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

Autor: Mazzinari G; Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain. gmazzinari@gmail.com.; Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain. gmazzinari@gmail.com.; Department of Statistics and Operational Research, Universidad de Valencia, Valencia, Spain. gmazzinari@gmail.com., Rovira L; Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain.; Department of Anaesthesiology, Hospital General Universitario de Valencia, Valencia, Spain., Vila Montañes M; Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain.; Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain., García Gregorio N; Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain.; Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain., Ayas Montero B; Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain.; Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain., Alberola Estellés MJ; Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain.; Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain., Flor B; Coloproctology Unit, Department of Surgery, Hospital Universitario y Politécnico la Fe, Valencia, Spain., Argente Navarro MP; Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain.; Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain., Diaz-Cambronero O; Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain.; Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain.
Jazyk: angličtina
Zdroj: Scientific reports [Sci Rep] 2024 Sep 02; Vol. 14 (1), pp. 20408. Date of Electronic Publication: 2024 Sep 02.
DOI: 10.1038/s41598-024-71611-z
Abstrakt: Maintaining patients' temperature during surgery is beneficial since hypothermia has been linked with perioperative complications. Laparoscopic surgery involves the insufflation of carbon dioxide (CO 2 ) 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 CO 2 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 CO 2 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, CO 2 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 CO 2 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 CO 2 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 CO 2 gases, but peritoneal hypothermia remains a concern, suggesting the importance of further research into regional effects.Trial registration: Clinicaltrials.gov: NCT04294758.
(© 2024. The Author(s).)
Databáze: MEDLINE
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