Prevalence and Outcome of Sepsis: Mortality and Prolonged Intensive Care Unit Stay among Sepsis Patients Admitted to a Tertiary Centre in Malaysia.

Background: Sepsis and septic shock are the leading causes of critical care-related mortality worldwide. This study aimed to determine the prevalence of sepsis, its intensive care unit (ICU) mortality rate and the factors associated with both ICU mortality and prolonged stay. Methods: A prospective cohort study was conducted from January 2019 to December 2019 with adult patients presenting evidence of sepsis who were admitted to the ICU. Parameters were assessed in the ICU to determine the association with all-cause ICU mortality and prolonged stay. Results: Out of 607 adults, 292 with sepsis were admitted to the ICU in 2019, with a mean age of 50.98 (standard deviation [SD] = 17.75) years old. There was, thus, a 48% incidence of sepsis. Mortality was observed in 78 patients (mortality rate = 26.7%) (95% confidence interval [CI]: 21.7, 32.2). Patients with higher Glasgow coma scale (GCS) scores had lower odds of ICU mortality (adjusted odds ratio [OR] = 0.90; 95% CI: 0.82, 0.98; P = 0.019), while patients with higher sequential organ failure assessment (SOFA) scores had higher odds (adjusted OR = 1.22; 95% CI: 1.11, 1.35; P < 0.001). Eighty patients (37.4%) who survived had prolonged ICU stays (95% CI: 30.9, 44.2). Patients with higher albumin levels had lower odds of a prolonged ICU stay (adjusted OR = 0.94; 95% CI: 0.90, 0.98; P = 0.006) and patients on renal replacement therapy had higher odds of a prolonged ICU stay (adjusted OR = 1.25; 95% CI: 1.74, 7.12; P < 0.001). Conclusion: Our study identified a sepsis prevalence of 48% and an ICU mortality rate of 26.7% among adult patients admitted to the ICU. GCS and SOFA scores were the most important factors associated with ICU mortality.

A Comparison of the Effects of Prolonged Infusion of Propofol 2% and 1% During Total Intravenous Anaesthesia Using Target-Controlled Infusion Technique for Elective Neurosurgery.

Background: Total intravenous anaesthesia (TIVA) with a combination of target-controlled infusions (TCIs) of propofol and remifentanil has been advocated for a favourable neurosurgical outcome. Neurosurgical procedures often involve a prolonged duration and large cumulative infusion of propofol. This study compares the serial serum lipid profile, acid-base balance and lactate level of neurosurgical patients anaesthetised with TCIs of propofol at 2% versus 1%. Methods: A total of 74 patients who underwent an elective craniotomy under general anaesthesia were randomised into two groups: i) propofol 1% (n = 37) and ii) propofol 2% (n = 37). All patients were anaesthetised using TCIs of propofol and remifentanil. Serial lipid profiles (serum triglyceride [TG] and cholesterol levels) were taken at the baseline, upon cessation of propofol and at 2 h post-operation. The total dosage, volume used and syringe changes of both groups were also documented. Results: The total volume of propofol used was significantly lower in the 2% group than the 1% group (157.19 mL [SD = 77.14] versus 335.17 mL [SD = 174.27]; P = 0.005) and the frequency of syringe changes was also less in the 2% than the 1% group (2 [3] versus 6 [3]; P < 0.001). However, there were no significant differences between the two groups in terms of serial serum TG, cholesterol, the acid-base balance or the lactate level. There was also no significant correlation of lipid profile with cumulative dose or volume of propofol infused between the two groups. Conclusion: Both concentrations of propofol, 1% and 2%, were comparable in terms of the serial lipid profile, acid-base balance and lactate level during TIVA using TCIs for elective neurosurgery. The benefits of propofol at 2% were that a lower volume was used and there were fewer syringe changes, which could minimise anaesthesia interruption throughout surgery.

The Practice, Outcome and Complications of Tracheostomy in Traumatic Brain Injury Patients in a Neurosurgical Intensive Care Unit: Surgical versus Percutaneous Tracheostomy and Early versus Late Tracheostomy.

Background: The tracheostomy procedure is commonly required to wean patients off the severe traumatic brain injury (TBI). This study aimed to determine the practice, outcome and complications of two techniques: i) surgical tracheostomy (ST) versus percutaneous tracheostomy (PT) and ii) two different times of procedure: early tracheostomy (ET) versus late tracheostomy (LT). Methods: This was a retrospective, cross-sectional study conducted from 1 January 2013 until 31 December 2017, involving 268 severe TBI patients who required tracheostomy during neurosurgical intensive care unit (Neuro-ICU) management. The data were obtained from their medical records. Results: When based on techniques, PT displayed a significantly shorter day of tracheostomy plan (7.0 [2.5] versus 8.3 [2.6] days; P < 0.001); day of execution (7.2 [2.6] versus 8.6 [2.9] days; P < 0.001); duration of mechanical ventilation (9.8 [3.4] versus 11.3 [3.1] days; P < 0.001) and duration of ICU stay (12.3 [3.7] versus 13.8 [3.5] days; P < 0.003) than ST. If based on timing, ET showed a significantly shorter duration of mechanical ventilation (8.8 [2.1] versus 12.9 [2.9] days; P < 0.001), length of ICU stay (11.4 [2.4] versus 15.2 [3.5] days; P < 0.001) and length of hospital stay (17.1 [3.2] versus 20.0 [4.0] days; P < 0.001) than LT. Conclusion: PT showed a shorter mechanical ventilation and ICU stay duration than ST. In comparison, ET showed shorter mechanical ventilation, ICU stay and hospital stay duration than LT.

Comparison of Combination Between Ketamine and Parecoxib as Multimodal Preemptive Analgesia With Ketamine Alone for Elective Laparotomy.

BACKGROUND: Preemptive analgesia is important for reducing postoperative analgesia requirement. Therefore, this study compared the efficacy of intravenous (IV) ketamine alone with the efficacy of a combination of low-dose IV ketamine and IV parecoxib as part of a multimodal preemptive analgesia regimen in patients undergoing elective laparotomy. METHODS: In this prospective study, 48 patients scheduled for elective laparotomy were randomized to two groups of preemptive analgesia, namely, group K-P, in which anestheologists administered a combination of 0.3 mg/kg IV ketamine and 40.0 mg IV parecoxib, or group K, in which ones gave 0.3 mg/kg IV ketamine alone. Patients from both groups underwent surgery under general anesthesia, and total intraoperative opioid requirement was recorded. After surgery, morphine administered by automated patient-controlled analgesia (PCA) infusion device was initiated in all patients. Pain score was assessed using the visual analogue scale (VAS), and postoperative opioid requirement was recorded at 1 and 4 hours, and subsequently from 4-hour intervals up to 24 hours after surgery. RESULTS: Compared to group K, group K-P required significantly lower rescue IV fentanyl in the recovery bay (0.10 ± 0.28 vs. 0.35 ± 0.46 µg/kg; P = 0.031), showing prolonged time-to-first analgesic request recorded by PCA device (70.8 ± 40.0 vs. 22.2 ± 15.8 mins; P ＜ 0.001), lower total morphine requirement delivered by PCA device (8.0 ± 4.6 vs. 16.8 ± 6.5 mg; P ＜ 0.001), and lower VAS values measured at all time points. There was no significant difference in intraoperative total opioid requirement between the groups. CONCLUSIONS: Among laparotomy patients, multimodal preemptive analgesia by the use of a combination of low-dose IV ketamine and IV parecoxib was more effective than IV ketamine alone in reducing pain scores and postoperative analgesia requirement (e.g., PCA-administered morphine).

Comparison of the Parker flex tip and the unoflex reinforced endotracheal tube for orotracheal fibreoptic intubation in simulated difficult intubation patients.

INTRODUCTION: The choice of endotracheal tube (ETT) is important for successful orotracheal fibreoptic intubation (OFI). The aim of this study was to compare the use of the Parker flex tip (PFT) with the unoflex reinforced (UFR) ETT during OFI. MATERIAL AND METHODS: A total of 58 patients who underwent elective surgery under general anaesthesia were randomised to two ETT groups, the PFT group (n = 29) and the UFR group (n = 29), for OFI in simulated difficult intubation patients using a rigid cervical collar. After successful standardised induction and relaxation, OFI and railroading of selected ETT were subsequently performed by a similarly experienced practitioner. Ease of insertion, degree of manipulation, time to successful intubation, post-intubation complications and haemodynamic changes were recorded for both groups. RESULTS: he percentage of easy intubation was comparable between both groups with a slightly higher percentage in the UFR group than the PFT group (69.0% vs. 62.0%; P = 0.599). Degree of manipulation was also comparable between the two groups; the percentage of cases in which manipulation was not required was slightly higher in the UFR group than the PFT group (69.0% vs. 62.1%; P = 0.849). Time to successful intubation was also comparable between the groups, although the time was slightly shorter for the UFR group than the PFT group (56.9 s ± 39.7 s vs. 63.9 s ± 36.9 s; P = 0.488). There were also no significant differences in other parameters. CONCLUSIONS: The Parker flex tip ETT was comparable to the unoflex reinforced ETT for OFI in simulated difficult airway patients.

Comparing the Effects of Pre-loading with Gelatine 4% Plasma Volume Expander and 6% Hydroxyethyl Starch Solution Before Spinal Anaesthesia for Lower Limb Orthopaedic Surgery.

BACKGROUND: Hypotension is a common complication following spinal anaesthesia. The administration of intravenous fluids prior to spinal anaesthesia, known as pre-loading, has been used to offset the hypotension effect; however, the ideal fluid for pre-loading is still a matter of debate. The objective of this study was to compare the effects of Gelaspan 4% and Volulyte 6% as pre-loading fluids. METHODS: A total of 93 patients with American Society of Anaesthesiologists (ASA) physical status I or II having lower limb orthopaedic surgery under spinal anaesthesia were randomised into two groups that received either Volulyte (n = 47) or Gelaspan (n = 46). Before the spinal anaesthesia, these patients were pre-loaded with 500 mL of the fluid of their respective group. Blood samples were taken before pre-loading and again after spinal anaesthesia and sent for venous blood gas and electrolyte level measurement. Baseline and intraoperative records of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and the requirement of ephedrine to treat hypotension were also recorded. RESULTS: Both fluids could not prevent significant reductions in SBP (P = 0.011), DBP (P = 0.002) and MAP (P = 0.001). There was also significant reduction in HR over time (P < 0.001). There was no significant difference in terms of ephedrine usage between both groups. Neither Volulyte 6% nor Gelaspan 4% caused significant changes in acid-base status. CONCLUSION: The use of 500 mL of either Gelaspan 4% or Volulyte 6% as pre-loading fluids did not significantly prevent the incidence of post-spinal anaesthesia hypotension following orthopaedic lower limb surgery; however, both were useful in the maintenance normal acid-base balance.

Sugammadex Rescue in Avoiding Intensive Care Unit Admission in an Octogenarian Undergoing Emergency Laparotomy.

Postlaparotomy management for elderly patients with underlying comorbidities is always a challenge because of poor cardiorespiratory reserves and prolonged effect of anesthetic drugs. For these reasons, such patients usually require intensive care unit (ICU) admission in the postoperative period. We report a case of an 85-year-old chronic smoker with controlled diabetes mellitus who needed an emergency laparotomy for a perforated gastric ulcer. Unfortunately, there was a shortage of ICU backup. With the successful conduct of an early surgery using combined general and regional anesthesia, the use of sugammadex (Bridion, Merck Sharp & Dohme Corp, Oss, the Netherlands) as a reversal agent, a skilled surgeon, and good postanesthesia care, the patient did not require ICU admission. He recovered fast and was discharged home 4 days after surgery. This case study aims to contribute to the literature on experience of a successful conduct of anesthesia in a high-risk geriatric patient when ICU facilities are limited.

Comparison of the Effects of Dexmedetomidine on the Induction of Anaesthesia Using Marsh and Schnider Pharmacokinetic Models of Propofol Target-Controlled Infusion.

BACKGROUND: The study aimed to determine the effects of dexmedetomidine on the induction of anaesthesia using different models (Marsh and Schnider) of propofol target-controlled infusion (TCI). METHODS: Sixty-four patients aged 18-60 years, American Society of Anaesthesiologists (ASA) class I-II who underwent elective surgery were randomised to a Marsh group (n = 32) or Schnider group (n = 32). All the patients received a 1 µg/kg loading dose of dexmedetomidine, followed by TCI anaesthesia with remifentanil at 2 ng/mL. After the effect-site concentration (Ce) of remifentanil reached 2 ng/mL, propofol TCI induction was started. Anaesthesia induction commenced in the Marsh group at a target plasma concentration (Cpt) of 2 µg/mL, whereas it started in the Schnider group at a target effect-site concentration (Cet) of 2 µg/mL. If induction was delayed after 3 min, the target concentration (Ct) was gradually increased to 0.5 µg/mL every 30 sec until successful induction. The Ct at successful induction, induction time, Ce at successful induction and haemodynamic parameters were recorded. RESULTS: The Ct for successful induction in the Schnider group was significantly lower than in the Marsh group (3.48 [0.90] versus 4.02 [0.67] µg/mL; P = 0.01). The induction time was also shorter in the Schnider group as compared with the Marsh group (134.96 [50.91] versus 161.59 [39.64]) sec; P = 0.02). There were no significant differences in haemodynamic parameters and Ce at successful induction. CONCLUSION: In the between-group comparison, dexmedetomidine reduced the Ct requirement for induction and shortened the induction time in the Schnider group. The inclusion of baseline groups without dexmedetomidine in a four-arm comparison of the two models would enhance the validity of the findings.

Anastomotic Leak after Bariatric Surgery from a Critical Care Perspective: A Lesson Shared.

Anastomotic leak after bariatric surgery is a rare complication with a recent prevalence ranging from 0.8% to 1.5%. The complication nevertheless can result in morbidity and even mortality. The purpose of this paper is to present a patient who suffered from an anastomotic leak presenting 2 days after laparoscopic sleeve gastrectomy in our intensive care unit. Review of the current literature regarding this complication from critical care perspective is also attempted.

Post-partum streptococcal toxic shock syndrome associated with necrotizing fasciitis.

We report a fatal case of post-partum streptococcal toxic shock syndrome in a patient who was previously healthy and had presented to the emergency department with an extensive blistering ecchymotic lesions over her right buttock and thigh associated with severe pain. The pregnancy had been uncomplicated, and the mode of delivery had been spontaneous vaginal delivery with an episiotomy. She was found to have septicemic shock requiring high inotropic support. Subsequently, she was treated for necrotizing fasciitis, complicated by septicemic shock and multiple organ failures. A consensus was reached for extensive wound debridement to remove the source of infection; however, this approach was abandoned due to the patient's hemodynamic instability and the extremely high risks of surgery. Both the high vaginal swab and blister fluid culture revealed Group A beta hemolytic streptococcus infection. Intravenous carbapenem in combination with clindamycin was given. Other strategies attempted for streptococcal toxic removal included continuous veno-venous hemofiltration and administration of intravenous immunoglobulin. Unfortunately, the patient's condition worsened, and she succumbed to death on day 7 of hospitalization.

Significance of a clean-tip catheter closed suctioning system in a high-setting ventilated, super morbidly obese patient with profuse respiratory secretions.

INTRODUCTION: Closed suctioning is commonly used in the context of high-setting mechanical ventilation (MV), given its ability to prevent lung volume loss that otherwise accompanies open suctioning. However, closed suctioning systems (CSS) are not equivalent regarding components and capabilities, and thus this technique may be differentially effective to adequately clear patient secretions from an endotracheal tube (ETT), which is of paramount importance when the tube size makes the ETT particularly vulnerable to block by patient secretions. CASE PRESENTATION: A 25-year-old super morbidly obese female (body mass index = 55 kg/meter2) presented with worsening shortness of breath. For MV, pairing of a 6 mm (mm) diameter ETT to accommodate the patient's vocal cord edema, with a CSS not designed to maintain a clean catheter tip, precipitated ETT blockage and respiratory acidosis. Replacement of these devices with a 6.5 mm ETT and a CSS designed to keep the catheter tip clean resolved the complications. After use of the different ETT and CSS for approximately one week, the patient was discharged to home. DISCUSSION: The clean-tip catheter CSS enabled a more patent airway than its counterpart device that did not have this feature. Use of a clean-tip catheter CSS was an important care development for this patient, because this individual's super morbidly obese condition minimized tolerance for MV complications that would exacerbate her pre-existing tenuous respiratory health status. CONCLUSION: Special attention should be given to the choices of ETT size and CSS to manage super morbidly obese patients who have a history of difficult airway access.

The dangers of accepting a single diagnosis: case report of concurrent Plasmodium knowlesi malaria and dengue infection.

BACKGROUND: Dengue and malaria are two common, mosquito-borne infections, which may lead to mortality if not managed properly. Concurrent infections of dengue and malaria are rare due to the different habitats of its vectors and activities of different carrier mosquitoes. The first case reported was in 2005. Since then, several concurrent infections have been reported between the dengue virus (DENV) and the malaria protozoans, Plasmodium falciparum and Plasmodium vivax. Symptoms of each infection may be masked by a simultaneous second infection, resulting in late treatment and severe complications. Plasmodium knowlesi is also a common cause of malaria in Malaysia with one of the highest rates of mortality. This report is one of the earliest in literature of concomitant infection between DENV and P. knowlesi in which a delay in diagnosis had placed a patient in a life-threatening situation. CASE PRESENTATION: A 59-year old man staying near the Belum-Temengor rainforest at the Malaysia-Thailand border was admitted with fever for 6 days, with respiratory distress. His non-structural protein 1 antigen and Anti-DENV Immunoglobulin M tests were positive. He was treated for severe dengue with compensated shock. Treating the dengue had so distracted the clinicians that a blood film for the malaria parasite was not done. Despite aggressive supportive treatment in the intensive care unit (ICU), the patient had unresolved acidosis as well as multi-organ failure involving respiratory, renal, liver, and haematological systems. It was due to the presentation of shivering in the ICU, that a blood film was done on the second day that revealed the presence of P. knowlesi with a parasite count of 520,000/µL. The patient was subsequently treated with artesunate-doxycycline and made a good recovery after nine days in ICU. CONCLUSIONS: This case contributes to the body of literature on co-infection between DENV and P. knowlesi and highlights the clinical consequences, which can be severe. Awareness should be raised among health-care workers on the possibility of dengue-malaria co-infection in this region. Further research is required to determine the real incidence and risk of co-infection in order to improve the management of acute febrile illness.

Comparison of Single-Shot Intrathecal Morphine Injection and Continuous Epidural Bupivacaine for Post-Operative Analgaesia after Elective Abdominal Hysterectomy.

BACKGROUND: Abdominal hysterectomy (AH) is painful. The aim of this study was to compare intrathecal morphine (ITM) and epidural bupivacaine (EB) for their analgaesia effectiveness after this surgery. METHODS: Thirty-two patients undergoing elective AH were randomised into Group ITM (ITM 0.2 mg + 2.5 mL 0.5% bupivacaine) (n = 16) and Group EB (0.25% bupivacaine bolus + continuous infusion of 0.1% bupivacaine-fentanyl 2 µg/mL) (n = 16).The procedure was performed before induction, and all patients subsequently received standard general anaesthesia. Both groups were provided patient-controlled analgaesia morphine (PCAM) as a backup. Visual analogue scale (VAS) scores, total morphine consumption, hospital stay duration, early mobilisation time and first PCAM demand time were recorded. RESULTS: The median VAS score was lower for ITM than for EB after the 1st hour [1.0 (IqR 1.0) versus 3.0 (IqR 3.0), P < 0.001], 8th hour [1.0 (IqR 1.0) versus 2.0 (IqR 1.0), P = 0.018] and 16th hour [1.0 (IqR1.0) versus (1.0 (IqR 1.0), P = 0.006]. The mean VAS score at the 4th hour was also lower for ITM [1.8 (SD 1.2) versus 2.9 (SD 1.4), P = 0.027]. Total morphine consumption [11.3 (SD 6.6) versus 16.5 (SD 4.8) mg, P = 0.016] and early mobilisation time [2.1 (SD 0.3) versus 2.6 (SD 0.9) days, P = 0.025] were also less for ITM. No significant differences were noted for other assessments. CONCLUSIONS: The VAS score was better for ITM than for EB at earlier hours after surgery. However, in terms of acceptable analgaesia (VAS ≤ 3), both techniques were comparable over 24 hours.

Target-controlled Infusion Propofol Versus Sevoflurane Anaesthesia for Emergency Traumatic Brain Surgery: Comparison of the Outcomes.

BACKGROUND: The choice of anaesthetic techniques is important for the outcome of traumatic brain injury (TBI) emergency surgery. The objective of this study was to compare patient outcomes for target-controlled infusion (TCI) of propofol and sevoflurane anaesthesia. METHODS: A total of 110 severe TBI patients, aged 18-60, who underwent emergency brain surgery were randomised into Group T (TCI) (n = 55) and Group S (sevoflurane) (n = 55). Anaesthesia was maintained in Group T with propofol target plasma concentration of 3-6 µg/mL and in Group S with minimum alveolar concentration (MAC) of sevoflurane 1.0-1.5. Both groups received TCI remifentanil 2-8 ng/mL for analgesia. After the surgery, patients were managed in the intensive care unit and were followed up until discharge for the outcome parameters. RESULTS: Demographic characteristics were comparable in both groups. Differences in Glasgow Outcome Scale (GOS) score at discharge were not significant between Group T and Group S (P = 0.25): the percentages of mortality (GOS 1) [27.3% versus 16.4%], vegetative and severe disability (GOS 2-3) [29.1% versus 41.8%] and good outcome (GOS 4-5) [43.6% versus 41.8%] were comparable in both groups. There were no significant differences in other outcome parameters. CONCLUSION: TCI propofol and sevoflurane anaesthesia were comparable in the outcomes of TBI patients after emergency surgery.

Balanced Fluid Versus Saline-Based Fluid in Post-operative Severe Traumatic Brain Injury Patients: Acid-Base and Electrolytes Assessment.

BACKGROUND: Normal saline (NS) is a common fluid of choice in neurosurgery and neuro-intensive care unit (ICU), but it does not contain other electrolytes and has the potential to cause hyperchloremic metabolic acidosis with prolonged infusion. These problems may be reduced with the availability of balanced fluid (BF), which becomes a more physiological isotonic solution with the presence of complete electrolyte content. This study aimed to compare the changes in electrolytes and acid-base between NS and BF (Sterofundin® ISO) therapy for post-operative severe traumatic brain injury (TBI) patients in neuro-ICU. METHODS: Sixty-six severe TBI patients who required emergency craniotomy or craniectomy and were planned for post-operative ventilation were randomised into NS (n = 33) and BF therapy groups (n = 33). The calculation of maintenance fluid given was based on the Holliday-Segar method. The electrolytes and acid-base parameters were assessed at an 8 h interval for 24 h. The data were analysed using repeated measures ANOVA. RESULTS: The NS group showed a significant lower base excess (-3.20 versus -1.35, P = 0.049), lower bicarbonate level (22.03 versus 23.48 mmol/L, P = 0.031), and more hyperchloremia (115.12 versus 111.74 mmol/L, P < 0.001) and hypokalemia (3.36 versus 3.70 mmol/L, P < 0.001) than the BF group at 24 h of therapy. The BF group showed a significantly higher level of calcium (1.97 versus 1.79 mmol/L, P = 0.003) and magnesium (0.94 versus 0.80 mmol/L, P < 0.001) than the NS group at 24 h of fluid therapy. No significant differences were found in pH, pCO2, lactate, and sodium level. CONCLUSION: BF therapy showed better effects in maintaining higher electrolyte parameters and reducing the trend toward hyperchloremic metabolic acidosis than the NS therapy during prolonged fluid therapy for postoperative TBI patients.

Difficult mask ventilation: simple step to make the impossible, possible!

Mask ventilation is one of the most important skills in airway management. Difficulty in mask ventilation can become life threatening if it is associated with difficulty in intubation during general anesthesia. We report a potential impossible ventilation condition which was safely and easily overcome with appropriate innovative modification of an Opsite adhesive film.

Passive Warming using a Heat-Band versus a Resistive Heating Blanket for the Prevention of Inadvertent Perioperative Hypothermia during Laparotomy for Gynaecological Surgery

Background: Inadvertent perioperative hypothermia (IPH) is a common problem, despite advancements in a variety of warming systems. The use of a resistive heating blanket (RHB) is a common but costly approach to patient warming. We have introduced the use of a heat-band in our centre as a cost-effective alternative to the RHB for patient warming. The efficacy of the heat-band in preventing IPH during laparotomy for gynaecological surgeries was compared with that of the RHB. Methods: Thirty-two patients undergoing surgeries under combined general-epidural anaesthesia, with an expected duration of surgery of 2–4 h, were randomised to receive either the heat-band or RHB. The core body temperatures of the two groups were compared at several perioperative times, in addition to the incidence of post-anaesthesia shivering, time to extubation and intraoperative blood loss. Results: The core body temperatures were comparable between the two groups in the pre-operative period, immediately after the induction of anaesthesia and skin incision, 1 h after the incision, at the time of complete skin closing, at extubation, upon arrival to the recovery room and 1 h post-operatively. There were no significant between-group differences in the incidence of post-anaesthesia shivering, time to extubation and intra-operative blood loss. Conclusion: The heat-band is as effective as the RHB in preventing IPH and its complications in gynaecological laparotomies.