Normothermia is protective during infrarenal aortic surgery

Abstract

Purpose: Mild hypothermia has been suggested to be protective against tissue ischemia during aortic operations. However, recent studies have documented detrimental cardiac effects of hypothermia during a variety of operative procedures. The influence of different warming methods and the impact of hypothermia during standard aortic procedures was assessed.

Methods: One hundred patients who underwent repair of infrarenal aortic aneurysms or aortoiliac occlusive disease were prospectively randomized into 2 groups, receiving either a circulating water mattress or a forced air warming blanket. Adjuvant warming methods were standardized. The day before surgery, 48-hour Holter monitors were applied and interpreted by a cardiologist blinded to the treatment. Randomization resulted in equivalent groups with regard to patient history, indications for surgery, body mass index, length of surgery, and fluid requirements.

Results: Core temperatures were significantly warmer during surgery (36.3 degrees C +/- 0.7 degrees C vs 35.4 +/- 0.8 degrees C) and after surgery (36.4 degrees C +/- 0.7 degrees C vs 35.6 degrees C +/- 0.9 degrees C) in patients with forced air warming (P <.001). The circulating water mattress group had significantly more metabolic acidosis perioperatively (P =.03). Postoperative length of stay, cardiac complications, and death rates were not significantly different. Subgroup analysis of 83 aneurysm patients comparing normothermia with hypothermia (temperature less than 36 degrees C) on arrival to the recovery room identified decreased cardiac output (P =.02), thrombocytopenia (P =.02), elevated prothrombin time (P =.04), and inferior Acute Physiology and Chronic Health Evaluation (APACHE) II scores (P <.001) in the hypothermic group. Holter analysis revealed more sinus tachycardia (ST) segment changes and ventricular tachycardia in hypothermic aneurysm patients (P =.05).

Conclusion: Patients treated with forced air blankets had significantly less metabolic acidosis and were kept significantly warmer than those treated with circulating water mattresses. Patients with aneurysms that were kept normothermic had a significantly improved clinical profile, with fewer cardiac events on the Holter recordings. We therefore conclude that (1) normothermia is protective for infrarenal aortic surgical patients; and (2) forced air warming blankets provide improved temperature maintenance compared with circulating water mattresses.