Prevention of Intraoperative Hypothermia in Laparoscopy by the Use of Body-Temperature and Humidified CO2: a Pilot Study

Abstract

Introduction Hypothermia is defined as a decrease in body core temperature to below 36 °C. If intraoperative heat-preserving measures are omitted, a patientʼs temperature will fall by 1 – 2 °C. Even mild forms of intraoperative hypothermia can lead to a marked increase in morbidity and mortality. The temperature of the insufflation gas is usually disregarded in the treatment and prevention of hypothermia. This study was conducted to investigate the effect of body-temperature and humidified CO2 on the intraoperative temperature profile and avoidance of hypothermia in laparoscopic surgery. Material and Methods In this retrospective, non-randomised case control study, 110 patients whose planned operation lasted at least 60 minutes were identified from 376 patients by means of an algorithm. Dry (20% humidity) CO2 at room temperature was insufflated in 51 patients (control group). 59 patients were insufflated with humidified (98% humidity) CO2 at body temperature (37 °C) (study group). These conditions were achieved with the HumiGard MR860 Surgical Humidification System (Fisher & Paykel Healthcare Limited, Auckland, New Zealand). The intraoperative temperature profile was evaluated by measurements every 10 minutes. Statistical analysis was performed with IBM® SPSS® Statistics 23.0.0. Results The intraoperative temperature in the control group fell steadily, while a continuous rise in temperature was observed in the study group. Warming was demonstrated in the study group with a start-end temperature difference of 0.09 °C, which differed significantly from the control group, in which it was − 0.09 °C (p = 0.011). The middle-end difference of 0.11 °C showed even higher significance in favour of the warmed gas (p = 0.003). The rate of hypothermia at the start of the operation fell from 50 to 36% in the study group and increased from 36 to 42% in the control group. Conclusion These results show that the use of body-temperature and humidified insufflation gas for laparoscopy can help to prevent intraoperative hypothermia.

The effect of warm and humidified gas insufflation in gynecological laparoscopy on maintenance of body temperature: a prospective randomized controlled multi-arm trial

“…This may be due to the fact that their sample size with ten patients per group was too small. The findings confirm our previously published results of a retrospective case-control analysis underlining the positive effect of the addition of warm and humidified gas insufflation [13].…”

“…The explanation lies within the pathophysiology of anaesthesia induction: The inhibition of vasoconstriction has the effect of core-to-peripheral redistribution of body heat, decreasing core temperature. This can best be antagonized via prewarming and external forced air warming [13,28,30]. After this redistribution, which causes the greatest heat loss, the effect of warm, humidified gas insufflation can kick in.…”

“…This factor is often overlooked when intraoperative hypothermia occurs. Evidence from previous studies show, however, that the risk of hypothermia can be reduced by the use of warmed and humidified insufflation gas [7][8][9][10][11][12][13]. The question is especially relevant in gynecology as women in particular tend towards intraoperative hypothermia [14].…”

“…Baseline Characteristics of the investigated patient groups (all participants who underwent surgery). This table was published before in the part describing postoperative pain[13] …”

Warm and humidified insufflation gas during gynecologic laparoscopic surgery reduces postoperative pain in predisposed patients—a randomized, controlled multi-arm trial

“…This article describes parts of this TePaLa trial (the effects on body temperature have not been published yet). The TePaLa trial is based on a retrospective pilot study showing the preventive effect of body temperature and humidified CO 2 on intraoperative hypothermia compared to room temperature and dry gas in laparoscopy that lasted at least 60 min [ 21 ]. As perception of postoperative pain was likely to be influenced by pre-existing endometriosis, the data were stratified for this disorder.…”