In upper abdominal surgery under general anesthesia, female sex, age over 70, smoking and COPD were independent risk factors for intra and postoperative pulmonary events.

SummaryOur aim was to compare peri-operative core temperatures and the incidence of hypothermia in obese and non-obese women with active forced-air warming. Twenty female patients scheduled for abdominal surgery were allocated to two groups according to body mass index. Ten obese (30.0-34.9 kg.m )2) and 10 non-obese (18.5-24.9 kg.m ) women received forced-air warming on their lower limbs. At the end of surgery, the mean (SD) core temperatures were 36.7 (0.5)°C in the obese group and 36.0 (0.6)°C in the non-obese group (p < 0.001). Only in the non-obese group was there a significant decrease in the intra-operative core temperature values (p < 0.001). The incidences of intra-operative hypothermia were lower in the obese group (10%) compared with non-obese group (60%; p = 0.019). In the postoperative recovery phase, the mean (SD) core temperature data were higher in the obese group than in the nonobese group (36.2 (0.4) vs 35.6 (0.5)°C, respectively (p < 0.001)). In conclusion, obese female patients have higher perioperative core temperature and a lower incidence of hypothermia compared with non-obese female patients during abdominal surgery with active forced-air warming. Accepted: 21 August 2012Unintentional peri-operative hypothermia (core temperatures between 34.5 and 35.9°C) often leads to adverse outcomes, including cardiac events secondary to sympathetic nervous system activation [1], surgicalwound infections and prolonged hospitalisation [2], coagulopathy and increased blood loss [3], impaired drug metabolism, delayed postoperative recovery period [4,5] and shivering [6]. Therefore, maintaining perioperative normothermia reduces morbidity [1][2][3] and the use of peri-operative warming devices has become routine.The prevalence of obesity has increased markedly worldwide in recent years [7]. In clinical practice, body mass index (BMI) is used to estimate the degree of obesity, which is classified in three levels: grade 1 (BMI from 30.0 to 34.9 kg.m ) [8]. The prevalence of grade-1 obesity is higher among both female and male obese populations than are the other grades [8]. Obese patients are more likely to vasoconstrict in cooler environments [9], have reduced heat redistribution from core to peripheral tissue after

RESUMO

The smaller volemic state from hypertonic (7.5%) saline (HS) solution administration in hemorrhagic shock can determine lesser systemic oxygen delivery and tissue oxygenation than conventional plasma expanders. In a model of hemorrhagic shock in dogs, we studied the systemic and gastrointestinal oxygenation effects of HS and hyperoncotic (6%) dextran-70 in combination with HS (HSD) solutions in comparison with lactated Ringer's (LR) and (6%) hydroxyethyl starch (HES) solutions. Forty-eight mongrel dogs were anesthetized, mechanically ventilated, and subjected to splenectomy. A gastric air tonometer was placed in the stomach for intramucosal gastric CO(2) (Pgco(2)) determination and for the calculation of intramucosal pH (pHi): The dogs were hemorrhaged (42% of blood volume) to hold mean arterial blood pressure at 40-50 mm Hg over 30 min and were then resuscitated with LR (n = 12) in a 3:1 relation to removed blood volume; HS (n = 12), 6 mL/kg; HSD (n = 12), 6 mL/kg; and HES (mean molecular weight, 200 kDa; degree of substitution, 0.5) (n = 12) in a 1:1 relation to the removed blood volume. Hemodynamic, systemic, and gastric oxygenation variables were measured at baseline, after 30 min of hemorrhage, and 5, 60, and 120 min after intravascular fluid resuscitation. After fluid resuscitation, HS showed significantly lower arterial pH and mixed venous Po(2) and higher systemic oxygen uptake index and systemic oxygenation extraction than LR and HES (P < 0.05), whereas HSD showed significantly lower arterial pH than LR and HES (P < 0.05). Only HS and HSD did not return arterial pH and pHi to control levels (P < 0.05). In conclusion, all solutions improved systemic and gastrointestinal oxygenation after hemorrhagic shock in dogs. However, the HS solution showed the worst response in comparison to LR and HES solutions in relation to systemic oxygenation, whereas HSD showed intermediate values. HS and HSD solutions did not return regional oxygenation to control values.

In nonpremedicated dogs, propofol Cp50(predicted) of 6.0 microg/mL may be recommended for induction of anesthesia. Propofol requirements for maintaining target-controlled infusion system-based anesthesia were reduced via infusion of remifentanil at a rate of 0.3 microg/kg/min.

Intraoperative hypotension and bradycardia were the complications observed more often. Hypotension was related to anesthetic technique (CSA), increased age, and female. Tachycardia and hypertension may not have been directly related to neuraxial blocks.

The thirty minute renal ischemia appears to have determined the alterations found in the renal function and histology in both groups. Metoprolol, used in G2, as to the time and dose applied didn't protect the kidney from the ischemic episode.

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