Warming with an underbody warming system reduces intraoperative hypothermia in patients undergoing laparoscopic gastrointestinal surgery: a randomized controlled study

Abstract

Background: Intraoperative hypothermia is a common event during laparoscopic abdominal surgery. On one hand, intraoperative hypothermia can delay the metabolism and prevent tissue damage. One the other hand, long-term and severe intraoperative hypothermia may also lead to perioperative complications, such as increasing of peripheral resistance, coagulation dysfunction, intraoperative hemorrhage and postoperative shivering. Maintenance of normothermia during surgical procedures may improve the quality of patient care.

Objectives: This study investigated the feasibility and efficacy of intraoperative cutaneous warming with an underbody warming system during laparoscopic gastrointestinal surgery.

Methods: 110 patients undergoing laparoscopic surgery for gastrointestinal cancer between January and December 2011 were randomized into the laparoscopic control (Control) group and laparoscopic intervention (Intervention) group. Nasopharyngeal temperature, prothrombin time, activated partial thromboplastin time, and thrombin time were measured before and during surgery, intraoperative and postoperative complications, as well as shivering after anesthesia and visual analog scale score for pain evaluation after surgery were also recorded. Clinical risk factors that may cause intraoperative hypothermia during laparoscopic surgery were also analyzed by correlation analysis.

Results: The two groups were comparable at the baseline. Intraoperative hypothermia was observed in 29 patients (52.7%) in Control group and 3 (5.5%) in Intervention group. Nasopharyngeal temperature in Control group was significantly decreased since 30min after the start of operation until the end of surgery comparing to that at the start of anesthesia, but there was no difference in the Intervention group. In Intervention group, the nasopharyngeal temperature was remaining at ∼36.5°C, indicating the feasibility and efficiency of the underbody warming system in preventing intraoperative hypothermia during laparoscopic gastrointestinal surgery. Moreover, with anesthesia and operation time increased, there was no significant change of coagulation function, hemoglobin level as well as less intraoperative hemorrhage, less postoperative shivering and lower visual analog scale score in Intervention group comparing to Control group. Multivariate logistic regression analysis revealed that anesthesia time and volume of CO2 were independent risk factors for perioperative hypothermia.

Conclusions: Cutaneous warming with an underbody warming system is a feasible and effective method to prevent intraoperative hypothermia during laparoscopic gastrointestinal surgery.

Keywords: Blood coagulation disorders; Correlation studies; Gastrointestinal neoplasm; Hypothermia; Laparoscopy; Warming insulation.