Litotomi Pozisyonunda Açık Abdominal Cerrahi Geçirecek Hastalarda Isıtma Sistemlerinin Etkinliğinin Karşılaştırılması
Özet
Inadvertent perioperative hypothermia is a significant complication observed during anesthesia and surgery. The patients undergoing open abdominal surgery at lithotomy position is a major risk group for hypothermia. Therefore; In this group of patients, it is very important to prewarm and use appropriate heating techniques. There are different heating systems used in abdominal surgery. Forced air blanket systems are cost-effective, easy to apply. Circulating water mattress system is a heating system which is more costly and does not have sufficient utilization when used alone but increases with its utilization when used with other methods. The aim of the study is to compare the effectiveness of heating technique in the upper body with forced air blanket systems, which is the standard method applied in our clinic in patients with open abdominal surgery in lithotomy position, with the effectiveness of the technique of preventing the hypothermia during the perioperative period with the heating technique in which the circulating water mattress is combined.
Between February and May 2019, 28 patients who undergo elective open abdominal surgery at litothomy position in the Department of General Surgery were randomized into two groups. Intraoperatively, in Group 1; heating is supplied using circulating water mattress together with upper body forced air warming blanket, In Group 2; heating is provided only with upper body forced air warming blankets. All patients are prewarmed using active heating method for 30 minutes before operation. During perioperative period; preoperative and postoperative tympanic temperatures; intraoperative peripheral, tympanic and esophageal temperatures were recorded. In the postoperative period, the heating is continued by active heating method. Data is analyzed by IBM SPSS Statistics 17.0 (IBM Corporation, Armonk, NY, USA).
The results indicate that both heating methods show similar efficacy in preventing perioperative hypothermia. When the measurement methods are compared to each other, esophageal and tympanic measurements are more stable, while the peripheral temperature fluctuations are obvious. The most valuable result of this study is that the prewarm of both groups for 30 minutes prevents redistribution hypothermia.
Our study shows that the body surface area that can be covered by heating devices such as lithotomy position is low, the incision line such as abdominal surgery is large, the loss of bleeding with irrigation fluids is high, even in the group with high risk of unwanted hypothermia 30 minutes over the course of prewarming after general anesthesia the temperature fluctuates significantly. Intraoperative heating method with forced air blanket system is effective in regulating the core temperature as much as the method in which it is combined with circulating water mattress system. In contrast to the general literature, it can be thought that the conductive heating of circulating water mattress system from the back is less effective due to the fact that the irrigation fluids flowing due to the characteristics of the abdominal surgeries act as a barrier between them. When the measurement methods are compared; tympanic and esophageal temperatures were similar in correlated temperature determination; It is seen that the actual fluctuation is in the peripheral temperature measurement. This can be attributed to the low reliability of the peripheral probes as well as to the heterogeneity of the heat transmitted by forced air blanket systems with the pathophysiological change created by general anesthesia at peripheral temperature.
In conclusion, our study showed that the warming methods including only forced-air warming and forced-air warming combined with circulating water mattress provided smilar normothermia status for patiance undergoing elective open abdominal surgery in litothomy position.
