Controle de temperatura em intervenção cirúrgica abdominal convencional: comparação entre os métodos de aquecimento por condução e condução associada à convecção
Temperature control in conventional abdominal surgery: comparison between conductive and the association of conductive and convective warming
Marcelo Lacava Pagnocca; Eun Joo Tai; Joana L. Dwan
Resumo
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Abstract
BACKGROUND AND OBJECTIVES: Intraoperative hypothermia is a common complication, and its development is favored by abdominal surgeries. The efficacy of the association of conductive and convective warming methods in the prevention of hypothermia, and its effects during postoperative recovery were the objectives of this study. METHODS: Forty-three patients of both genders, ages 18 to 88 years, undergoing xyphopubic laparotomy under general anesthesia and monitoring of the esophageal temperature were randomly divided in two groups, according to the warming method: COND (n = 24), circulating-water mattress at 37° C on the back, and COND + CONV (n = 19), circulating-water mattress associated with warm air blanket at 42° C over the thorax and upper limbs. Weight, gender, age, duration of surgery and anesthesia, temperature on anesthetic induction (Mi), consecutive hours (M1, M2), end of surgery (Mes) and anesthesia (Mea), and admission (Ma-REC) and discharge (Md-REC) from the post-anesthetic recovery room (PARR), besides the postoperative incidence of tremors and complaints of cold, were analyzed. RESULTS: Both groups were similar regarding all parameters analyzed, except temperatures on M2, M3, M4, Mes, and Mea. The temperature of patients in the COND group decreased from the second hour of anesthetic induction on, but in the COND + CONV group it only happened in the fourth hour. Patients in the COND group presented hypothermia upon admission and discharge from the PARR. CONCLUSIONS: The association of different warming methods delayed the beginning and reduced the severity of intraoperative hypothermia, but it did not reduce the complaints of feeling cold and tremors.
Referencias
Vaughan MS, Vaughan RW, Cork RC. Postoperative hypothermia in adults: Relationship of age, anesthesia, and shivering to rewarming. Anesth Analg. 1981;60:746-751.
Sessler DI. Perioperative thermoregulation and heat balance. Ann NY Acad Sci. 1997;813:757-777.
Sessler DI. Mied perioperative hypothermia. N Eng J Med. 1997;336:1730-1737.
Sessler DI. Perioperative heat balance. Anesthesiology. 2000;92:578-596.
Schubert A. Side effects of mild hypothermia. J Neurosurg Anesthesiol. 1995;7:139-147.
Frank SM, Shir Y, Raja SN. Core hypothermia and skin surface temperature gradients: epidural vs. general anesthesia and the effects of age. Anesthesiology. 1994;80:502-508.
Frank SM, Fleisher LA, Breslow MJ. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: a randomized clinical trial. JAMA. 1997;277:1127-1134.
Hendolin H, Lansimies E. Skin and central temperatures during continuous epidural analgesia and general anesthesia in patients subjected to open prostatectomy. Ann Clin Res. 1982;14:181-186.
Taguchi A, Ratnaraj J, Kabon B. Effects of a circulating-water garment and forced-air warming on body heat content and core temperature. Anesthesiology. 2004;100:1058-1064.
Sessler DI, Moayeri A, Støen R. Thermoregulatory vasoconstriction decreases cutaneous heat loss. Anesthesiology. 1990;73:656-660.
Clough D, Kurz A, Sessler DI. Thermoregulatory vasoconstriction does not impede core warming during cutaneous heating. Anesthesiology. 1996;85:281-288.
Sessler DI, Moayeri A. Skin-surface warming: heat flux and central temperature. Anesthesiology. 1990;73:218-224.
Sessler DI, McGuire J, Sessler AM. Perioperative thermal insulation. Anesthesiology. 1991;74:875-879.
Kurz A, Kurz M, Poeschl G. Forced-air warming maintains intraoperative normothermia better than circulating-water mattresses. Anesth Anag. 1993;77:89-95.
Negishi C, Hasegawa K, Mukai S. Resistive heating and forced-air warming are comparably effective. Anesth Analg. 2003;96:1683-1687.
Lenhardt R. Monitoring and thermal management. Best Pract Res Clin Anesthesiol. 2003;17:569-581.
Johnson RA, Wichern DW. Applied Multivariate Statistical Analysis. 1992.
Mekjavic IB, Rempel ME. Determination of esophageal probe insertion length based on standing and sitting height. J Appl Physiol. 1990;69:376-379.
El-Gamal N, El-Kassabany N, Frank SM. Age related thermoregulatory differences in a warm operating environment (approximately 26 degrees C). Anesth Analg. 2000;90:694-698.
Lennon RL, Hosking MP, Conover MA. Evaluation of forced-air system for warming hypothermic postoperative patients. Anesth Analg. 1990;70:424-427.
Sessler DI. Consequences and treatment of perioperative hypothermia. Anesthesiol Clin North Am. 1994;12:425-456.
Kober A, Scheck T, Fulesdi B. Effectiveness of resistive heating compared with passive warming in treating hypothermia associated with minor trauma: a randomized trial. Mayo Clin Proc. 2001;76:369-375.
Hynson J, Sessler DI. Intraoperative warming therapies: a comparison of three devices. J Clin Anesth. 1992;4:194-199.
Taguchi A, Arkilic CF, Sessler DI. Negative pressure rewarming vs. forced air warming in hypothermic postanesthetic volunteers. Anesth Analg. 2001;92:261-266.
Schmied H, Kurz A, Sessler DI. Mild hypothermia increases blood loss and transfusions requirements during total hip arthroplasty. Lancet. 1996;347:289-292.
Kurz A, Sessler DI, Narzt E. Morphometric influences of intraoperative core temperature changes. Anesth Analg. 1995;80:562-567.
Kim JY, Shinn H, Oh YJ. The effect of skin surface warming during anesthesia preparation on preventing redistribution hypothermia in the early operative period of off-pump coronary artery bypass surgery. Eur J Cardiothorac Surg. 2006;29:343-347.
Janicki PK, Higgins MS, Janssen J. Comparison of two different temperature maintenance strategies during open abdominal surgery: upper body forced-air warming versus whole body water garment. Anesthesiology. 2001;95:868-874.
Frank SM, Higgins MS, Breslow MJ. The catecholamine, cortisol and hemodynamic responses to mild perioperative hypothermia: a randomized clinical trial. Anesthesiology. 1995;82:83-93.
Bräuer A, Pacholik L, Perl T. Conductive heat exchange with a gel-coated circulating water mattress. Anesth Analg. 2004;99:1742-1746.
Pagnocca ML, Frerichs E, Machado AN. Hipotermia intra-operatória em adultos: comparação da prevalência em dois hospitais-escola da cidade de São Paulo. Diag & Trat. 2008;13:4-7.
Campos-Suarez JM, Casas-Vila JI, Litvan-Suquieni H. Air-convection heater for abdominal surgery: Study of the relation between surgical time and the efficacy of body temperature maintenance. Rev Esp Anestesiol Reanim. 1997;44:47-51.
Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med. 1996;334:1209-1215.
Leslie K, Sessler DI, Bjorksten AR. Mild hypothermia alters propofol pharmacokinetics and increases the duration of action of atracurium. Anesth Analg. 1995;80:1007-1014.
Heier T, Caldwess JE, Sessler DI. Mild intraoperative hypothermia increases duration of action and spontaneous recovery of vecuronium blockade during nitrous oxide-isoflurane anesthesia en humans. Anesthesiology. 1991;74:815-819.
Lenhardt R, Marker E, Goll V. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology. 1997;87:1318-1323.
Rohrer M, Natale A. Effect of hypothermia on the coagulation cascade. Crit Care Med. 1992;20:1402-1405.
Leslie K, Sessler DI. The implications of hypothermia for early tracheal extubation following cardiac surgery. J Cardiothorac Vasc Anesth. 1998;12:30-34.