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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 1999 July-August;65(7-8):507-14

language: English

Short­ening the dis­charging ­time after ­total hip replace­ment ­under com­bined spinal/epi­dural anes­thesia by ­actively ­warming the ­patient ­during sur­gery

Casati A. 1, Fanelli G. 1, Ricci A. 2, Musto P. 3, Cedrati V. 1, Altimari G. 2, Baroncini S. 2, Pattono R. 3, Montanini S. 4, Torri G. 1

1 Università ­degli ­Studi - ­Milano, IRCCS H San Raf­faele, Isti­tuto di Anes­te­sio­logia e Rian­i­maz­ione;
2 Università ­degli ­Studi - ­Bologna, Pol­i­clinico S. ­Orsola, Isti­tuto di Anes­te­sio­logia e Rian­i­maz­ione;
3 Università ­degli ­Studi - ­Torino, Ospe­dale S. Gio­vanni Bat­tista, Isti­tuto di Anes­te­sio­logia e Rian­i­maz­ione;
4 Università ­degli ­Studi - Mes­sina, Pol­i­clinico Uni­ver­sit­ario, Isti­tuto di Anes­te­sio­logia e Rian­i­maz­ione


Back­ground. To com­pare pas­sive ­thermal insu­la­tion by reflec­tive blan­kets ­with ­forced-air ­active ­warming on the effi­cacy of nor­mo­thermia main­te­nance and ­time for dis­charging ­from the ­recovery ­room ­after com­bined ­spinal/epi­dural anes­thesia for ­total hip arthro­plasty.
­Methods. ­Design: pros­pec­tive, ran­dom­ized ­study. Set­ting: inpa­tient anes­thesia at ­three Uni­ver­sity Depart­ments of ortho­pedic sur­gery. ­Patients: 50 ASA phys­ical ­status I-III ­patients, who ­were sched­uled for elec­tive ­total hip arthro­plasty. Inter­ven­tions: ­patients ­received com­bined ­spinal/epi­dural anes­thesia (CSE) ­with intra­thecal injec­tion of 15 mg of 0.5% hyper­baric bupiv­a­caine. All pro­ce­dures ­started 8-10 a.m., and oper­ating ­room tem­per­a­ture was main­tained ­between 21-23°C, ­with rel­a­tive ­humidity ­ranging ­between 40-45%. As ­warming ­therapy ­patients ­received ­either pas­sive ­thermal insu­la­tion of the ­trunk, the two ­upper ­limbs and the unop­er­ated ­lower ­limb ­with reflec­tive blan­kets (­group pas­sive, n=25), or ­forced-air ­active ­warming of the two ­upper ­limbs (group ­active, n=25). ­Core tem­per­a­ture was meas­ured ­before CSE place­ment (base­line), and ­then ­every 30 min ­until ­recovery of nor­mo­thermia.
­Results. Dem­o­graphic ­data, dura­tion of sur­gery, intra­op­er­a­tive ­blood ­losses, and crys­tal­loid infu­sion ­were sim­ilar in the two ­groups. Arte­rial ­blood pres­sure ­decreased in ­both ­groups com­pared ­with base­line ­values, ­while no dif­fer­ences in ­heart ­rate ­were ­observed ­during the ­study. ­Core tem­per­a­tures in pas­sive ­group ­patients ­decreased ­more mark­edly ­than in ­actively ­warmed ­patients, ­with a 1°C dif­fer­ence ­between the two ­groups at the end of sur­gery (p<0.0005). At ­recovery ­room ­entry ­seven ­patients in ­group ­active (24%) and 16 ­patients in ­group pas­sive (64%) ­showed a ­core tem­per­a­ture <36°C (p<0.01). Achieve­ment of ­both dis­charging cri­teria and nor­mo­thermia ­required 32±18 min in ­active ­group and 74±52 min in pas­sive ­group (p<0.0005).
Con­clu­sions. ­Forced-air cuta­neous ­warming ­allows the anes­the­sio­lo­gist to main­tain nor­mo­thermia ­during com­bined ­spinal/epi­dural anes­thesia for ­total hip replace­ment ­even if the con­vec­tive ­blanket is ­placed on a rel­a­tively ­small ­skin sur­face ­with ­reflex vaso­con­stric­tion. Main­taining ­core nor­mo­thermia ­decreased the dura­tion of post­an­es­thesia ­recovery and may, there­fore, ­reduce ­costs of ­care.

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