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Prevention of Intraoperative Hypothermia in Laparoscopy by the Use of Body-Temperature and Humidified CO 2 : a Pilot Study.

ABSTRACT: Introduction Hypothermia is defined as a decrease in body core temperature to below 36?°C. If intraoperative heat-preserving measures are omitted, a patient's temperature will fall by 1?-?2?°C. Even mild forms of intraoperative hypothermia can lead to a marked increase in morbidity and mortality. The temperature of the insufflation gas is usually disregarded in the treatment and prevention of hypothermia. This study was conducted to investigate the effect of body-temperature and humidified CO 2 on the intraoperative temperature profile and avoidance of hypothermia in laparoscopic surgery. Material and Methods In this retrospective, non-randomised case control study, 110 patients whose planned operation lasted at least 60 minutes were identified from 376 patients by means of an algorithm. Dry (20% humidity) CO 2 at room temperature was insufflated in 51 patients (control group). 59 patients were insufflated with humidified (98% humidity) CO 2 at body temperature (37?°C) (study group). These conditions were achieved with the HumiGard MR860 Surgical Humidification System (Fisher & Paykel Healthcare Limited, Auckland, New Zealand). The intraoperative temperature profile was evaluated by measurements every 10 minutes. Statistical analysis was performed with IBM ® SPSS ® Statistics 23.0.0. Results The intraoperative temperature in the control group fell steadily, while a continuous rise in temperature was observed in the study group. Warming was demonstrated in the study group with a start-end temperature difference of 0.09?°C, which differed significantly from the control group, in which it was -?0.09?°C (p?=?0.011). The middle-end difference of 0.11?°C showed even higher significance in favour of the warmed gas (p?=?0.003). The rate of hypothermia at the start of the operation fell from 50 to 36% in the study group and increased from 36 to 42% in the control group. Conclusion These results show that the use of body-temperature and humidified insufflation gas for laparoscopy can help to prevent intraoperative hypothermia.

SUBMITTER: Wittenborn J

PROVIDER: S-EPMC6739204 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Prevention of Intraoperative Hypothermia in Laparoscopy by the Use of Body-Temperature and Humidified CO <sub>2</sub> : a Pilot Study.

Wittenborn Julia J Clausen Annika A Zeppernick Felix F Stickeler Elmar E Meinhold-Heerlein Ivo I

Geburtshilfe und Frauenheilkunde 20190911 9

<b>Introduction</b> Hypothermia is defined as a decrease in body core temperature to below 36 °C. If intraoperative heat-preserving measures are omitted, a patient's temperature will fall by 1 - 2 °C. Even mild forms of intraoperative hypothermia can lead to a marked increase in morbidity and mortality. The temperature of the insufflation gas is usually disregarded in the treatment and prevention of hypothermia. This study was conducted to investigate the effect of body-temperature and humidifie ...[more]

PMID: 31523097

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Project description:Introduction: Surgery for chronic anal fissure is challenging for every proctologist. Solving the pain by guaranteeing rapid and effective healing is the objective, but what is the price to pay today in functional terms? Though this result is nowadays partially achievable through interventions that include the execution of an internal sphincterotomy among the procedures, it is necessary to underline the high rate of patients who can present faecal incontinence. The aim of this study is to explore the effectiveness of scanner-assisted CO2 laser fissurectomy. Methods: From April 2021 to September 2021, all consecutive patients who affected by chronic anal fissure suitable for surgery, meeting the inclusion and exclusion criteria, were evaluated. All planned data were recorded before surgery, then at 24 h, 1 week, and 1 month follow-up. A scanner-assisted CO2 laser was used in this study to achieve a smooth and dried wound with a minimal tissue thermal damage, to ensure good postsurgical pain control, rapid and functional, elastic and stable healing, and to prevent potential relapses. Paracetamol 1 g every 8 h was prescribed for the first 24 h and then continued according to each patient's need. Ketorolac 15 mg was prescribed as rescue. Results: Mean pain intensity ≤3, considered as the principal endpoint, was recorded in 26 out of the 29 patients who enrolled in the study with a final success rate of 89.7% at 1-month follow-up. Pain and anal itching showed a statistically significant reduction while bleeding, burning, and maximum pain, and REALIS score showed a reduction too at the end of the follow-up period. Reepithelisation proved to be extremely fast and effective: 22 of 29 (75.9%) showed a complete healing and 5 showed a partial reepithelisation at 1-month follow-up. Discussion: Outcomes of this study showed that it is undoubtedly necessary to change the surgical approach in case of anal fissure. The internal sphincterotomy procedure must be most of all questioned, where the availability of cutting-edge technological tools must be avoided and offered only in selected cases. Scanner-assisted CO2 laser showed great results in terms of pain control and wound healing, secondary to an extremely precise ablation, vaporisation, and debridement procedures with minimal lateral thermal damage.

Project description:BACKGROUND:Animal studies have shown that peritoneal injury can be minimized by insufflating the abdominal cavity with warm humidified carbon dioxide gas. METHODS:A single-blind RCT was performed at a tertiary colorectal unit. Inclusion criteria were patient aged 18?years and over undergoing open elective surgery. The intervention group received warmed (37°C), humidified (98 per cent relative humidity) carbon dioxide (WHCO2 group). Multiple markers of peritoneal inflammation and oxidative damage were used to compare groups, including cytokines and chemokines, apoptosis, the 3-chlorotyrosine/native tyrosine ratio, and light microscopy on peritoneal biopsies at the start (T0 ) and end (Tend ) of the operation. Postoperative clinical outcomes were compared between the groups. RESULTS:Of 40 patients enrolled, 20 in the WHCO2 group and 19 in the control group were available for analysis. A significant log(Tend /T0 ) difference between control and WHCO2 groups was documented for interleukin (IL) 2 (5·3 versus 2·8 respectively; P = 0·028) and IL-4 (3·5 versus 2·0; P = 0·041), whereas apoptosis assays documented no significant change in caspase activity, and similar apoptosis rates were documented along the peritoneal edge in both groups. The 3-chlorotyrosine/tyrosine ratio had increased at Tend by 1·1-fold in the WHCO2 group and by 3·1-fold in the control group. Under light microscopy, peritoneum was visible in 11 of 19 samples from the control group and in 19 of 20 samples from the WHCO2 group (P = 0·006). The only difference in clinical outcomes between intervention and control groups was the number of days to passage of flatus (2·5 versus 5·0?days respectively; P = 0·008). CONCLUSION:The use of warmed, humidified carbon dioxide appears to reduce some markers related to peritoneal oxidative damage during laparotomy. No difference was observed in clinical outcomes, but the study was underpowered for analysis of surgical results. Registration number: NCT02975947 ( www.ClinicalTrials.gov/).

Dataset Information

Prevention of Intraoperative Hypothermia in Laparoscopy by the Use of Body-Temperature and Humidified CO 2 : a Pilot Study.

Publications

Prevention of Intraoperative Hypothermia in Laparoscopy by the Use of Body-Temperature and Humidified CO <sub>2</sub> : a Pilot Study.

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