: 1141 to 1,519); costs decreased by $423,3573/year (99% CI: -$720,030 to -112,783). Bottles of desflurane increased by 726/year (99% CI: 288 to 1,164); costs increased by $171,578/year (99% CI: $136,951 to $206,205). The amount of calculated greenhouse gas emissions released into the atmosphere over this period was 37,000 tonnes of carbon dioxide equivalents, with isoflurane contributing 6%, sevoflurane 17%, and desflurane 77% of this total. In conclusion, isoflurane is no longer being used in the majority of Victorian public hospitals, with sevoflurane and desflurane remaining as the primary volatile agents, utilised respectively at a ratio of 2.2 to 1, and costs at 0.8 to 1.