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Lee JJ, Choi GJ, Lee WJ, Choi SB, Kang H. Effect of active airway warming with a heated-humidified breathing circuit on core body temperature in patients under general anesthesia: a systematic review and meta-analysis with trial sequential analysis. Korean J Anesthesiol 2023; 76:17-33. [PMID: 35859301 PMCID: PMC9902183 DOI: 10.4097/kja.22200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/19/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The application of a heated-humidified breathing circuit (HHBC) may reduce respiratory heat loss during mechanical ventilation, but its effect in preventing intraoperative hypothermia is controversial. This study aimed to investigate the effectiveness of HHBC in maintaining the core temperature of patients receiving mechanical ventilation under general anesthesia. METHODS We searched MEDLINE, Embase, Cochrane library (CENTRAL), and Google Scholar to identify all randomized controlled trials (RCTs) up to February 2022 that compared the intraoperative core temperature in patients with heated humidifier (HH) and other circuit devices. The primary outcome was the intraoperative core temperature at the end of surgery. The weighted mean differences (WMDs) between the groups and their 95% CIs were calculated for each outcome. We performed a trial sequential analysis of the primary outcomes to assess whether our results were conclusive. RESULTS Eighteen RCTs with 993 patients were included in the analysis. A significantly higher core temperature was observed at the end of surgery in patients with HH than those with no device (WMD = 0.734, 95% CI [0.443, 1.025]) or heat and moisture exchanger (WMD = 0.368, 95% CI [0.118, 0.618]), but with substantial heterogeneity. CONCLUSIONS Although HHBC did not absolutely prevent hypothermia, this meta-analysis suggests that it can be used as an effective supplemental device to maintain the intraoperative core temperature under general anesthesia. However, considering the substantial heterogeneity and limitations of this study, further well-designed studies are needed to clarify the effectiveness of HHBC.
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Affiliation(s)
- Je Jin Lee
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Geun Joo Choi
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Won Jun Lee
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Sang Bong Choi
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea,Corresponding author: Hyun Kang, M.D., Ph.D., M.P.H. Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, KoreaTel: +82-2-6299-2586Fax: +82-2-6299-2585
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Herff H, Schroeder DC, Bowden K, Paal P, Mitterlechner T, Wenzel V. Temperature loss by ventilation in a calorimetric bench model. Med Gas Res 2021; 10:27-29. [PMID: 32189666 PMCID: PMC7871931 DOI: 10.4103/2045-9912.279980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In intensive care medicine heat moisture exchangers are standard tools to warm and humidify ventilation gases in order to prevent temperature loss of patients or airway epithelia damage. Despite being at risk of hypothermia especially after trauma, intubated emergency medicine patients are often ventilated with dry and in winter probably cold ventilation gases. We tried to assess the amount of temperature-loss due to ventilation with cold, dry medical oxygen in comparison to ventilation with warm and humidified oxygen. We ventilated a 50-kg water-dummy representing the calorimetric capacity of a 60-kg patient over a period of 2 hours (tidal volume 6.6 mL/kg = 400 mL; respiratory rate 13/min). Our formal null-hypothesis was that there would be no differences in temperature loss in a 50 kg water-dummy between ventilation with dry oxygen at 10°C vs. ventilation with humidified oxygen at 43°C. After 2 hours the temperature in the water-dummy using cold and dry oxygen was 29.7 ± 0.1°C compared to 30.4 ± 0.1°C using warm and humidified oxygen. This difference in cooling rates between both ventilation attempts of 0.7 ± 0.1°C after 2 hours represents an increased cooling rate of ~0.35°C per hour. Ventilation with cool, dry oxygen using an automated transport ventilator resulted in a 0.35°C faster cooling rate per hour than ventilation with warm humidified oxygen in a bench model simulating calorimetric features of a 60-kg human body.
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Affiliation(s)
- Holger Herff
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Daniel C Schroeder
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Kevin Bowden
- O-Two Medical Technologies Inc., Brampton, Canada
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Mitterlechner
- Department of Anesthesiology, Privatklinik Hochrum, Sanatorium der Kreuzschwestern, Rum, Austria
| | - Volker Wenzel
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Klinikum Friedrichshafen, Friedrichshafen, Germany
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Shin KS, Lee GY, Chun EH, Kim YJ, Kim WJ. Effect of short-term prewarming on body temperature in arthroscopic shoulder surgery. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.4.388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Kwang-seob Shin
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Guie Yong Lee
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Eun Hee Chun
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Youn Jin Kim
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Won Joong Kim
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Gillies D, Todd DA, Foster JP, Batuwitage BT. Heat and moisture exchangers versus heated humidifiers for mechanically ventilated adults and children. Cochrane Database Syst Rev 2017; 9:CD004711. [PMID: 28905374 PMCID: PMC6483749 DOI: 10.1002/14651858.cd004711.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Invasive ventilation is used to assist or replace breathing when a person is unable to breathe adequately on their own. Because the upper airway is bypassed during mechanical ventilation, the respiratory system is no longer able to warm and moisten inhaled gases, potentially causing additional breathing problems in people who already require assisted breathing. To prevent these problems, gases are artificially warmed and humidified. There are two main forms of humidification, heat and moisture exchangers (HME) or heated humidifiers (HH). Both are associated with potential benefits and advantages but it is unclear whether HME or HH are more effective in preventing some of the negative outcomes associated with mechanical ventilation. This review was originally published in 2010 and updated in 2017. OBJECTIVES To assess whether heat and moisture exchangers or heated humidifiers are more effective in preventing complications in people receiving invasive mechanical ventilation and to identify whether the age group of participants, length of humidification, type of HME, and ventilation delivered through a tracheostomy had an effect on these findings. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and CINAHL up to May 2017 to identify randomized controlled trials (RCTs) and reference lists of included studies and relevant reviews. There were no language limitations. SELECTION CRITERIA We included RCTs comparing HMEs to HHs in adults and children receiving invasive ventilation. We included randomized cross-over studies. DATA COLLECTION AND ANALYSIS We assessed the quality of each study and extracted the relevant data. Where possible, we analysed data through meta-analysis. For dichotomous outcomes, we calculated the risk ratio (RR) and 95% confidence interval (95% CI). For continuous outcomes, we calculated the mean difference (MD) and 95% CI or standardized mean difference (SMD) and 95% CI for parallel studies. For cross-over trials, we calculated the MD and 95% CI using correlation estimates to correct for paired analyses. We aimed to conduct subgroup analyses based on the age group of participants, how long they received humidification, type of HME and whether ventilation was delivered through a tracheostomy. We also conducted sensitivity analysis to identify whether the quality of trials had an effect on meta-analytic findings. MAIN RESULTS We included 34 trials with 2848 participants; 26 studies were parallel-group design (2725 participants) and eight used a cross-over design (123 participants). Only three included studies reported data for infants or children. Two further studies (76 participants) are awaiting classification.There was no overall statistical difference in artificial airway occlusion (RR 1.59, 95% CI 0.60 to 4.19; participants = 2171; studies = 15; I2 = 54%), mortality (RR 1.03, 95% CI 0.89 to 1.20; participants = 1951; studies = 12; I2 = 0%) or pneumonia (RR 0.93, 95% CI 0.73 to 1.19; participants = 2251; studies = 13; I2 = 27%). There was some evidence that hydrophobic HMEs may reduce the risk of pneumonia compared to HHs (RR 0.48, 95% CI 0.28 to 0.82; participants = 469; studies = 3; I2 = 0%)..The overall GRADE quality of evidence was low. Although the overall methodological risk of bias was generally unclear for selection and detection bias and low risk for follow-up, the selection of study participants who were considered suitable for HME and in some studies removing participants from the HME group made the findings of this review difficult to generalize. AUTHORS' CONCLUSIONS The available evidence suggests no difference between HMEs and HHs on the primary outcomes of airway blockages, pneumonia and mortality. However, the overall low quality of this evidence makes it difficult to be confident about these findings. Further research is needed to compare HMEs to HHs, particularly in paediatric and neonatal populations, but research is also needed to more effectively compare different types of HME to each other as well as different types of HH.
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Affiliation(s)
| | - David A Todd
- The Canberra HospitalNeonatal UnitCentre for Newborn CarePO Box 11, WodenCanberraACTAustralia2606
| | - Jann P Foster
- Western Sydney UniversitySchool of Nursing and MidwiferyPenrith DCAustralia
| | - Bisanth T Batuwitage
- Queen Alexandra Hospital, Portsmouth Hospitals NHS TrustDepartment of AnaesthesiaSouthwick Hill RoadPortsmouthUKPO6 3LY
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Park S, Yoon SH, Youn AM, Song SH, Hwang JG. Heated wire humidification circuit attenuates the decrease of core temperature during general anesthesia in patients undergoing arthroscopic hip surgery. Korean J Anesthesiol 2017; 70:619-625. [PMID: 29225745 PMCID: PMC5716820 DOI: 10.4097/kjae.2017.70.6.619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 04/28/2017] [Accepted: 05/02/2017] [Indexed: 01/05/2023] Open
Abstract
Background Intraoperative hypothermia is common in patients undergoing general anesthesia during arthroscopic hip surgery. In the present study, we assessed the effect of heating and humidifying the airway with a heated wire humidification circuit (HHC) to attenuate the decrease of core temperature and prevent hypothermia in patients undergoing arthroscopic hip surgery under general anesthesia. Methods Fifty-six patients scheduled for arthroscopic hip surgery were randomly assigned to either a control group using a breathing circuit connected with a heat and moisture exchanger (HME) (n = 28) or an HHC group using a heated wire humidification circuit (n = 28). The decrease in core temperature was measured from anesthetic induction and every 15 minutes thereafter using an esophageal stethoscope. Results Decrease in core temperature from anesthetic induction to 120 minutes after induction was lower in the HHC group (–0.60 ± 0.27℃) compared to the control group (–0.86 ± 0.29℃) (P = 0.001). However, there was no statistically significant difference in the incidence of intraoperative hypothermia or the incidence of shivering in the postanesthetic care unit. Conclusions The use of HHC may be considered as a method to attenuate intraoperative decrease in core temperature during arthroscopic hip surgery performed under general anesthesia and exceeding 2 hours in duration.
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Affiliation(s)
- Sooyong Park
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Seok-Hwa Yoon
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Ann Misun Youn
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Seung Hyun Song
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Ja Gyung Hwang
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
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Vargas M, Chiumello D, Sutherasan Y, Ball L, Esquinas AM, Pelosi P, Servillo G. Heat and moisture exchangers (HMEs) and heated humidifiers (HHs) in adult critically ill patients: a systematic review, meta-analysis and meta-regression of randomized controlled trials. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:123. [PMID: 28552074 PMCID: PMC5447307 DOI: 10.1186/s13054-017-1710-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 05/09/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aims of this systematic review and meta-analysis of randomized controlled trials are to evaluate the effects of active heated humidifiers (HHs) and moisture exchangers (HMEs) in preventing artificial airway occlusion and pneumonia, and on mortality in adult critically ill patients. In addition, we planned to perform a meta-regression analysis to evaluate the relationship between the incidence of artificial airway occlusion, pneumonia and mortality and clinical features of adult critically ill patients. METHODS Computerized databases were searched for randomized controlled trials (RCTs) comparing HHs and HMEs and reporting artificial airway occlusion, pneumonia and mortality as predefined outcomes. Relative risk (RR), 95% confidence interval for each outcome and I 2 were estimated for each outcome. Furthermore, weighted random-effect meta-regression analysis was performed to test the relationship between the effect size on each considered outcome and covariates. RESULTS Eighteen RCTs and 2442 adult critically ill patients were included in the analysis. The incidence of artificial airway occlusion (RR = 1.853; 95% CI 0.792-4.338), pneumonia (RR = 932; 95% CI 0.730-1.190) and mortality (RR = 1.023; 95% CI 0.878-1.192) were not different in patients treated with HMEs and HHs. However, in the subgroup analyses the incidence of airway occlusion was higher in HMEs compared with HHs with non-heated wire (RR = 3.776; 95% CI 1.560-9.143). According to the meta-regression, the effect size in the treatment group on artificial airway occlusion was influenced by the percentage of patients with pneumonia (β = -0.058; p = 0.027; favors HMEs in studies with high prevalence of pneumonia), and a trend was observed for an effect of the duration of mechanical ventilation (MV) (β = -0.108; p = 0.054; favors HMEs in studies with longer MV time). CONCLUSIONS In this meta-analysis we found no superiority of HMEs and HHs, in terms of artificial airway occlusion, pneumonia and mortality. A trend favoring HMEs was observed in studies including a high percentage of patients with pneumonia diagnosis at admission and those with prolonged MV. However, the choice of humidifiers should be made according to the clinical context, trying to avoid possible complications and reaching the appropriate performance at lower costs.
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Affiliation(s)
- Maria Vargas
- Department of Neurosciences, Reproductive and Odonthostomatological Sciences, University of Naples "Federico II", Naples, Italy.
| | - Davide Chiumello
- Dipartimento di Emergenza - Urgenza, ASST Santi Paolo e Carlo; Dipartimento di Scienze della salute, Università degli Studi di Milano, Milan, Italy
| | - Yuda Sutherasan
- Division of pulmonary and critical care medicine, Faculty of medicine Ramathibodi hospital, Mahidol University, 270 RAMA VI road, Bangkok, 10400, Thailand
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics, AOU IRCCS San Martino- IST, University of Genoa, Genoa, Italy
| | | | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, AOU IRCCS San Martino- IST, University of Genoa, Genoa, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odonthostomatological Sciences, University of Naples "Federico II", Naples, Italy
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Kim E, Lee SY, Lim YJ, Choi JY, Jeon YT, Hwang JW, Park HP. Effect of a new heated and humidified breathing circuit with a fluid-warming device on intraoperative core temperature: a prospective randomized study. J Anesth 2015; 29:499-507. [DOI: 10.1007/s00540-015-1994-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/22/2015] [Indexed: 11/30/2022]
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Esquinas AM. Perioperative hypothermia during surgery: is warming humidification a complete solution? Korean J Anesthesiol 2014; 66:256-7. [PMID: 24729852 PMCID: PMC3983426 DOI: 10.4097/kjae.2014.66.3.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Sappenfield JW, Hong CM, Galvagno SM. Perioperative temperature measurement and management: moving beyond the Surgical Care Improvement Project. ACTA ACUST UNITED AC 2013. [DOI: 10.7243/2049-9752-2-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kwak IS, Choi DY, Lee TH, Bae JY, Lim TW, Kim KM. The effect of heated breathing circuit on body temperature and humidity of anesthetic gas in major burns. Korean J Anesthesiol 2013; 64:6-11. [PMID: 23372879 PMCID: PMC3558651 DOI: 10.4097/kjae.2013.64.1.6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 06/27/2012] [Accepted: 07/17/2012] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Cold and dry gas mixtures during general anesthesia cause the impairment of cilliary function and hypothermia. Hypothermia and pulmonary complications are critical for the patients with major burn. We examined the effect of heated breathing circuit (HBC) about temperature and humidity with major burned patients. METHODS Sixty patients with major burn over total body surface area 25% scheduled for escharectomy and skin graft were enrolled. We randomly assigned patients to receiving HBC (HBC group) or conventional breathing circuit (control group) during general anesthesia. The esophageal temperature of the patients and the temperature and the absolute humidity of the circuit were recorded every 15 min after endotracheal intubation up to 180 min. RESULTS There was no significant difference of the core temperature between two groups during anesthesia. The relative humidity of HBC group was significantly greater compared to control group (98% vs. 48%, P < 0.01). In both groups, all measured temperatures were significantly lower than that after intubation. CONCLUSIONS The use of HBC helped maintain airway humidity, however it did not have the effect to minimize a body temperature drop in major burns.
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Affiliation(s)
- In-Suk Kwak
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Do Young Choi
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Tae-Hyung Lee
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Ji Young Bae
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Tae-Wan Lim
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Kwang-Min Kim
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
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Lee HK, Jang YH, Choi KW, Lee JH. The effect of electrically heated humidifier on the body temperature and blood loss in spinal surgery under general anesthesia. Korean J Anesthesiol 2011; 61:112-6. [PMID: 21927679 PMCID: PMC3167128 DOI: 10.4097/kjae.2011.61.2.112] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 01/26/2011] [Accepted: 02/07/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND General anesthesia often produces some degree of hypothermia and hypothermia causes much more blood loss during surgery than normothermia. Electrically heated humidifiers (EHHs) have been used for patients under general anesthesia and in the intensive care unit. However, the benefits of the EHH have not been widely reported in the literature. METHODS Patients scheduled for posterior lumbar spine fusion, were randomly assigned to a mechanically ventilated with EHH circuit group or to a conventional respiratory circuit group. Their tympanic membrane temperature was monitored every 30 min after induction up to 180 min, and perioperative blood losses, transfusion requirements during surgery, and other complications were noted. RESULTS Patients in the control group (n = 40) showed a lower mean body temperature at all times than immediately after induction, while the EHH group (n = 40) showed a lower body temperature from 60 minute after induction comparing to the initial temperature. Furthermore, patients in the EHH group had a higher mean body temperature than patients in the control group during surgery (35.9 ± 0.4 vs 35.4 ± 0.5, P < 0.001). Mean intraoperative blood loss (9.75 ± 5.4 vs 7.48 ± 3.9, P = 0.035) and transfusion requirements (57.5% vs 25%, P = 0.006) were significantly less in the EHH group, but postoperative blood loss, duration of hospitalization, and other complications were not significantly different in the two study groups. CONCLUSIONS The use of an electrically heated humidifier did not prevent a body temperature drop under general anesthesia. However, it helped maintain body temperature and was associated less blood loss and transfusion requirement during surgery.
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Affiliation(s)
- Hyun Kyu Lee
- Department of Anesthesiology and Pain Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Yeon-Hee Jang
- Department of Anesthesiology and Pain Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Kwan-Woong Choi
- Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Ho Lee
- Department of Anesthesiology and Pain Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
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Kelly M, Gillies D, Todd DA, Lockwood C. Heated humidification versus heat and moisture exchangers for ventilated adults and children. Cochrane Database Syst Rev 2010:CD004711. [PMID: 20393939 DOI: 10.1002/14651858.cd004711.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Humidification by artificial means must be provided when the upper airway is bypassed during mechanical ventilation. Heated humidification (HH) and heat and moisture exchangers (HME) are the most commonly used types of artificial humidification in this situation. OBJECTIVES To determine whether HHs or HMEs are more effective in preventing mortality and other complications in people who are mechanically ventilated. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 4) and MEDLINE, EMBASE and CINAHL (January, 2010) to identify relevant randomized controlled trials (RCTs). SELECTION CRITERIA We included RCTs comparing heat and moisture exchangers (HMEs) to heated humidifiers (HHs) in mechanically ventilated adults and children. We included randomized crossover studies. DATA COLLECTION AND ANALYSIS We assessed the quality of each study and extracted the relevant data. Where appropriate, results from relevant studies were meta-analysed for individual outcomes. MAIN RESULTS We included 33 trials with 2833 participants, 25 studies were parallel group design (n = 2710) and eight crossover design (n = 123). Only three included studies reported data for infants or children. There was no overall effect on artificial airway occlusion, mortality, pneumonia, or respiratory complications; however, the PaCO(2) and minute ventilation were increased when HMEs were compared to HHs and body temperature was lower. The cost of HMEs was lower in all studies that reported this outcome. There was some evidence that hydrophobic HMEs may reduce the risk of pneumonia and that blockages of artificial airways may be increased with the use of HMEs in certain subgroups of patients. AUTHORS' CONCLUSIONS There is little evidence of an overall difference between HMEs and HHs. However, hydrophobic HMEs may reduce the risk of pneumonia and the use of an HME may increase artificial airway occlusion in certain subgroups of patients. Therefore, HMEs may not be suitable for patients with limited respiratory reserve or prone to airway blockage. Further research is needed relating to hydrophobic versus hygroscopic HMEs and the use of HMEs in the paediatric and neonatal populations. As the design of HMEs evolves, evaluation of new generation HMEs will also need to be undertaken.
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Affiliation(s)
- Margaret Kelly
- Nursing Research & Practice Development Unit, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, Australia, 2145
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Bergonse Neto N, Von Bahten LC, Moura LM, Coelho MDS, Stori Junior WDS, Bergonse GDFR. Modelo mecânico para simulação do condicionamento pulmonar do ar respirado. J Bras Pneumol 2007; 33:255-62. [PMID: 17906785 DOI: 10.1590/s1806-37132007000300005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 09/01/2006] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: A criação de um modelo mecânico que pudesse ser regulado para simular o condicionamento do ar inspirado e expirado nos mesmos valores normais de temperatura, pressão e umidade relativa do aparelho respiratório de um homem jovem hígido sob ventilação mecânica. MÉTODOS: Utilizando-se diversos tipos de materiais, um aparelho mecânico foi construído e regulado com valores normais de capacidade vital, volume corrente, pressão inspiratória máxima, pressão expiratória final positiva e temperatura do gás dentro do sistema. O aparelho foi submetido a ventilação mecânica por um período de 29,8 min. A cada dois segundos, foram registradas as alterações de temperatura do ar circulado no sistema. RESULTADOS: Mediante análise estatística dos dados coletados observou-se que o aparelho construído foi eficiente no condicionamento do ar aproximadamente nos moldes do aparelho respiratório de um ser humano. CONCLUSÃO: Ao final deste estudo, conseguiu-se desenvolver um aparelho mecânico capaz de simular o condicionamento do ar respirado nas mesmas condições de temperatura, pressão e umidade do aparelho respiratório de um ser humano hígido.
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Cassey JG, Armstrong PJ, Smith GE, Farrell PT. The safety and effectiveness of a modified convection heating system for children during anesthesia. Paediatr Anaesth 2006; 16:654-62. [PMID: 16719882 DOI: 10.1111/j.1460-9592.2006.01848.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Convection heating shows most promise in maintaining children's core temperatures under anesthesia. We have previously shown that a modified convection heating technique worked in a mannequin model and sought to establish its safety and effectiveness in a clinical study. METHODS Children were recruited who were having elective surgery under general anesthesia lasting >90 min. The children were anesthetized and maintained in a room temperature of 21 degrees C. Warming was performed by a 'Bair Hugger' attached to a heat dissipation box, producing turbulent air from multiple outlet holes on its face. A plastic sheet covered the child, was attached to the top of the box, tucked into the sides of the bed and left open at the head end. Temperatures at various sites (air, skin, and core) were continuously monitored using thermistors connected to a datalogger and laptop. Analysis was performed using Excel. RESULTS The study comprised 40 children ranging in age from 2 days to 12.5 years and weigh 2.5-73 kg. Operations were 'peripheral' (e.g. urethroplasty) lasting 90 min to major laparotomy lasting 590 min. Body surface area uncovered was 5-25%. Skin temperatures rose to a maximum of c. 40 degrees C. Core temperatures rose after a 12-min lag by 0.01-0.04 degrees C x min(-1). In children who became hyperthermic, cooling was readily achieved by turning the heating off and leaving the fan running. CONCLUSIONS The technique is safe and effective for children throughout the pediatric range. The practice of increasing room temperature above 21 degrees C for elective cases should be abandoned. Continuous monitoring of core temperature is necessary to prevent hyperthermia.
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Affiliation(s)
- John G Cassey
- Department of Paediatric Surgery, John Hunter Hospital, Newcastle, Australia.
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Johansson A, Lundberg D, Luttropp HH. The effect of heat and moisture exchanger on humidity and body temperature in a low-flow anaesthesia system. Acta Anaesthesiol Scand 2003; 47:564-8. [PMID: 12699514 DOI: 10.1034/j.1399-6576.2003.00108.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Artificial humidification of dry inspired gases seems to reduce the drop in body temperature during surgery. The aim of this study was to evaluate the humidity and temperature of anaesthetic gases with heat and moisture exchangers (HMEs). The secondary aim was to evaluate if HMEs in combination with low-flow anaesthesia could prevent a decrease in the body temperature during general anaesthesia. METHODS Ninety patients scheduled for general surgery were randomised to receive a fresh gas flow of 1.0, 3.0 or 6.0 l min-1 with or without HMEs in a circle anaesthesia system. Relative humidity, absolute humidity, temperature of inspired gases and body temperatures were measured during 120 min of anaesthesia. RESULTS The inspiratory absolute humidity levels with HMEs were 32.7 +/- 3.1, 32.1 +/- 1.1 and 29.2 +/- 1.9 mg H2O l(-1) and 26.6 +/- 2.3, 22.6 +/- 3.0 and 13.0 +/- 2.6 mg H2O l(-1) without HMEs after 120 min of anaesthesia with 1.0, 3.0, or 6.0 l min(-1) fresh gas flows (P < 0.05, between with and without HME). The relative humidity levels with HMEs were 93.8 +/- 3.3, 92.7 +/- 2.2 and 90.7 +/- 3.5%, and without the HMEs 95.2 +/- 4.5, 86.8 +/- 8.0 and 52.8 +/- 9.8% (P < 0.05, between with and without HMEs in the 3.0 and 6.0 l min(-1) groups). The inspiratory gas temperatures with HMEs were 32.5 +/- 2.0, 32.4 +/- 0.5 and 31.0 +/- 1.9 degrees C, and 28.4 +/- 1.5, 27.1 +/- 0.8 and 26.1 +/- 0.6 degrees C without HMEs after 120 min of anaesthesia (P < 0.05, between with and without HME). The tympanic membrane temperatures at 120 min of anaesthesia were 35.8 +/- 0.6, 35.5 +/- 0.6 and 35.4 +/- 0.8 degrees C in the groups with HMEs, and 35.8 +/- 0.6, 35.3 +/- 0.7 and 35.3 +/- 0.9 degrees C in the groups without the HMEs (NS). CONCLUSIONS The HMEs improved the inspiratory absolute humidity, relative humidity and temperature of the anaesthetic gases during different fresh gas flows. However, the HMEs were not able to prevent a body temperature drop during low-flow anaesthesia.
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Affiliation(s)
- A Johansson
- Department of Anaesthesiology and Intensive Care, Lund University Hospital, Lund, Sweden.
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Recommended practices for safe care through identification of potential hazards in the surgical environment. AORN J 2003; 77:661-6, 669-70. [PMID: 12691254 DOI: 10.1016/s0001-2092(06)61261-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Recommended practices for safety through identification of potential hazards in the perioperative environment. Association of periOperative Registered Nurses. AORN J 2000; 72:690-2, 695-8. [PMID: 11076288 DOI: 10.1016/s0001-2092(06)61238-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ginsberg S, Solina A, Papp D, Krause T, Pantin E, Scott G, Chuzhin Y, Cody R, Israel A. A prospective comparison of three heat preservation methods for patients undergoing hypothermic cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2000; 14:501-5. [PMID: 11052428 DOI: 10.1053/jcan.2000.9489] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To prospectively compare 3 methods of body heat preservation in patients undergoing surgery requiring the use of hypothermic cardiopulmonary bypass (CPB). DESIGN Prospective, randomized, and nonblinded. SETTING University teaching hospital. PARTICIPANTS Adult cardiac surgery patients (n = 101). INTERVENTIONS Subjects were randomly assigned to 1 of 3 treatment groups: Group 1 (n = 33) used a fluid-filled warming blanket, group 2 (n = 31) used a heated and humidified breathing circuit, and group 3 (n = 37) used intravenous fluid warmers for the administration of all fluids. Treatments started on separation from CPB and concluded at the end of the intraoperative experience. Anesthetic technique, minute ventilation, conduct of CPB, and room temperature in the operating room were standardized. MEASUREMENTS AND MAIN RESULTS Blood temperature was measured at its nadir on CPB, on separation from CPB, and just before departure from the operating room. No differences were found among groups for CPB duration, coldest venous temperature on CPB, rewarming time, rate of rewarming, room temperature, or blood temperature on separation from CPB. There were no significant differences found in post-CPB temperature afterdrop among groups. CONCLUSIONS This study suggests that there is no statistically significant disparity in the effectiveness of these 3 intraoperative heat preservation methods. Ease of use and cost-effectiveness should guide the choice of warming method post-CPB.
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Affiliation(s)
- S Ginsberg
- Department of Anesthesia, UMDNJ-Robert Wood Johnson Medical School, Piscataway, NJ 08901-1977, USA
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Subayi L, Chergui K, Beydon L. [Heat and moisture exchanging filters for conditioning of inspired gases in adult anesthesia and resuscitation]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1998; 17:699-708. [PMID: 9750808 DOI: 10.1016/s0750-7658(98)80107-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Heat and moisture-exchanging filters (HMEFs) are increasingly used in clinical practice. At the same time, new scientific data are available which clarify the benefits of these devices. DATA SOURCES We searched in the Medline database for all papers written in English or French, without limiting date of publication, using the following key-words separately or in combination: humidity, temperature, mechanical ventilation, equipment. STUDY SELECTION From the 200 articles provided by Medline, we selected those directly concerning HMEFs. Some older studies and those on HMEFs no longer available were excluded. DATA EXTRACTION Principle data available from the literature were analysed. DATA SYNTHESIS Humidification and warming of the inspired gas mixture is mandatory during mechanical ventilation. There is a direct link between HMEF performance and the characteristics of tracheal secretions. This justified the recommendation for the use of HMEFs with a humidity output above 30 mg of water per litre of gas mixture. In this case, HMEFs are as efficient as conventional heated humidifiers. HMEFs seem to decrease the rate of nosocomial pneumonia in comparison with heated humidifiers. HMEFs induce a slight increase of dead space which should be taken into consideration during weaning from mechanical ventilation. There are demonstrable data in the literature suggesting the possibility of cross viral infection via the anaesthetic machine when an HMEF is not used. There are no data which suggest a specific type of HMEF regarding viral filtration. CONCLUSION According to the literature data, using an HMEF is essential in anaesthesia and is highly recommended in intensive care.
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Affiliation(s)
- L Subayi
- Département d'anesthésie-réanimation, CHU d'Angers, France
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Boots RJ, Howe S, George N, Harris FM, Faoagali J. Clinical utility of hygroscopic heat and moisture exchangers in intensive care patients. Crit Care Med 1997; 25:1707-12. [PMID: 9377886 DOI: 10.1097/00003246-199710000-00021] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the degree of bacterial circuit colonization, frequency of ventilator-associated pneumonia (VAP), character of respiratory secretions, rewarming of hypothermic patients, disposable costs, and air flow resistance in intensive care patients ventilated using either a heat and moisture exchanger (HME) or hot water (HW) humidifier circuit. DESIGN A prospective, randomized blinded trial of patients in the intensive care unit undergoing mechanical ventilation. SETTING A metropolitan teaching hospital. PATIENTS One hundred sixteen patients undergoing mechanical ventilation for a minimum period of 48 hrs were enrolled. INTERVENTIONS Patients were randomized to three ventilation groups using a) an HW circuit with a 2-day circuit change (n = 41); or b) a bacterial-viral filtering HME in the circuit, with either a 2-day (n = 42); or c) a 4-day circuit change (n = 33). MEASUREMENTS AND MAIN RESULTS Circuit colonization was assessed using quantitative culture of washings taken from the circuit tubing and semiquantitative culture of swabs from the Y connectors. Sixty-seven percent of HW circuits became contaminated compared with 12% in the two HME groups (p < .0001). Median colony counts were lower in the HME groups (p < .0001). If circuits at first circuit change were contaminated in the HW group, 89% of subsequent circuit changes became contaminated compared with 0% and 25% for the 2- and 4-day HME groups, respectively. The frequency of VAP, the time to resolution of admission hypothermia, and the volume and fluidity of secretions were similar for all groups. The resistance of the HME after 24 hrs of use was < 0.025 cm H2O/L at gas flows of 40 L/min. HME use resulted in a cost reduction of $1.48 (Australian)/day. CONCLUSIONS Circuits with a bacterial-viral filtering HME are less readily colonized by bacteria. Contamination is a random event. Humidification technique has no influence on the frequency rate of VAP, the effectiveness of rewarming, nor the character of the respiratory secretions. Breathing resistance is generally low and disposable costs are reduced when an HME is used.
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Affiliation(s)
- R J Boots
- Department of Anaesthesiology, Royal Brisbane Hospital, Queensland, Australia
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Sheaff CM, Fildes JJ, Keogh P, Smith RF, Barrett JA. Safety of 65 degrees C intravenous fluid for the treatment of hypothermia. Am J Surg 1996; 172:52-5. [PMID: 8686803 DOI: 10.1016/s0002-9610(96)00055-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND To demonstrate the safety and efficacy of 65 degrees C (149 degrees F) centrally administered intravenous fluid (CIVF) compared to conventional 40 degrees C (104 degrees F) CIVF in the treatment of hypothermia. METHOD Ten beagles (9-13 kg) were prospectively randomized to receive 65 degrees C or 40 degrees C CIVF. They were anesthetized and data were collected at baseline, during hypothermia, and after 1 and 2 hours of rewarming. The plasma free/total hemoglobin (PFHb/THb) was measured to detect hemolysis. Each subject was cooled to 30 degrees C (86 degrees F) and then received either 65 degrees C or 40 degrees C CIVF through a specialized catheter in the superior vena cava for 2 hours in addition to conventional rewarming techniques. All subjects survived 7 days, after which they were sacrificed and a complete autopsy was performed. RESULTS The rewarming rate was 3.7 degrees C/hr in the 65 degrees C CIVF group and 1.75 degrees C/hr in the 40 degrees C CIVF group. Core temperatures were significantly different after 1 hour (33.4 degrees +/- 0.77 degrees versus 31.7 degrees +/- 0.57 degrees, P < 0.01) and 2 hours (37 degrees +/- 1.03 degrees versus 33.4 degrees +/- 0.89 degrees, P < 0.001). PFHb/THb was not different. Two intimal injuries occurred in each group but these were remote from the infusion site. Blinded examination by two pathologists could not differentiate the etiology of these injuries from mechanical trauma. CONCLUSION CIVF at 65 degrees C is a safe and effective means of treating hypothermia.
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Affiliation(s)
- C M Sheaff
- Department of Trauma Surgery, Cook County Hospital, Chicago, Illinois, USA
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Affiliation(s)
- R M Tappen
- College of Nursing, Florida Atlantic University, Boca Raton, USA
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Abstract
STUDY OBJECTIVE To compare the effectiveness of three commonly used intraoperative warming devices. DESIGN A randomized, prospective clinical trial. SETTING The surgical suite of a university medical center. PATIENTS Twenty adult patients undergoing kidney transplantation for end-stage renal disease. INTERVENTIONS Patients were assigned to one of four warming therapy groups: circulating-water blanket (40 degrees C), heated humidifier (40 degrees C), forced-air warmer (43 degrees C, blanket covering legs), or control (no extra warming). Intravenous fluids were warmed (37 degrees C), and fresh gas flow was 5 L/min for all groups. No passive heat and moisture exchangers were used. MEASUREMENTS AND MAIN RESULTS The central temperature (tympanic membrane thermocouple) decreased approximately 1 degree C during the first hour of anesthesia in all groups. After three hours of anesthesia, the decrease in the tympanic membrane temperature from baseline (preinduction) was least in the forced-air warmer group (-0.5 degrees C +/- 0.4 degrees C), intermediate in the circulating-water blanket group (-1.2 degrees C +/- 0.4 degrees C), and greatest in the heated humidifier and control groups (-2.0 degrees C +/- 0.5 degrees C and -2.0 degrees C +/- 0.7 degrees C, respectively). Total cutaneous heat loss measured with distributed thermal flux transducers was approximately 35W (watts = joules/sec) less in the forced-air warmer group than in the others. Heat gain across the back from the circulating-water blanket was approximately 7W versus a loss of approximately 3W in patients lying on a standard foam mattress. CONCLUSION The forced-air warmer applied to only a limited skin surface area transferred more heat and was clinically more effective (at maintaining central body temperature) than were the other devices. The characteristic early decrease in central temperature observed in all groups regardless of warming therapy is consistent with the theory of anesthetic-induced heat redistribution within the body.
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Affiliation(s)
- J M Hynson
- Department of Anesthesia, University of California, San Francisco 94143-0648 USA
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