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

Advances in the multimodal management of perioperative hypothermia: approaches from traditional Chinese and Western medicine

PURPOSE

Maintaining normothermia during the perioperative period is crucial for preventing complications, such as surgical site infections, prolonged hospital stays, and adverse cardiovascular events. This study aimed to elucidate methods of perioperative temperature management by integrating Western and traditional Chinese medicine (TCM) approaches. By combining advanced techniques of Western medicine with holistic and preventative practices of TCM, we aimed to provide a comprehensive strategy for effective perioperative thermal regulation.

METHODS

And a comprehensive literature review was conducted to analyze the causes of perioperative hypothermia and methods of perioperative temperature management from both Western and traditional Chinese medicine (TCM) perspectives. Special emphasis was placed on evaluating the underlying factors contributing to perioperative hypothermia, as well as the effectiveness, selection criteria, indications, contraindications, adverse reactions, and potential complications associated with various temperature management techniques.

RESULTS

Effective prevention and management strategies include preoperative risk assessment, physical warming measures, environmental temperature control, pharmacological interventions, perioperative temperature monitoring, comprehensive warming protocols, and postoperative warming and monitoring. Integrating traditional Chinese medicine provides additional methods to enhance overall effectiveness and patient outcomes. By combining these approaches, healthcare providers can significantly reduce the incidence of inadvertent perioperative hypothermia (IPH) and its associated complications, improving patient safety and recovery.

CONCLUSION

For IPH, a complex and challenging medical condition, both traditional Chinese medicine and Western medicine have established their own theoretical bases and developed corresponding prevention and treatment methods. However, it is important to note that although each of these methods has unique value and potential, they also have specific indications and unavoidable limitations. Therefore, by integrating and combining the complementary strengths and resources of traditional Chinese medicine and Western medicine, we can achieve a more comprehensive and effective prevention of IPH, ultimately improving the health and well-being of those affected.

Estimation of the difference between peritoneal microenvironment and core body temperature during laparoscopic surgery - a prospective observational study

Maintaining patients' temperature during surgery is beneficial since hypothermia has been linked with perioperative complications. Laparoscopic surgery involves the insufflation of carbon dioxide (CO2) into the peritoneal cavity and has become the standard in many surgical indications since it is associated with better and faster recovery. However, the use of cold and dry CO2 insufflation can lead to perioperative hypothermia. We aimed to assess the difference between intraperitoneal and core temperatures during laparoscopic surgery and evaluate the influence of duration and CO2 insufflation volume by fitting a mixed generalized additive model. In this prospective observational single-center cohort trial, we included patients aged over 17 with American Society of Anesthesiology risk scores I to III undergoing laparoscopic surgery. Anesthesia, ventilation, and analgesia followed standard protocols, while patients received active warming using blankets and warmed fluids. Temperature data, CO2 ventilation parameters, and intraabdominal pressure were collected. We recruited 51 patients. The core temperature was maintained above 36 °C and progressively raised toward 37 °C as pneumoperitoneum time passed. In contrast, the intraperitoneal temperature decreased, thus creating a widening difference from 0.4 [25th-75th percentile: 0.2-0.8] °C at the beginning to 2.3 [2.1-2.3] °C after 240 min. Pneumoperitoneum duration and CO2 insufflation volume significantly increased this temperature difference (P < 0.001 for both parameters). Core vs. intraperitoneal temperature difference increased linearly by 0.01 T °C per minute of pneumoperitoneum time up to 120 min and then 0.05 T °C per minute. Each insufflated liter per unit of time, i.e. every 10 min, increased the temperature difference by approximately 0.009 T °C. Our findings highlight the impact of pneumoperitoneum duration and CO2 insufflation volume on the difference between core and intraperitoneal temperatures. Implementing adequate external warming during laparoscopic surgery effectively maintains core temperature despite the use of dry and unwarmed CO2 gases, but peritoneal hypothermia remains a concern, suggesting the importance of further research into regional effects.Trial registration: Clinicaltrials.gov: NCT04294758.

A multi-center study to predict the risk of intraoperative hypothermia in gynecological surgery patients using preoperative variables

OBJECTIVES

Hypothermia is highly common in patients undergoing gynecological surgeries under general anesthesia, so the length of hospitalization and even the risk of mortality are substantially increased. Our aim was to develop a simple and practical model to preoperatively identify gynecological surgery patients at risk of intraoperative hypothermia.

METHODS

In this retrospective study, we collected data from 802 patients who underwent gynecological surgery at three medical centers from June 2022 to August 2023. We further allocated the patients to a training group, an internal validation group, or an external validation group. The preliminary predictive factors for intraoperative hypothermia in gynecological patients were determined using the least absolute shrinkage and selection operator (LASSO) method. The final predictive factors were subsequently identified through multivariate logistic regression analysis, and a nomogram for predicting the occurrence of hypothermia was established.

RESULTS

A total of 802 patients were included, with 314 patients in the training cohort (mean age 48.5 ± 12.6 years), 130 patients in the internal validation cohort (mean age 49.9 ± 12.5 years), and 358 patients in the external validation cohort (mean age 47.6 ± 14.0 years). LASSO regression and multivariate logistic regression analyses indicated that body mass index, minimally invasive surgery, baseline heart rate, baseline body temperature, history of previous surgery, and aspartate aminotransferase level were associated with intraoperative hypothermia in gynecological surgery patients. This nomogram was constructed based on these six variables, with a C-index of 0.712 for the training cohort.

CONCLUSIONS

We established a practical predictive model that can be used to preoperatively predict the occurrence of hypothermia in gynecological surgery patients.

CLINICAL TRIAL REGISTRATION

chictr.org.cn, identifier ChiCTR2300071859.