Thermal Balance during Transurethral Resection of the Prostate: A Comparison of General Anaesthesia and Epidural Analgesia

Abstract

Heat loss during anaesthesia and surgery is a common problem. In patients with restricted cardio-pulmonary reserves this may endanger the postoperative outcome. In order to compare thermal balance we studied 25 men undergoing transurethral resection of the prostate (TURP), using either general anaesthesia (G.A.) or epidural analgesia (E.A.). Oxygen uptake, catecholamines, peripheral and central temperatures were followed in the per- and postoperative period. Heat production and total body heat were calculated from oxygen uptake and temperature measurements, respectively. Transurethral resection of the prostate resulted in a peroperative heat loss which was not influenced by the anaesthetic technique used and averaged 370 kJ during the first hour of surgery. G.A. reduced heat production while this was uninfluenced by E.A. After termination of general anaesthesia, oxygen uptake and plasma catecholamines increased, while no such changes could be detected using epidural analgesia. The ability to increase mean body temperature by increasing heat production was negatively correlated to age.

Effect of Continuously Warmed Irrigating Solution during Transurethral Resection

“…2 ,16,17 Another factor is that patients who undergo transurethral resection, especially TUR-P, are generally elderly, and tend to exhibit more pronounced and prolonged hypothermia. 2,17,18 In conclusion, this study has shown that the use of a continuously warmed solution, combined with other means, such as an operating room temperature of 25°C and the use of an active warming mattress, is effective in preventing hypothermia during transurethral resection under spinal anaesthesia, especially during TUR-P. The effect in patients under other anaesthesia techniques remains unclear.…”

Prospective observational study of the effectiveness of prewarming on perioperative hypothermia in surgical patients submitted to spinal anesthesia

“…When the negative effects of spinal anesthesia on body temperature are aggravated by other factors occurring during surgery, such as by glycine infusion during transurethral resection (TUR), temperature can decrease more profoundly. Bladder irrigation with liquids at ambient temperature can cause a decrease in body temperature of one or two degrees centigrade 9 . Prewarming (pw) associated to intraoperative warming could be beneficial in this type of patients under spinal anesthesia.…”

When asleep, one is cooler on beta–blockade than on placebo

“…In the present study, the patients represented a mmewhat narrow age range. Some previous studies havr reported that elderly patients have a lower capacity to maintain body temperature during anaesthesia (2,20,21), but data are not unanimous (4); the reported temperature changes might, for example, havc been influenced by various drug treatments.…”