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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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