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Effect of pre-warming on perioperative hypothermia during holmium laser enucleation of the prostate under spinal anesthesia: a prospective randomized controlled trial.

ABSTRACT: BACKGROUND:The purpose of this study is to assess whether the application of preoperative forced air warming set to high temperature (>?43?°C) for brief period can increase temperature on admission to the postanesthesia care unit (PACU) and prevent hypothermia or shivering during holmium laser enucleation of the prostate performed under spinal anesthesia. METHODS:Fifty patients were enrolled were assigned randomly to receive passive insulation (control group, n?=?25) or forced-air skin surface warming for 20?min before spinal anesthesia (pre-warming group, n?=?25). The primary outcome was temperature at PACU admission. RESULTS:The pre-warming group had a significantly higher temperature on admission to the PACU than the control group (35.9?°C [0.1] vs 35.6?°C [0.1], P?=?0.023; 95% confidence interval of mean difference, 0.1?°C-0.5?°C). The trend of decreasing core temperature intraoperatively was not different between groups (P?=?0.237), but intraoperative core temperature remained approximately 0.2?°C higher in the pre-warming group (P?=?0.005). The incidence of hypothermia on admission to the PACU was significantly lower in the pre-warming group (56% vs 88%, P?=?0.025). Shivering occurred in 14 patients in the control group, and 4 patients in the pre-warming group (P?=?0.007). CONCLUSION:Brief pre-warming at 45?°C increased perioperative temperature and decreased the incidence of hypothermia and shivering. However, it was not sufficient to modify the decline of intraoperative core temperature or completely prevent hypothermia and shivering. Continuing pre-warming to immediately before induction of spinal anesthesia or combining pre-warming with intraoperative active warming may be necessary to produce clearer thermal benefits in this surgical population. TRIAL REGISTRATION:This trial was registered with Clinicaltrials.gov, NCT03184506 , 5th June 2017.

SUBMITTER: Jun JH

PROVIDER: S-EPMC6304002 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Effect of pre-warming on perioperative hypothermia during holmium laser enucleation of the prostate under spinal anesthesia: a prospective randomized controlled trial.

Jun Joo-Hyun JH Chung Mi Hwa MH Kim Eun Mi EM Jun In-Jung IJ Kim Jung Hwa JH Hyeon Joon-Sang JS Lee Mi Hyeon MH Lee Hye Sun HS Choi Eun Mi EM

BMC anesthesiology 20181222 1

<h4>Background</h4>The purpose of this study is to assess whether the application of preoperative forced air warming set to high temperature (> 43 °C) for brief period can increase temperature on admission to the postanesthesia care unit (PACU) and prevent hypothermia or shivering during holmium laser enucleation of the prostate performed under spinal anesthesia.<h4>Methods</h4>Fifty patients were enrolled were assigned randomly to receive passive insulation (control group, n = 25) or forced-air ...[more]

PMID: 30579334

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Project description:ObjectiveTo demonstrate how bladder ultrasound can be useful in completing morcellation during difficult Holmium Laser Enucleation of the Prostate (HoLEP). As HoLEP has emerged as a standard of care for the treatment of benign prostatic hyperplasia, multiple studies have reported the potentially catastrophic complication of bladder injury during morcellation. This video aims to assist any urologist performing HoLEP by providing step-by-step instruction for using ultrasound to complete morcellation safely.MethodsEnucleation is performed using a 26-French continuous flow scope, off-set laser bridge with a laser stabilization catheter, and a 550 µm holmium laser fiber. Once the median and lateral lobes have been enucleated, the outer sheath is removed and the nephroscope is inserted to facilitate morcellation. Under dual inflow irrigation, the Piranha morcellator (Richard Wolf, Knittlingen, Germany) is introduced and set to the manufacturer's recommended settings of 1500 rpm. A 3.5-MHz convex abdominal ultrasound transducer (Hitachi Prosound Alpha 7; Hitachi Aloka Medical America, Wallingford, CT) under B-mode is used to visualize the bladder, predominantly in the sagittal orientation. Morcellation proceeds under simultaneous ultrasound and direct cystoscopic guidance.ResultsThe distended bladder is visualized concurrently with the ultrasound and via the nephroscope as the Piranha engages the adenoma and begins morcellation. Once the adenoma is engaged, the operator then drops their hands to place the morcellator in the center of the bladder. Ultrasound provides real-time feedback as to the location of the morcellator in relation to the adenoma and bladder.ConclusionThis video highlights the use of intraoperative bladder ultrasound as a visual aid to assist during the morcellation portion of HoLEP. This proof of concept demonstrates that ultrasound can be an additional tool to utilize during difficult cases when cystoscopic visualization during morcellation is limited.

Dataset Information

Effect of pre-warming on perioperative hypothermia during holmium laser enucleation of the prostate under spinal anesthesia: a prospective randomized controlled trial.

Publications

Effect of pre-warming on perioperative hypothermia during holmium laser enucleation of the prostate under spinal anesthesia: a prospective randomized controlled trial.

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