Prevention of laparoscopic surgery induced hypothermia with warmed humidified insufflation: Is the experimental combination of a warming blanket synergistic?

<div><p>Introduction</p><p>Maintaining normothermia during anesthesia is imperative to provide quality patient care and to prevent adverse outcomes. Prolonged laparoscopic procedures have been identified as a potential risk factor for hypothermia, due to continuous insufflation of cold and dry carbon dioxide. Perioperative hypothermia is associated with increased hospital cost and many complications including; impaired drug metabolism, impaired immune function, cardiac morbidity, shivering, coagulopathy.</p><p>Methods</p><p>In this experimental study, four pigs underwent four interventions each, resulting in 16 total trials. Using standardized general anesthesia in a randomized Latin-square sequence the four interventions include: 1. Control group without an administered pneumoperitoneum, 2. Administered standard pneumoperitoneum using 21°C insufflated gas and under-body forced-air warming, 3. Administered pneumoperitoneum with insufflation of warmed/humidified carbon dioxide, 4. Administered pneumoperitoneum with insufflation of warmed/humidified carbon dioxide and under-body forced-air warming. The primary outcome was distal esophageal temperature change 4 hours after trocar insertion.</p><p>Results</p><p>Four hours after trocar insertion, pigs in the control group lost 2.1 ± 0.4°C; pigs with warmed and humidified insufflation lost 1.8 ± 0.4°C; pigs with forced-air warming group lost 1.3 ± 0.9°C; and pigs exposed to a combination of warmed and humidified insufflation with forced-air warming increased by 0.3 ± 0.2°C.</p><p>Conclusion</p><p>This experimental animal study provides evidence that a combination of warmed and humidified insufflation of carbon dioxide (CO₂) in conjunction with forced-air warming is an effective strategy in the prevention of perioperative hypothermia. Further clinical trials investigating humans are therefore indicated.</p></div

Changes in core temperatures during the study period in each group.

<p><i>Circle blue line</i>: control group (no insufflation); <i>Square green line</i>: warmed insufflation group (heating and humidification of the insufflation CO₂); <i>Triangle orange line</i>: forced air group (standard insufflation with lower-body warming blanket); <i>Triangle red line</i>: combination group (heating and humidification of the insufflation CO₂ in association with underbody warming blanket).Red Star stands at time after which the difference in temperature becomes significant across groups control group versus combination group i.e. 210 min.</p

Additional file 1 of Early non-invasive ventilation and high-flow nasal oxygen therapy for preventing endotracheal intubation in hypoxemic blunt chest trauma patients: the OptiTHO randomized trial

Additional file 1: Study Protocol