Effect of continuously warmed irrigating solution during transurethral resection

Is it necessary to use forced air warming in core endourological procedures where warmed intravenous and irrigation fluids are routinely used?

Objective:

Perioperative hypothermia is an important consideration for all surgical specialties, but susceptibility may vary between them. Current guidance on prevention of this does not differentiate between specialties. We hypothesise that in core endourological surgery, the use of warmed irrigation sufficiently protects patients from hypothermia and that forced air warming (FAW) does not provide any added benefit.

Materials and methods:

Between November 2015 and January 2016, all case notes were reviewed for patients who had undergone core urological procedures. Data collated included age, body mass index, procedure length, perioperative temperatures and warming methods used. The sample population was stratified according to warming devices used. The difference in temperature change between groups was assessed using analysis of variance (ANOVA) and in specific groups using the Student’s t-test. Perioperative hypothermia was defined as a finishing temperature < 36.0°C or a temperature drop of greater that 1.0°C.

Results:

Perioperative hypothermia occurred in 2 out of 226 patients, both from those receiving FAW, warmed irrigation and warmed intravenous (IV) fluid. No significant difference was noted between all groups in terms of absolute temperature change (ANOVA P = 0.111). Furthermore, there was no significant change in absolute temperature when comparing groups with FAW, warmed irrigation and warmed IV fluid with those with warmed irrigation and warmed IV fluid alone.

Conclusion:

The routine use of FAW in core endourological surgery may not be necessary. In most procedures, particularly those of short duration, there appears to be no added benefit in using FAW in combination with warmed irrigation and IV fluid.

Level of evidence:

3b

Effect of irrigation fluid temperature on core temperature and hemodynamic changes in transurethral resection of prostate under spinal anesthesia

Background:

Hypothermia is a frequent observation in elderly males undergoing transurethral resection of prostate (TURP) under spinal anesthesia. The use of irrigating fluids at room temperature results in a decrease body temperature. Warmed irrigating solutions have shown to reduce heat loss and the resultant shivering. Such investigation was not much tried in low resource settings.

Aim:

To compare the resultant change in core temperature and hemodynamic changes among patients undergoing TURP surgery under spinal anesthesia using warm and room temperature irrigation fluids.

Settings and Design:

Randomized prospective study at a tertiary care center.

Methods:

This study was conducted on 40 male patients aged 50-85 years undergoing TURP under spinal anesthesia. Of which, 20 patients received irrigation fluid at room temperature 21°C and 20 patients received irrigation fluid at 37°C after random allocation. Core temperatures and hemodynamic parameters were assessed in all patients at preoperative, intra-operative, and postoperative periods. Intra-operative shivering was also noted in both groups.

Statistical Analysis:

Unpaired and Paired Student's t-test.

Results:

For patients who underwent irrigation with fluid at room temperature Core temperature drop from 36.97°C in preoperative to 34.54°C in postoperative period with an effective difference of 2.38°C. Among patients who received warmed irrigation fluid at 37°C had core temperature drop from 36.97°C to 36.17°C and the effect of fall was 0.8°C. This difference was statistically significant (P < 0.001). Shivering of Grades 1 and 2 was observed in nine patients, of Group 1 while only three patients had Grades 1 and 2 shivering in Group 2. The hemodynamic parameters were similar in the two groups and did not reach significant difference.

Conclusion:

Use of warm irrigation fluid during TURP reduces the risk of perioperative hypothermia and shivering.

The effects of irrigation fluid on core temperature in endoscopic urological surgery

AIMS AND METHOD

A prospective observational study of 100 patients undergoing various types of endoscopic urological surgery including transurethral resection of the prostate (TURP), transurethral resection of bladder tumour (TURBT), percutaneous nephrolithotomy (PCNL) and Cystoscopies, was reformed to determine the temperature difference between preoperative and postoperative core temperatures and to determine whether this change was related to the age, weight, type of anaesthetic, operation duration, type of operation, amount of irrigant fluid used and whether warming the fluid to 370C made a difference to the degree of temperature change. All the above variables were recorded for each patient as well as the preoperative and postoperative temperatures. Statistical analysis was carried out using SPSS.

RESULTS

The mean age was 64 years and the mean weight was 75kg in the study. Seventy-six patients had a general anaesthetic while 24 had a spinal anaesthetic. The study included 29 TURPs, 10 TURBTs, six PCNLs and 55 Cystoscopies. Age and type of anaesthetic did not correlate significantly with temperature change. As weight increased patients tend to preserve their core temperature more efficiently. The highest degree of temperature drop was in the PCNL group. There was a significant relationship between the duration of operation and temperature drop (p<0.05) as well as the amount of irrigation fluid used (p<0.05). Average temperature drop for patients who underwent irrigation with fluid at room temperature (n=43) was 1.37 degrees C and 0.95 degrees C for those whose fluids were warmed to body temperature (n=57). This difference was statistically significant (p=0.03).

CONCLUSIONS

There is a drop in temperature in patients undergoing most endoscopic operations on the GU tract and this appears to be multifactorial in origin, relating significantly to weight, amount of irrigation fluid used, type and duration of operation. Warming irrigant fluid to body temperature appears to significantly reduce the degree of temperature drop with consequent potential benefit.

Effect of warm intravenous and irrigating fluids on body temperature during transurethral resection of the prostate gland

Background

Transurethral resection of the prostate gland with irrigation fluid at room temperature leads to perioperative hypothermia which could give rise to adverse cardiovascular events in the perioperative period. The use of isothermic irrigation fluid reduces but does not eliminate this risk. Routine use of warm intravenous fluids along with isothermic irrigation had not been documented. This study set out to investigate the effect of the use of warm intravenous fluid together with isothermic irrigation fluid on the body temperature in patients undergoing transurethral resection of the prostate gland.

Methods

One hundred and twenty consented patients with obstructing benign prostatic hyperplasia were randomly assigned to one of 3 groups. Group 1 received irrigation and intravenous fluids at room temperature, group 2 received warmed irrigation fluid at 38°C along with intravenous fluid at room temperature while group 3 patients received warmed irrigation fluid and warmed intravenous fluids at 38°C. Their perioperative body temperature changes were monitored, analyzed and compared.

Results

The mean decrease in body temperature at the end of the procedure was significantly greater in group 1 (0.98 ± 0.56°C) than in group 2 (0.42 ± .21°C) (p < 0.001). Significantly more patients in group 1 also experienced shivering. However, in group 3, there was no significant change in the mean body temperature (p > 0.05) and none of them felt cold or shivered.

Conclusion

It is concluded that the use of isothermic irrigation fluid together with warm intravenous fluids during TURP prevents the occurrence of perioperative hypothermia.

Trial registration number

CCT-NAPN-15944

Transurethral resection of the prostate

Transuretheral resection of prostate (TURP) is a common operation in most hospitals. The patients are elderly and usually have concomitant diseases such as diabetes, hypertension, cardiac and respiratory ailments that increase their perioperative risk. Perioperative morbidity and mortality approaches 20% and 1% respectively. Regional anesthesia, notably spinal anesthesia, offers many advantages over general anesthesia for TURP with some evidence of lower morbidity even though similar mortality rates and overall outcomes are reported for both groups. Procedure-specific complications include TURP syndrome, bladder perforation, primary fibrinolysis, bacteremia, and septicemia. All are associated with significant morbidity and mortality but amenable to early and aggressive therapeutic intervention.

Effect of temperature and flow rate of irrigant on coagulation necrosis in canine prostate treated with neodymium:YAG laser

We studied the effect of the irrigant temperature (5 degrees-38 degrees C) and flow rate (100-500 mL/min) on the extent of coagulation necrosis induced during Nd:YAG laser irradiation in the canine prostate model. The tissue response was quantified based on histopathologic evaluation of the lesions. Changing the irrigant temperature or the flow rate within the ranges studied did not significantly affect the size of the thermal lesions. The intraprostatic temperature distribution during laser irradiation is mainly governed by blood perfusion rather than by irrigant variables.