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Lepine HL, Llata FM, Porto BC, Hobaica NC, Passerotti CC, Sanderberg RA, Artifon EL, Otoch JP, da Cruz JA. Effect of irrigation solution temperature on complications of percutaneous nephrolithotomy: a systematic review of the literature, meta-analysis and trial sequential analysis of randomized clinical trials. Minerva Urol Nephrol 2024; 76:554-562. [PMID: 38819387 DOI: 10.23736/s2724-6051.24.05731-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
INTRODUCTION The optimal temperature of irrigation solution in patients undergoing PCNL is still unclear. Accordingly, this study aims to investigate the effects of different irrigation solution temperatures (cold/room temperature irrigation fluid versus warm/body temperature fluid). Our primary endpoint was hypothermia rate. Secondary outcomes were shivering rate, mean temperature decrease, mean patient final temperature, blood loss, and operative time. EVIDENCE ACQUISITION This systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were searched in November 2023. Among 299 studies screened, eight were selected for full-text review, resulting in four randomized clinical trials that fit inclusion criteria and desired outcomes. Studies selection and data extraction were performed by multiple reviewers and a random-effects model was used for pooling of data. EVIDENCE SYNTHESIS The primary outcome, hypothermia rate, showed a significant statistical difference between groups, occurring less frequently in the experimental group (35-37 ºC) than in the cold/room temperature irrigation group (RR 0.64;95%CI 0.46, 0.89; P<0.008; I2=33%). Secondary outcomes such as shivering rate (RR 0.46; 95%CI 0.31, 0.67; P<0.0001; I2=0%) and mean final temperatures (MD 0.43; 95%CI 0.12, 0.75; I2=82%) also showed statistically significant differences between groups, favoring the irrigation with heated fluid. CONCLUSIONS There was a decreased rate of hypothermia and shivering among patients undergoing PCNL with warm irrigation fluid. Mean final temperatures were also higher in the experimental group. As to blood loss, mean hemoglobin decrease showed no statistically significant difference between groups, prompting further investigation of the influence of Irrigation solution temperature on blood loss volume.
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Affiliation(s)
- Henrique L Lepine
- Department of Surgical Technique and Experimental Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Breno C Porto
- Department of Surgical Technique and Experimental Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Carlo C Passerotti
- Specialized Center for Urology, German Hospital Oswaldo Cruz, São Paulo, Brazil
| | | | - Everson L Artifon
- Department of Surgical Technique and Experimental Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Jose P Otoch
- Department of Surgical Technique and Experimental Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Jose A da Cruz
- Department of Surgical Technique and Experimental Surgery, University of São Paulo School of Medicine, São Paulo, Brazil -
- Specialized Center for Urology, German Hospital Oswaldo Cruz, São Paulo, Brazil
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Tonyali S, von Bargen MF, Ozkan A, Gratzke C, Miernik A. The heat is on: the impact of excessive temperature increments on complications of laser treatment for ureteral and renal stones. World J Urol 2023; 41:3853-3865. [PMID: 38010538 PMCID: PMC10693507 DOI: 10.1007/s00345-023-04652-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/21/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE Technological advancements in the field of urology have led to a paradigm shift in the management of urolithiasis towards minimally invasive endourological interventions, namely ureteroscopy and percutaneous nephrolithotomy. However, concerns regarding the potential for thermal injury during laser lithotripsy have arisen, as studies have indicated that the threshold for cellular thermal injury (43 °C) can be exceeded, even with conventional low-power laser settings. This review aims to identify the factors that contribute to temperature increments during laser treatment using current laser systems and evaluate their impact on patient outcomes. MATERIALS AND METHODS To select studies for inclusion, a search was performed on online databases including PubMed and Google Scholar. Keywords such as 'temperature' or 'heat' were combined with 'lithotripsy', 'nephrolithotomy', 'ureteroscopy', or 'retrograde intrarenal surgery', both individually and in various combinations. RESULTS Various strategies have been proposed to mitigate temperature rise, such as reducing laser energy or frequency, shortening the duration of laser activation, increasing the irrigation fluid flow rate, and using room temperature or chilled water for irrigation. It is important to note that higher irrigation fluid flow rates should be approached cautiously due to potential increases in intrarenal pressure and associated infectious complications. The utilization of a ureteral access sheath (UAS) may offer benefits by facilitating irrigation fluid outflow, thereby reducing intrapelvic pressure and intrarenal fluid temperature. CONCLUSION Achieving a balance between laser power, duration of laser activation, and irrigation fluid rate and temperature appears to be crucial for urologists to minimize excessive temperature rise.
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Affiliation(s)
- Senol Tonyali
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Center, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Maximilian Ferry von Bargen
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Center, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Arif Ozkan
- Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Center, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Center, Hugstetter Str. 55, 79106, Freiburg, Germany
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Dagli R, Bağbancı MŞ, Dadalı M, Erşekerci E. Are Operating Rooms With Laminar Airflow a Risk for Inadvertent Perioperative Hypothermia During Ureterorenoscopic Lithotripsy Under Spinal Anesthesia? A Prospective Randomized Clinical Trial. J Patient Saf 2022; 18:e1027-e1033. [PMID: 35067621 DOI: 10.1097/pts.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Inadvertent perioperative hypothermia (IPH), defined as a core temperature <36°C, is common during a surgical procedure and is associated with high morbidity and mortality. Laminar (LAS) and conventional airflow systems (CAS) are used frequently for clean microenvironmental surgical areas in operating rooms. In LAS, the cold airflow is directed toward the patient, unlike CAS. Does this airflow in LAS cause heat loss from the patient by convection more than CAS? We aimed to compare the IPH frequencies of these airflow systems on patients who underwent ureterorenoscopic lithotripsy (ureterorenoscopic surgery) under spinal anesthesia. METHODS The study was a prospective, parallel-group, randomized trial. A total of 246 volunteers were included in the study and divided into group LAS (n = 123) and group CAS (n = 123). Randomization of patients was performed using the closed-envelope method (as 1:1).The tympanic membrane temperature of patients was measured before spinal anesthesia ( T0 ) and then every 15 minutes ( T n ) during the procedure. The IPH ratio and the change of the tympanic temperatures (Δ T ) were recorded (clinical trial number: IRCT20180324039145N5). RESULTS In total, there were no statistical differences between the IPH ratios of group LAS and group CAS (61.2% [71 of 116] versus 49.6% [57 of 115], respectively; P = 0.075). The IPH ratio was 55.4% (128 of 231). The tympanic temperatures of patients decreased about 0.64°C (0.45°C) at the 30th minute. In both groups, Δ 30 was similar (0.62; 95% confidence interval, 0.52-0.72 [ P = 0.65]; 95% confidence interval, 0.55-0.74 [ P = 0.236], respectively). CONCLUSIONS The risk for IPH of both LAS and CAS in the operating room is similar during ureterorenoscopic surgery.
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Affiliation(s)
- Recai Dagli
- From the Departments of Anaesthesiology and Reanimation
| | | | - Mümtaz Dadalı
- Urology, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir, Turkey
| | - Erol Erşekerci
- Urology, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir, Turkey
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Zhang H, Wang J, Zhu S, Li J. Full title: The prevalence of and predictors for perioperative hypothermia in postanaesthesia care unit. J Clin Nurs 2021; 31:2584-2592. [PMID: 34750903 DOI: 10.1111/jocn.16080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hypothermia is a common clinical issue during the perioperative period. The patients with perioperative inadvertent hypothermia are associated with higher risk of postoperative complications and higher hospitalisation costs. AIMS The aim of this study is to explore the prevalence of and predictors for hypothermia in patients entering postanaesthesia care unit. DESIGN Retrospective cohort study. METHODS A rigorous retrospective cohort study was conducted according to the STROBE reporting checklist. A total of 7216 patients were enrolled in this study. The perioperative variables potentially related to hypothermia were collected. Univariate analysis and multivariate logistic regression analysis were performed to investigate the contributing factors. RESULTS The overall prevalence of inadvertent hypothermia in postanaesthesia care unit was 21.3% (n = 1505). The multivariate logistic regression analysis showed that age >65 (OR = 1.561, 95% CI 1.371-1.778, p < .001), non-supine position [lateral decubitus position (OR = 1.341, 95% CI 1.133-1.586, p = .001), lithotomy position (OR = 1.639, 95% CI 1.295-2.075, p < .001)], non-superficial surgery (OR = 2.195, 95% CI 1.566-3.077, p < .001), non-open surgery [laparoscopic surgery (OR = 1.205, 95% CI 1.020-1.423, p = .029), endoscopic surgery (OR = 1.430, 95%CI 1.084-1.887, p = .011)], the volume of intravenous infusion fluid >1000 ml (OR = 1.814, 95% CI 1.500-2.194, p < .001), blood transfusion (OR = 1.552, 95% CI 1.159-2.078, p = .003), operation performed in the summer or fall (OR = 1.874, 95%CI 1.656-2.122, p < .001) and use of dexmedetomidine (OR = 1.147, 95%CI 1.015-1.296, p = .028) were associated with increased risk of hypothermia. In contrast, our finding showed that body mass index ≥25 kg/m2 (OR = 0.556, 95%CI 0.491-0.630, p < .001), higher baseline body temperature (OR = 0.641, 95%CI 0.541-0.761, p < .001) and duration of fasting ≥18 h (OR = 0.487, 95%CI 0.345-0.689, p < .001) were associated with decreased risk of hypothermia. Compared with non-hypothermic patients, patients with hypothermia were associated with prolonged length of hospital days (5 vs. 4 days, p < .001). CONCLUSION For patients admitted to postanaesthesia care unit after elective procedures, old age, non-supine position, non-open surgery, non-superficial surgery, large volume of intravenous infusion fluid, dexmedetomidine, blood transfusion and Summer or Fall operative season were associated with increased risk of hypothermia, whereas high body mass index, high baseline body temperature and long fasting duration were associated with decreased risk of hypothermia. RELEVANCE TO CLINICAL PRACTICE The outcomes of this study will raise the concerns of perioperative care team on hypothermia in surgical patients. Measures should be taken to improve perioperative hypothermia and clinical outcome.
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Affiliation(s)
- Hong Zhang
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Jiechu Wang
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Sainan Zhu
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Jinlei Li
- Department of Anesthesiology, Yale University, New Haven, Connecticut, USA
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Liu C, Wang Z, Liu J, Xu Y. Cost-Effectiveness Analysis Based on Intelligent Electronic Medical Arthroscopy for the Treatment of Varus Knee Osteoarthritis. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5569872. [PMID: 34035884 PMCID: PMC8121568 DOI: 10.1155/2021/5569872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/08/2021] [Accepted: 04/25/2021] [Indexed: 11/17/2022]
Abstract
The incidence of inverted knee osteoarthritis is slowly increasing, there are technical limitations in the treatment, and the operation is difficult. In this article, we will study the benefits and costs of arthroscopic cleaning treatments based on intelligent electronic medicine. This article focuses on knee osteoarthritis patients in the EL database. There are 12 male patients, accounting for 66.67%, and 6 female patients, accounting for 33.33%. The average body mass index (BMI) of the patients was 28.08, the average time from first knee discomfort to surgery was 28.44 months, and the average time of arthroscopic debridement treatment for patients with VKOH knee osteoarthritis was 143.11 minutes. One case of perioperative complication occurred within 35 days after operation, which was a soleus muscle intermuscular venous thrombosis. After immobilization and enhanced anticoagulation for 1 week, it was stable without risk of shedding. The average postoperative study time was 20.00 months. The electronic medical arthroscopy cleaning treatment plan in this article can greatly improve the quality of life of patients and can check the pathological state in time, with low cost. In the course of treatment, comprehensive treatment costs can be saved by 45%. Arthroscopic clean-up treatment can not only reduce knee pain and other uncomfortable symptoms, restore normal knee joint function, and improve the quality of life of patients, but also correct the unequal length of the lower limbs, thereby avoiding spinal degeneration caused by knee instability. Therefore, it is the first choice for the treatment of advanced knee osteoarthritis in patients with VKOH.
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Affiliation(s)
- Chunfeng Liu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, China
- Department of Orthopedics, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou 215028, Jiangsu, China
| | - Zhen Wang
- Department of Orthopedics, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou 215028, Jiangsu, China
| | - Jinlian Liu
- Department of Orthopedics, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou 215028, Jiangsu, China
| | - Yaozeng Xu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, China
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Debono B, Wainwright TW, Wang MY, Sigmundsson FG, Yang MMH, Smid-Nanninga H, Bonnal A, Le Huec JC, Fawcett WJ, Ljungqvist O, Lonjon G, de Boer HD. Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Spine J 2021; 21:729-752. [PMID: 33444664 DOI: 10.1016/j.spinee.2021.01.001] [Citation(s) in RCA: 150] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/02/2020] [Accepted: 01/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care have led to improvements in outcomes in numerous surgical areas, through multimodal optimization of patient pathway, reduction of complications, improved patient experience and reduction in the length of stay. ERAS represent a relatively new paradigm in spine surgery. PURPOSE This multidisciplinary consensus review summarizes the literature and proposes recommendations for the perioperative care of patients undergoing lumbar fusion surgery with an ERAS program. STUDY DESIGN This is a review article. METHODS Under the impetus of the ERAS® society, a multidisciplinary guideline development group was constituted by bringing together international experts involved in the practice of ERAS and spine surgery. This group identified 22 ERAS items for lumbar fusion. A systematic search in the English language was performed in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Systematic reviews, randomized controlled trials, and cohort studies were included, and the evidence was graded according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Consensus recommendation was reached by the group after a critical appraisal of the literature. RESULTS Two hundred fifty-six articles were included to develop the consensus statements for 22 ERAS items; one ERAS item (prehabilitation) was excluded from the final summary due to very poor quality and conflicting evidence in lumbar spinal fusion. From these remaining 21 ERAS items, 28 recommendations were included. All recommendations on ERAS protocol items are based on the best available evidence. These included nine preoperative, eleven intraoperative, and six postoperative recommendations. They span topics from preoperative patient education and nutritional evaluation, intraoperative anesthetic and surgical techniques, and postoperative multimodal analgesic strategies. The level of evidence for the use of each recommendation is presented. CONCLUSION Based on the best evidence available for each ERAS item within the multidisciplinary perioperative care pathways, the ERAS® Society presents this comprehensive consensus review for perioperative care in lumbar fusion.
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Affiliation(s)
- Bertrand Debono
- Paris-Versailles Spine Center (Centre Francilien du Dos), Paris, France; Ramsay Santé-Hôpital Privé de Versailles, Versailles, France.
| | - Thomas W Wainwright
- Research Institute, Bournemouth University, Bournemouth, UK; The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, Bournemouth, UK
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Freyr G Sigmundsson
- Department of Orthopedic Surgery, Örebro University Hospital, Södra Grev Rosengatan, Örebro, Sweden
| | - Michael M H Yang
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Aurélien Bonnal
- Department of Anesthesiology, Clinique St-Jean- Sud de France, Santécité Group. St Jean de Vedas, Montpellier Metropole, France
| | - Jean-Charles Le Huec
- Department of Orthopedic Surgery - Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - William J Fawcett
- Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Olle Ljungqvist
- School of Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden
| | - Guillaume Lonjon
- Department of Orthopedic Surgery, Orthosud, Clinique St-Jean- Sud de France, SantéCité Group. St Jean de Vedas, Montpellier Metropole, France
| | - Hans D de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, the Netherlands
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Wang C, Yang P, Zhang D, Zhang Y, Shen Y, Li H, Yu T, Qi C. [The effect of different continuous saline irrigation volume under arthroscopy on early postoperative pain and swelling of the knee]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:178-182. [PMID: 33624470 DOI: 10.7507/1002-1892.202006134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effect of different saline irrigation volume under arthroscopy on early postoperative pain and swelling of the knee. Methods The clinical data of 539 patients with meniscus injury treated by arthroscopic menisci reformation who met the selection criteria between July 2016 and February 2020 were retrospectively analyzed. They were divided into three groups according to the continuous saline irrigation volume during the operation: 176 patients in the non-irrigation group (group A), 183 patients in the 1 liter-irrigation group (group B), and 180 patients in the 3 liters-irrigation group (group C). There was no significant difference in gender, age, cause of injury, sides of injury, body mass index, disease duration, smoking history, and classification of meniscus injury among 3 groups ( P>0.05). At 6, 12, 24, 48, and 72 hours after operation, the patient's pain level was evaluated by the visual analogue scale (VAS) score, and the knee swelling situation was evaluated by the swelling ratings (the difference between both sides in circumference of the 2 cm upper patella of the knee). Knee skin temperature (the difference of the skin temperature between both sides) and the C-reactive protein (CRP) level in serum were measured at the 1st and 3rd days after operation. Range of motion of the knee was measured at the 1st, 3rd, and 5th days after operation. Results All incisions healed by first intention without any complication after operation. The VAS scores of each group showed a slow increase trend after operation, and gradually decreased to less than the VAS score of 6 hours at 48 hours after operation. There was no significant difference in VAS scores among the 3 groups at each time point after operation ( P>0.05). The swelling ratings of the knee in each group showed a gradually decrease trend after operation. There was no significant difference in the swelling ratings of the knee among the 3 groups at each time point after operation ( P>0.05). The skin temperature of the knee in each group decreased at the 3rd day after operation than the 1st day, and there was no significant difference in the skin temperature of the knee among the 3 groups at each time point after operation ( P>0.05). There was no significant difference in CRP level within the group and among the 3 groups at each time point after operation ( P>0.05). Range of motion of the knee in each group increased gradually at the 1st, 3rd, and 5th days after operation, and there was no significant difference among the 3 groups at each time point after operation ( P>0.05). Conclusion The different continuous saline irrigation volume would not affect the early postoperative pain, swelling, and inflammation of the knee during the arthroscopic menisci plasty.
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Affiliation(s)
- Chen Wang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Pu Yang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Dongfang Zhang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Yi Zhang
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Youliang Shen
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Haifeng Li
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Tengbo Yu
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
| | - Chao Qi
- Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P.R.China
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Alston SE. Preventing Hypothermia During Shoulder Arthroscopy: Implementing a Pilot Warming Protocol. AORN J 2020; 112:524-528. [PMID: 33113185 DOI: 10.1002/aorn.13217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/24/2020] [Indexed: 11/07/2022]
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Honkavuo L, Loe SAK. Nurse Anesthetists' and Operating Theater Nurses' Experiences with Inadvertent Hypothermia in Clinical Perioperative Nursing Care. J Perianesth Nurs 2020; 35:676-681. [PMID: 32605863 DOI: 10.1016/j.jopan.2020.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To deepen the understanding of and describe nurse anesthetists' and operating theater nurses' experiences with inadvertent hypothermia in clinical perioperative nursing care. DESIGN Qualitative, explorative, and descriptive study that carries an inductive nature. METHODS Focus group interviews with 16 nurse anesthetists and operating theater nurses from four hospitals in Norway. Gadamer's hermeneutics has guided the study's interpretation. FINDINGS Taking the temperature and measures against inadvertent hypothermia perioperatively are not always systematically implemented. In the data material, three thematic units emerged: routines and habits, the culture of the perioperative unit, and silent suffering. CONCLUSIONS Complications caused by inadvertent hypothermia in surgical patients can lead to unnecessary suffering and prolong the hospital stay. The surgical team's cooperation and responsibility are linked to routine nursing interventions. These depend on the nurses' knowledge and experience as well as their clinical and subjective assessment of the patient's physical condition and the surgical techniques used.
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Affiliation(s)
- Leena Honkavuo
- Department of Caring Science, Faculty of Educational and Welfare Studies, Åbo Akademi University, Vasa, Finland.
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Lin Y, Zhou C, Liu Z, Wu K, Chen S, Wang W, Chen Y, Wang H. Room Temperature Versus Warm Irrigation Fluid Used for Patients Undergoing Arthroscopic Shoulder Surgery: A Systematic Review and Meta Analysis. J Perianesth Nurs 2020; 35:48-53. [PMID: 31564621 DOI: 10.1016/j.jopan.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/09/2019] [Accepted: 06/15/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of this study was to analyze whether warm irrigation fluid could reduce postoperative adverse effects in patients undergoing arthroscopic shoulder surgery compared with room temperature irrigation fluid. DESIGN A systematic review and meta-analysis of clinical trials was performed. METHODS A computerized search of electronic databases was performed. The inclusion criteria were studies comparing the clinical effects of room temperature and warm irrigation fluid on patients undergoing arthroscopic shoulder surgery. FINDINGS Warm irrigation fluid reduced the degree of core body temperature drop and the incidence of hypothermia. A statistically lower incidence of shivering also occurred in the warm irrigation fluid group. CONCLUSIONS The use of warm irrigation fluid better maintains core body temperature and reduces incidence of shivering than room temperature irrigation fluid. Therefore, warm irrigation fluid is a better choice for arthroscopic shoulder surgery.
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Affiliation(s)
- Youbin Lin
- Department of Orthopaedics, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Chunbin Zhou
- Department of Orthopaedics, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Zhaoyong Liu
- Department of Orthopaedics, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Kezhou Wu
- Department of Orthopaedics, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Shubiao Chen
- Department of Orthopaedics, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Weihao Wang
- Department of Orthopaedics, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yelong Chen
- Department of Orthopaedics, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Hu Wang
- Department of Orthopaedics, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
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Kati B, Buyukfirat E, Pelit ES, Yagmur I, Demir M, Albayrak IH, Ciftci H. Percutaneous Nephrolithotomy with Different Temperature Irrigation and Effects on Surgical Complications and Anesthesiology Applications. J Endourol 2019; 32:1050-1053. [PMID: 30280908 DOI: 10.1089/end.2018.0581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Percutaneous nephrolithotomy (PCNL) is a widely accepted and frequently performed operation for large kidney stones. However, there is not much information about the effects of irrigation fluid temperature as well as many other factors that affect success and complications during the operation. In this study, we aimed to investigate the surgical and anesthesiological effects of irrigation fluid used in body temperature and room temperature during and after PCNL. MATERIAL AND METHODS A total of 108 PCNL patients were performed between June 2016 and April 2018. The half of these patients (54) were performed with body temperature (37°C) irrigation fluid, hence known as body temperature group (BTG), and the other half with room temperature (22°C) irrigation fluid, called as room temperature group (RTG). For the study, we recorded the body temperature of the patients during and after the operation, the amount of irrigation fluid used, the size and location of the kidney stones, the duration of the operation, postoperative shivering time during the patient's wake-up period, pre- and postoperative hemoglobin value, additional blood requirements, postoperative analgesic requirements, and postoperative urinary tract infections. RESULTS The age of patients, gender distribution, height, weight, body mass index, stone size, and postoperative analgesic requirement showed no significant differences in two groups. The postoperative body heat was significantly higher in the BTG than the RTG. The duration of waking was significantly higher in the RTG than the BTG. The amount of hemorrhage was significantly less in the patients who were irrigated in the RTG. CONCLUSION The temperature of the irrigation fluid can affect many parameters in the PCNL. We recommend using irrigation in room temperature especially with patients having bleeding risks and irrigation fluid in body temperature especially with patients having anesthetic risks for easier waking process.
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Affiliation(s)
- Bulent Kati
- 1 Department of Urology, Faculty of Medicine, Harran University , Sanliurfa, Turkey
| | - Evren Buyukfirat
- 2 Department of Anesthesiology and Reanimation, Faculty of Medicine, Harran University , Sanliurfa, Turkey
| | - Eyyup Sabri Pelit
- 1 Department of Urology, Faculty of Medicine, Harran University , Sanliurfa, Turkey
| | - Ismail Yagmur
- 1 Department of Urology, Faculty of Medicine, Harran University , Sanliurfa, Turkey
| | - Mehmet Demir
- 1 Department of Urology, Faculty of Medicine, Harran University , Sanliurfa, Turkey
| | | | - Halil Ciftci
- 1 Department of Urology, Faculty of Medicine, Harran University , Sanliurfa, Turkey
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Azhar F, Dyer JE, Clarke L. Is it necessary to use forced air warming in core endourological procedures where warmed intravenous and irrigation fluids are routinely used? JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818816544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Perioperative hypothermia is an important consideration for all surgical specialties, but susceptibility may vary between them. Current guidance on prevention of this does not differentiate between specialties. We hypothesise that in core endourological surgery, the use of warmed irrigation sufficiently protects patients from hypothermia and that forced air warming (FAW) does not provide any added benefit. Materials and methods: Between November 2015 and January 2016, all case notes were reviewed for patients who had undergone core urological procedures. Data collated included age, body mass index, procedure length, perioperative temperatures and warming methods used. The sample population was stratified according to warming devices used. The difference in temperature change between groups was assessed using analysis of variance (ANOVA) and in specific groups using the Student’s t-test. Perioperative hypothermia was defined as a finishing temperature < 36.0°C or a temperature drop of greater that 1.0°C. Results: Perioperative hypothermia occurred in 2 out of 226 patients, both from those receiving FAW, warmed irrigation and warmed intravenous (IV) fluid. No significant difference was noted between all groups in terms of absolute temperature change (ANOVA P = 0.111). Furthermore, there was no significant change in absolute temperature when comparing groups with FAW, warmed irrigation and warmed IV fluid with those with warmed irrigation and warmed IV fluid alone. Conclusion: The routine use of FAW in core endourological surgery may not be necessary. In most procedures, particularly those of short duration, there appears to be no added benefit in using FAW in combination with warmed irrigation and IV fluid. Level of evidence: 3b
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Affiliation(s)
- Fowz Azhar
- Urology Department, Salford Royal NHS Foundation Trusts, UK
| | - James E Dyer
- Urology Department, Salford Royal NHS Foundation Trusts, UK
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Rashwan DA, Rashwan SA, Abd Al Raouf S. Efficacy of preoperative hydrocortisone versus tramadol for attenuation of postoperative shivering after percutaneous nephrolithotripsy: A randomized controlled trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2015.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Doaa A. Rashwan
- Anesthesia and Surgical ICU Department, Faculty of Medicine, Beni Sueif University, Egypt
| | - Samaa A. Rashwan
- Anesthesia and Surgical ICU Department, Faculty of Medicine, Beni Sueif University, Egypt
| | - Sabah Abd Al Raouf
- Anesthesia, Pain and Surgical ICU Department, Faculty of Medicine, Cairo University, Egypt
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Steelman VM, Chae S, Duff J, Anderson MJ, Zaidi A. Warming of Irrigation Fluids for Prevention of Perioperative Hypothermia During Arthroscopy: A Systematic Review and Meta-analysis. Arthroscopy 2018; 34:930-942.e2. [PMID: 29217304 DOI: 10.1016/j.arthro.2017.09.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether warming of irrigation fluids (32°C-40°C) compared with using room-temperature irrigation fluids (20°C-22°C) decreases the risk of perioperative hypothermia (<36°C) for patients undergoing shoulder, hip, or knee arthroscopy. METHODS One reviewer, with the assistance of a medical librarian, searched the following databases: PubMed, Embase, Cochrane Central, SPORTDiscus, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health Literature). Level I and II studies involving shoulder, hip, or knee arthroscopy were included. Two reviewers screened the abstracts and titles. Two reviewers assessed the risk of bias of selected studies using The Cochrane Collaboration tool. Meta-analyses were conducted on the following outcomes: hypothermia, lowest temperature, maximum temperature drop, and shivering. RESULTS Seven studies of patients undergoing arthroscopy were included in the qualitative synthesis (5 shoulder studies, 1 hip study, and 1 knee study; 501 patients). The study involving knee arthroscopy was excluded from the meta-analyses because of insufficient data and high clinical heterogeneity (surgical site distal to the core, not involving extravasation of large amounts of fluid). The remaining 6 studies were included in 1 or more meta-analyses: hypothermia (5 shoulder and 1 hip study), lowest temperature (3 shoulder and 1 hip study), maximum temperature drop (2 shoulder and 1 hip study), and shivering (5 shoulder and 1 hip study). Warming of irrigation fluids for shoulder or hip arthroscopy significantly decreased the risk of hypothermia (odds ratio, 0.15; 95% confidence interval [CI], 0.06-0.40; P = .0001), increased the lowest mean temperature (mean difference, 0.46°C; 95% CI, 0.11°C-0.81°C; P = .01), decreased the maximum temperature drop (mean difference, -0.64°C; 95% CI, -0.94°C to -0.35°C; P < .0001), and decreased the risk of shivering (odds ratio, 0.25; 95% CI, 0.07-0.86; P = .03). CONCLUSIONS When irrigation fluids are warmed for shoulder and hip arthroscopy, the risk of hypothermia is less, the drop in intraoperative temperature is less, the lowest body temperature is higher, and the risk of postoperative shivering is reduced. LEVEL OF EVIDENCE Level II, systematic review of Level I and II studies.
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Affiliation(s)
| | - Sena Chae
- College of Nursing, University of Iowa, Iowa City, Iowa, U.S.A
| | - Jed Duff
- University of Newcastle, Callaghan, Australia
| | | | - Adnan Zaidi
- University of Iowa Sports Medicine, Iowa City, Iowa, U.S.A
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Ogg MJ. Clinical Issues-December 2017. AORN J 2017; 106:552-559. [PMID: 29173380 DOI: 10.1016/j.aorn.2017.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/09/2017] [Indexed: 11/24/2022]
Abstract
Bed bugs Key words: bed bugs, pest management, infestation, transmission. Warming irrigation fluids Key words: irrigation fluid, warming fluid, hypothermia, warming cabinet. Fasting before surgery Key words: fasting, NPO, liquids, solids. Advanced cardiac life support requirements for perioperative nurses Key words: advanced cardiac life support, ACLS certification, pediatric advanced life support, PALS certification, basic life support.
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Horn EP, Klar E, Höcker J, Bräuer A, Bein B, Wulf H, Torossian A. Vermeidung perioperativer Hypothermie. Chirurg 2017; 88:422-428. [DOI: 10.1007/s00104-016-0357-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fujita T, Okada N, Kanamori J, Sato T, Mayanagi S, Torigoe K, Oshita A, Yamamoto H, Daiko H. Thermogenesis induced by amino acid administration prevents intraoperative hypothermia and reduces postoperative infectious complications after thoracoscopic esophagectomy. Dis Esophagus 2017; 30:1-7. [PMID: 27003457 DOI: 10.1111/dote.12460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Minimally invasive thoracoscopic esophagectomy has potential advantages in minimizing the impairment of respiratory function and reducing surgical stress. However, thoracoscopic esophagectomy occasionally results in anesthesia-induced hypothermia, particularly in cases involving artificial pneumothorax with CO2. Thermogenesis induced by amino acid administration has been reported during anesthesia. Here, we tested the efficacy of amino acid treatment for the prevention of hypothermia, and we investigated the potential of this treatment to reduce postoperative infectious complications after thoracoscopic esophagectomy. We conducted a randomized trial in patients with esophageal cancer who underwent thoracoscopic esophagectomy in the prone position in two groups and analyzed the incidences of hypothermia and surgical complications. One-hundred and thirty patients were randomized. Administration of amino acids resulted in a significant increase in core body temperature. In the saline (n = 60) and amino acid (n = 70) administration groups, 30% and 14.2% of patients, respectively, experienced infectious surgical complications (P = 0.029), and 21.6% and 22.8% of patients, respectively, experienced noninfectious surgical complications (P = 0.86). Univariate analysis revealed that blood loss and amino acid administration were significant factors for infectious surgical complications. Multivariate analysis revealed that amino acid administration was an independent factor reducing infectious surgical complications (P = 0.025, 95% confidence interval: 0.105-0.864). Administration of amino acids prevents hypothermia and reduces postoperative infectious complications after thoracoscopic esophagectomy.
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Affiliation(s)
- T Fujita
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - N Okada
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - J Kanamori
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - T Sato
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - S Mayanagi
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - K Torigoe
- Division of Anesthesiology, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - A Oshita
- Division of Anesthesiology, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - H Yamamoto
- Division of Anesthesiology, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - H Daiko
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
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Torossian A, Bräuer A, Höcker J, Bein B, Wulf H, Horn EP. Preventing inadvertent perioperative hypothermia. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:166-72. [PMID: 25837741 DOI: 10.3238/arztebl.2015.0166] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND 25-90% of all patients undergoing elective surgery suffer from inadvertent postoperative hypothermia, i.e., a core body temperature below 36°C. Compared to normothermic patients, these patients have more frequent wound infections (relative risk [RR] 3.25, 95% confidence interval [CI] 1.35-7.84), cardiac complications (RR 4.49, 95% CI 1.00-20.16), and blood transfusions (RR 1.33, 95% CI 1.06-1.66). Hypothermic patients feel uncomfortable, and shivering raises oxygen consumption by about 40%. METHODS This guideline is based on a systematic review of the literature up to and including October 2012 and a further one from November 2012 to August 2014. The recommendations were developed and agreed upon by representatives of five medical specialty societies in a structured consensus process. RESULTS The patient's core temperature should be measured 1-2 hours before the start of anesthesia, and either continuously or every 15 minutes during surgery. Depending on the nature of the operation, the site of temperature measurement should be oral, naso-/oropharyngeal, esophageal, vesical, or tympanic (direct). The patient should be actively prewarmed 20-30 minutes before surgery to counteract the decline in temperature. Prewarmed patients must be actively warmed intraoperatively as well if the planned duration of anesthesia is longer than 60 minutes (without prewarming, 30 minutes). The ambient temperature in the operating room should be at least 21°C for adult patients and at least 24°C for children. Infusions and blood transfusions that are given at rates of >500 mL/h should be warmed first. Perioperatively, the largest possible area of the body surface should be thermally insulated. Emergence from general anesthesia should take place at normal body temperature. Postoperative hypothermia, if present, should be treated by the administration of convective or conductive heat until normothermia is achieved. Shivering can be treated with medications. CONCLUSION Inadvertent perioperative hypothermia can adversely affect the outcome of surgery and the patient's postoperative course. It should be actively prevented.
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Affiliation(s)
- Alexander Torossian
- Clinic of Anesthesiology and Intensive Care Medicine, UKGM Giessen and Marburg, Marburg, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Department of Anaesthesia and Surgical Critical Care, Asklepios Clinic St. Georg, Hamburg, Department of Anaesthesiology and Intensive Care Medicine, Regio Kliniken Pinneberg
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Pan X, Ye L, Liu Z, Wen H, Hu Y, Xu X. Effect of irrigation fluid temperature on core body temperature and inflammatory response during arthroscopic shoulder surgery. Arch Orthop Trauma Surg 2015; 135:1131-9. [PMID: 25983115 DOI: 10.1007/s00402-015-2246-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Indexed: 02/09/2023]
Abstract
PURPOSE This study was designed to evaluate the influence of irrigation fluid on the patients' physiological response to arthroscopic shoulder surgery. METHODS Patients who were scheduled for arthroscopic shoulder surgery were prospectively included in this study. They were randomly assigned to receive warm arthroscopic irrigation fluid (Group W, n = 33) or room temperature irrigation fluid (Group RT, n = 33) intraoperatively. Core body temperature was measured at regular intervals. The proinflammatory cytokines TNF-α, IL-1, IL-6, and IL-10 were measured in drainage fluid and serum. RESULTS The changes of core body temperatures in Group RT were similar with those in Group W within 15 min after induction of anesthesia, but the decreases in Group RT were significantly greater after then. The lowest temperature was 35.1 ± 0.4 °C in Group RT and 35.9 ± 0.3 °C in Group W, the difference was statistically different (P < 0.05). Hypothermia occurred in 31 out of 33 subjects in Group RT (31/33; 94 %), but was significantly lower in Group W (9/24; 27 %; P < 0.05). Serum TNF-α changes were undetectable postoperatively. No statistical significant differences in serum IL-1 and serum IL-10 levels were observed between groups. Serum IL-6 levels were significantly lower in Group W (P < 0.05). The levels of the above cytokines in drainage fluid were all significantly lower in Group W after surgery (P < 0.05). CONCLUSION Hypothermia occurs more often in arthroscopic shoulder surgery by using room temperature irrigation fluid compared with warm irrigation fluid. And local inflammatory response is significantly reduced by using warm irrigation fluid. It seems that warm irrigation fluid is more recommendable for arthroscopic shoulder surgery.
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Affiliation(s)
- Xiaoyun Pan
- The Osteopathy Department, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Zhou B, Wang G, Yang S, He X, Liu Y. The effects of amino acid infusions on core body temperature during the perioperative period: a systematic review. J Perianesth Nurs 2014; 29:491-500. [PMID: 25458629 DOI: 10.1016/j.jopan.2014.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 03/09/2014] [Accepted: 04/07/2014] [Indexed: 11/29/2022]
Abstract
The aim of this systematic review was to determine the effect of amino acid infusions on core body temperature and shivering. We searched the PubMed, EMBASE, CINAHL, and Cochrane Register of Controlled Trials databases to identify randomized controlled trials that met the inclusion criteria. A total of 11 eligible trials involving 506 participants were identified. Amino acid infusions were associated with shorter periods of mechanical ventilation and hospitalization and less perioperative shivering, mechanical intubation, and hospitalization in surgical patients without hepatic, renal, or severe metabolic disorders. It is recommended that infusions are warmed before administration to avoid further decrease in core body temperature.
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Tekgul ZT, Pektas S, Yildirim U, Karaman Y, Cakmak M, Ozkarakas H, Gonullu M. A prospective randomized double-blind study on the effects of the temperature of irrigation solutions on thermoregulation and postoperative complications in percutaneous nephrolithotomy. J Anesth 2014; 29:165-9. [DOI: 10.1007/s00540-014-1888-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
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De S, Torricelli FCM, Sarkissian C, Kartha G, Monga M. Evaluating the Automated Thermedx Fluid Management System in a Ureteroscopy Model. J Endourol 2014; 28:549-53. [DOI: 10.1089/end.2013.0697] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shubha De
- Glickman Urologic and Kidney Institute, The Cleveland Clinic, Cleveland, Ohio
| | | | - Carl Sarkissian
- Glickman Urologic and Kidney Institute, The Cleveland Clinic, Cleveland, Ohio
| | - Ganesh Kartha
- Glickman Urologic and Kidney Institute, The Cleveland Clinic, Cleveland, Ohio
| | - Manoj Monga
- Glickman Urologic and Kidney Institute, The Cleveland Clinic, Cleveland, Ohio
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Duff J, Di Staso R, Cobbe KA, Draper N, Tan S, Halliday E, Middleton S, Lam L, Walker K. Preventing hypothermia in elective arthroscopic shoulder surgery patients: a protocol for a randomised controlled trial. BMC Surg 2012; 12:14. [PMID: 22817672 PMCID: PMC3411492 DOI: 10.1186/1471-2482-12-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 07/20/2012] [Indexed: 11/10/2022] Open
Abstract
Background Patients having arthroscopic shoulder surgery frequently experience periods of inadvertent hypothermia. This common perioperative problem has been linked to adverse patient outcomes such as myocardial ischaemia, surgical site infection and coagulopathy. International perioperative guidelines recommend patient warming, using a forced air warming device, and the use of warmed intraoperative irrigation solutions for the prevention of hypothermia in at-risk patient groups. This trial will investigate the effect of these interventions on patients’ temperature, thermal comfort, and total recovery time. Method/Design The trial will employ a randomised 2 x 2 factorial design. Eligible patients will be stratified by anaesthetist and block randomised into one of four groups: Group one will receive preoperative warming with a forced air warming device; group two will receive warmed intraoperative irrigation solutions; group three will receive both preoperative warming and warmed intraoperative irrigation solutions; and group four will receive neither intervention. Participants in all four groups will receive active intraoperative warming with a forced air warming device. The primary outcome measures are postoperative temperature, thermal comfort, and total recovery time. Primary outcomes will undergo a two-way analysis of variance controlling for covariants such as operating room ambient temperature and volume of intraoperative irrigation solution. Discussion This trial is designed to confirm the effectiveness of these interventions at maintaining perioperative normothermia and to evaluate if this translates into improved patient outcomes. Australian New Zealand Clinical Trials Registry number ACTRN12610000591055
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Affiliation(s)
- Jed Duff
- St Vincent's Private Hospital, and Nursing Research Institute, St Vincent’s & Mater Health Sydney-Australian Catholic University, Victoria Street, Darlinghurst, NSW, 2010, Australia.
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