Impact of brief prewarming on anesthesia-related core-temperature drop, hemodynamics, microperfusion and postoperative ventilation in cytoreductive surgery of ovarian cancer: a randomized trial.

Kaufner, L; Niggemann, P; Baum, T; Casu, S; Sehouli, J; Bietenbeck, A; Boschmann, M; Spies, C D; Henkelmann, A; von Heymann, C

doi:10.1186/s12871-019-0828-1

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Title:: Impact of brief prewarming on anesthesia-related core-temperature drop, hemodynamics, microperfusion and postoperative ventilation in cytoreductive surgery of ovarian cancer: a randomized trial.
Document type:: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
Author(s):: Kaufner, L; Niggemann, P; Baum, T; Casu, S; Sehouli, J; Bietenbeck, A; Boschmann, M; Spies, C D; Henkelmann, A; von Heymann, C
Abstract:: BACKGROUND: General (GA)- and epidural-anesthesia may cause a drop in body-core-temperature (BCTdrop), and hypothermia, which may alter tissue oxygenation (StO2) and microperfusion after cytoreductive surgery for ovarian cancer. Cell metabolism of subcutaneous fat- or skeletal muscle cells, measured in microdialysis, may be affected. We hypothesized that forced-air prewarming during epidural catheter placement and induction of GA maintains normothermia and improves microperfusion. METHODS: After ethics approval 47 women scheduled for cytoreductive surgery were prospectively enrolled. Women in the study group were treated with a prewarming of 43 °C during epidural catheter placement. BCT (Spot on®, 3 M) was measured before (T1), after induction of GA (T2) at 15 min (T3) after start of surgery, and until 2 h after ICU admission (TICU2h). Primary endpoint was BCTdrop between T1 and T2. Microperfusion-, hemodynamic- and clinical outcomes were defined as secondary outcomes. Statistical analysis used the Mann-Whitney-U- and non-parametric-longitudinal tests. RESULTS: BCTdrop was 0.35 °C with prewarming and 0.9 °C without prewarming (p < 0.005) and BCT remained higher over the observation period (ΔT4 = 0.9 °C up to ΔT7 = 0.95 °C, p < 0.001). No significant differences in hemodynamic parameters, transfusion, arterial lactate and dCO2 were measured. In microdialysis the ethanol ratio was temporarily, but not significantly, reduced after prewarming. Lactate, glucose and glycerol after PW tended to be more constant over the entire period. Postoperatively, six women without prewarming, but none after prewarming were mechanical ventilated (p < 0.001). CONCLUSION: Prewarming at 43 °C reduces the BCTdrop and maintains normothermia without impeding the perioperative routine patient flow. Microdialysis indicate better preserved parameters of microperfusion. TRIAL REGISTRATION: ClinicalTrials.gov ; ID: NCT02364219 ; Date of registration: 18-febr-2015.
Journal title abbreviation:: BMC Anesthesiol
Year:: 2019
Journal volume:: 19
Journal issue:: 1
Fulltext / DOI:: doi:10.1186/s12871-019-0828-1
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/31438849
Print-ISSN:: 1471-2253
TUM Institution:: Institut für Klinische Chemie und Pathobiochemie
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