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

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

doi:10.1186/s12871-019-0828-1

Abstract

BackgroundGeneral (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.MethodsAfter 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.ResultsBCTdrop 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).ConclusionPrewarming at 43 °C reduces the BCTdrop and maintains normothermia without impeding the perioperative routine patient flow. Microdialysis indicate better preserved parameters of microperfusion.Trial registrationClinicalTrials.gov; ID: NCT02364219; Date of registration: 18-febr-2015.

Highlights

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
The body core temperature change from Temperature at time before induction of anesthesia (T1) to Temperature after induction of anesthesia (T2) amounted to 0.35 °C in the prewarm group and 0.9 °C in the standard group (Fig. 3) with a significant difference (ΔT) at T2 = 0.55 °C (p < 0.005) between both groups (Fig. 3)
Despite pre- and intraoperative forced-air warming the drop in body core temperature with induction of GA still occurs, which can be significantly alleviated by prewarming, which is in line with earlier results [12, 22]

Summary

Introduction

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. A shift of thresholds for vasoconstriction and shivering as well as sympathicolysisrelated vasodilatation caused by epidural anesthesia (EDA) result in a redistribution of warm blood from the body core to the periphery [3]. As a result of impaired microperfusion cell metabolism of subcutaneous fat- or skeletal muscle cells, measured in microdialysis (MD), may be affected [10]

Methods

Results

Discussion

Conclusion