| Objective:To observe the effects of two kinds of carbon dioxide absorbent(soda lime and calcium lime)on the body temperature of patients undergoing laparoscopic nephrectomy under general anesthesia.Methods:Seventy patients undergo laparoscopic nephrectomy were involved,whose ASA grades were Ⅰ and Ⅱ,aging from 18～70 years old.All were randomly divided into two groups(n=35,each),soda lime group(Na group)and calcium lime group(Ca group).The OR temperature was maintained at 22℃～23 ℃.0.05mg/kg midazolam,0.2μg/kg sufentanil,0.2mg/kg etomidate and 0.6mg/kg rocuronium were used through iv to anesthesia induction,LMA Supreme laryngeal mask was used.Sevoflurane was inhaled to maintain anesthesia state during the operation with vol of 2～3%.Sufentanil and rocuronium was added to patients intermittently.In the process,the same group of doctors do the surgery,medical temperature maintaining blanket and an infusion heater were not used.The fluid and peritoneal infusion were consistent with the room temperature.Carbon dioxide pneumoperitoneum pressure was controlled between 10-12mmHg,and the ETCO2 was adjusted between 30～40mmHg.Data of general:gender,age,height,weight,infusion volume,bleeding volume,urine volume,operation time,anesthesia time,sputum characteristics and adverse reactions such as agitation,delirium,nausea and vomiting were recorded respectively.Other data:soda lime and calcium lime temperature,inspired and expired gas temperature,nasopharyngeal temperature,forearm temperature,fingertip temperature was collected at the following time intervals:anesthesia induction(TO)、15min(T1),30min(T2),45min(T3),60min(T4),75min(T5),90min(T6),105min(T7),120min(T8),135min(T9),150min(T10)after anesthesia induction and the end of the operation(T11).The heart rate(HR),mean arterial pressure(MAP),ETC02 were also recorded.Perioperative,postoperative,postoperative 24h,postoperative 72h blood samples were collected for the determination of concentrations of ALT,AST,Cr,BUN.Results:1.General informationThere was no statistically significant difference in terms of gender,age,height,weight,BMI index,anesthesia and operation time,blood loss during the operation,transfusion volume and urine output,adverse reactions(P>0.05).There was no significant difference between two groups in ALT,AST,CR,BUN,and there was no significant difference between two groups(P>0.05).2.Lime temperatureAt the time point of T0,there was no significant difference(P>0.05)between the lime temperature(P>0.05).Lime temperature increased sharply after the start of mechanical ventilation.The temperature of two groups reached the highest point at T7 point,Na group increased by 74%from(24.68 + 1.23)to(42.96 + 2.94);Ca group increased(51.73 + 2.24)which is 2.1 times of beginning(24.71 + 1.34).There was diminutive fluctuation from T7 point to the end of the operation.At each time point the temperature of calcium lime was higher than soda lime with significant difference(P<0.01).3.Inspired gas temperature(Ti)At the TO point,the inspired gas temperature in two groups was basically the same with no significant difference(P>0.05).T1 increased slowly after the time point T1 and reached the highest temperature at the time point T11.At the time point of T2,T7,T8,T9,T10,T11 TI of Ca group was significantly higher than that of Na group(P<0.01).4.Expired gas temperature(Te)Expired gas temperature of two groups keep increasing during the mechanical ventilation and reach to the highest point at the end of operation.Compared the time point TO and T11,Na group increased from(30.05±0.53)to(31.32±0.51);Ca group increased(30.03±0.45)to(31.44±0.63).There was no significant difference between the two groups in terms of TE(P>0.05).5.Temperature difference between expired gas and inspired gas(TI-E)TI-E of two groups kept fluctuating within 2-3℃.TI-E of Ca group was smaller than Na group with significant difference at T4,T5,T6,T7,T9 and T10 points(P<0.05).6.Nasopharyngeal temperature and temperature difference between anterior wall and fingertip(Ta-f)The nasopharyngeal temperature was kept declining after T2 point.The decline is more significant before 60min and then decreased gently.There were no patients occurred hypothermia.There was no significant difference of nasopharyngeal temperature between the two groups(P>0.05).Ta-f increased from negative to positive after T4 point.There was no significant difference between the two groups in terms of Ta-f(P>0.05).7.Liver and kidney functionsThere was no statistically difference in the level of ALT,AST,CR,BUN between two groups at the time of perioperative,postoperative,postoperative 24h,postoperative 72h(P>0.05).Conclusion:There were no significant differences in patient body temperature who undergoing laparoscopic nephrectomy using calcium lime and soda lime two carbon dioxides under the condition that laryngeal mask was used.Calcium lime and soda lime are not the main causes of hypothermia in patients. |
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