| Perioperative hypothermia is a common problem in perioperative setting mainly caused by the inhibition of thermoregulation induced by anesthesia. Hypothermia may result in serious complications including myocardial complications, coagulopathy, decreased drug metabolism,prolonged recovery, surgical wound infections. Maintenance of normothermia during surgeries may improve patient care quality. On the one hand the perioperative hypothermia is still lack of further study,On the other hand, foreign clinical guidelines recommend to prevent hypothermia,with the active measures to prevent warm effectiveness,however, There is still lack of consensus On the effectiveness of active warming measures to improve the prognosis of the patients undergoing surgeries. Currently,Forced air warming remains one of the most effectiveness warming applications. The study investigated to compare the efficacy between forced-air warming system and conventional warming care practiced on patients undergoing hip replacement surgery.Patients undergoing elective hip arthroplasty under general anaesthesia gave written consent and were enrolled in the study between December 2014 and February 2016 at Peking Union Medical College Hospital, Beijing. Inclusion criteria consisted of ASA classes 1 through 3,over 18 years of age, preoperative core temperature between 36.0 and37.5 ℃. Exclusion criteria were: core temperature at arrival in the operating room was above 37.5 ℃ or less than 36℃,history of infection and fever within 4 weeks before surgery, uncontrolled insulin-independent diabetes mellitus(preoperative glucose>250mg·dl-1), hyperthyroidism and hypothyroidism, Raynaud disease, use of steroid or immunosuppressantwithin 4 weeks before surgery, history of bleeding disorders, morbid obesity(body mass index > 35kg·m-2) clinically significant laboratory abnormalities(Hb≤10.0g·l-1, Platelets≤100,000ml-1, WBC(white blood cell)< 3000dl-1, Fibrinogen < 200mg·dl-1, Thromboplastin time > 40 s,Prothrombin time>40s, International normalized ratio(INR)<70%). The patients were randomly assigned via a computer generated randomization list to treatment with either underbody forced-air warming or conventional passive warming care.The changes of core temperature for whole perioperative period and the amount of blood loss were recorded. Crystalloid, colloid and allogeneic blood were recorded by strict protocol. Additional demographic and perioperative characteristics were compared with net blood loss,transfusion requirements during surgery, intraoperative and postoperative complications were also recorded. Further outcome measures conclude in cardiovascular adverse events and surgical site infection(SSI), of which time frame is 30 days and 90 days after hip replacement surgery.A total of 64 patients were enrolled and analyzed in this trial: 35 patients in Control and 29 patients in the Intervention group respectively.There was no statistically significant difference in type of procedures, as well as the majority of the demographic parameters and intraoperative data among the two patient population, including patient gender, body mass index, basal body temperature, American Society of Anesthesiologists score.Intraoperative hypothermia was observed in 23 of the 35 patients(65.71%) measured by tympanic membrane thermometer in the Control group, the Spot-on sensor observed 25 patients(68.57%),the esophageal thermometer observed 24 patients(72.73%)correspondingly. While the incidence of hypothermia in the intervention group is 3.57% according to the tympanic and 7.40% measured by SpotOnTM sensor, esophageal thermometer measured 12.50% incidence of hypothermia, which showed asignificant(P < 0.05) effect on preventing perioperative hypothermia 。Blood loss was significantly decreased in intervention group during intraoperative period, and the rate of patient who required transfusion was not significant difference compared with the control group. Initial haemoglobin concentrations, intraoperative drug, operation time were comparable in the two groupsThe total allogenic blood transfusion were observed no significantly different between groups. The tested intraoperative coagulation did not have significant alterations with operation time extend. Due to the limitation of sample size, there is not observed the significance difference between the two groups compared the risk of wound infection and length of stay in hospital.We found that the underbody forced-air warming system is efficient in preventing intraoperative hypothermia and could reduce risk of blood loss during major surgery. |
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