Comparison of warming methods for core temperature preservation during total knee arthroplasty using a pneumatic tourniquet

다국어 초록 (Multilingual Abstract)

Background: It is important to ensure that patients are normothe- rmic during surgery. In total knee arthroplasty, the pneumatic tourniquet affects body temperature. We compared the ability of two warming devices to preserve core temperature in patients using a lower limb tourniquet under general anesthesia.
Methods: We included 132 patients with American Society of Anesthesiologists physical status I–II who were scheduled to undergo total knee arthroplasty. The patients were randomly divided into four groups (n = 33): group 1, without any heating method; group 2, with fluid warming; group 3, with forced-air warming; and group 4, with a combination of the two heating methods. After the induction of anesthesia, the esophageal and urinary bladder temperatures were monitored and recorded every 5 min before tourniquet deflation and every 1 min after tourniquet deflation.
Results: Before tourniquet deflation, compared with group 1, the odds ratios of groups 3 and 4 were less than 1. After tourniquet deflation, compared with group 1, the odds ratios of all groups using warming devices were less than 1. In particular, group 4 showed the largest hypothermia-preventive effect among the four groups. There was a significant correlation between esophageal temperature and bladder temperature before and after tourniquet deflation.
Conclusions: After tourniquet deflation, a combination of a fluid warmer and forced-air warmer is the most effective method to prevent hypothermia, although either a fluid warmer or forced-air warmer alone could help to prevent hypothermia. Urinary bladder temperature changes correlate well with esophageal temperature changes throughout this operation.

참고문헌 (Reference)

1 Jeong SM, "Warming of intravenous fluids prevents hypothermia during off-pump coronary artery bypass graft surgery" 22 : 67-70, 2008

2 Estebe JP, "Use of a pneumatic tourniquet induces changes in central temperature" 77 : 786-788, 1996

3 Sato H, "Urinary bladder and oesophageal temperatures correlate better in patients with high rather than low urinary flow rates during non-cardiac surgery" 25 : 805-809, 2008

4 Hart SR, "Unintended perioperative hypothermia" 11 : 259-270, 2011

5 Buggy DJ, "Thermoregulation, mild perioperative hypothermia and postanaesthetic shivering" 84 : 615-628, 2000

6 Kasai T, "The vasoconstriction threshold is increased in obese patients during general anaesthesia" 47 : 588-592, 2003

7 Girardis M, "The hemodynamic and metabolic effects of tourniquet application during knee surgery" 91 : 727-731, 2000

8 Forstot RM, "The etiology and management of inadvertent perioperative hypothermia" 7 : 657-674, 1995

9 Rajagopalan S, "The effects of mild perioperative hypothermia on blood loss and transfusion requirement" 108 : 71-77, 2008

10 Fallis WM, "The effect of urine flow rate on urinary bladder temperature in critically ill adults" 34 : 209-216, 2005

11 Lefrant JY, "Temperature measurement in intensive care patients: Comparison of urinary bladder, oesophageal, rectal, axillary, and inguinal methods versus pulmonary artery core method" 29 : 414-418, 2003

12 Modig J, "Systemic reactions to tourniquet ischaemia" 22 : 609-614, 1978

13 Roth JV, "Some unanswered questions about temperature management" 109 : 1695-1699, 2009

14 Cork RC, "Precision and accuracy of intraoperative temperature monitoring" 62 : 211-214, 1983

15 Kurz A, "Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of wound infection and temperature group" 334 : 1209-1215, 1996

16 Sessler DI, "Perioperative heat balance" 92 : 578-596, 2000

17 Morris RH, "Operating room temperature and the anesthetized, paralyzed patient" 102 : 95-97, 1971

18 Fallis WM, "Monitoring urinary bladder temperature in the intensive care unit: State of the science" 11 : 38-45, 2002

19 Kaye AD, "Miller's Anesthesia" Churchill Livingstone 1728-, 2010

20 Enriori PJ, "Leptin action in the dorsomedial hypothalamus increases sympathetic tone to brown adipose tissue in spite of systemic leptin resistance" 31 : 12189-12197, 2011

21 Ikeda T, "Intraoperative phenylephrine infusion decreases the magnitude of redistribution hypothermia" 89 : 462-465, 1999

22 Sanders BJ, "Intraoperative hypothermia associated with lower extremity tourniquet deflation" 8 : 504-507, 1996

23 Kim YS, "Intra-operative warming with a forced-air warmer in preventing hypothermia after tourniquet deflation in elderly patients" 37 : 1457-1464, 2009

24 Horowitz PE, "Flow rates and warming efficacy with hotline and ranger blood/fluid warmers" 99 : 788-792, 2004

25 Li C, "Effects of pre-cooling and pre-heating procedures on cement polymerization and thermal osteonecrosis in cemented hip replacements" 25 : 559-564, 2003

26 Beilin B, "Effects of mild perioperative hypothermia on cellular immune responses" 89 : 1133-1140, 1998

27 Clark-Price SC, "Comparison of three different methods to prevent heat loss in healthy dogs undergoing 90 minutes of general anesthesia" 40 : 280-284, 2013

28 Fernandes LA, "Comparison of peri-operative core temperature in obese and non-obese patients" 67 : 1364-1369, 2012

29 Akata T, "Changes in body temperature following deflation of limb pneumatic tourniquet" 10 : 17-22, 1998

30 El-Gamal N, "Age-related thermoregulatory differences in a warm operating room environment(approximately 26 degrees c)" 90 : 694-698, 2000