Effects of intraoperative hypothermia on stress hormon response in surgical patients

Background/Aim. Surgical stress itself, as well as hypothermia induced by general anaesthesia, and low ambient temperature activate stress hormone response with changes in catecholamines and counter regulatory hormones. The aim of this study is to investigate the acute hormone stress response in patients who underwent major surgical procedures and the efficiency of external and internal warming methods in alleviation of these changes. Methods. 60 patients who underwent major open abdominal surgical procedures were randomly divided in 4 groups: control non-warmed (C), externally warmed using forced-air warming mattress (W), internally warmed using intravenous amino acids (A), and warmed with combination of external and internal method (A+W). Oesophageal temperature was used as measure of core temperature. Blood samples for hormone measurement were obtained in 2 time points for catecholamines: 90 minutes before and 120 minutes after finishing the surgery; and in additional 2 time points for cortisol, prolactin and testosterone: (24 and 48 hours after surgery). Results. In W and A+W group the temperatures did not significantly differ between time points, but in C and A groups decreased constantly, with statistically significant difference between the anaesthesia induction and 120th minute (35,61?0,42 vs 33,86?0,71 ?C; p<0,000 and 35,81?0,54 vs 34,45?0,41 ?C; p<0,000 , respectively). Catecholamine concentrations in all groups showed significant increase during surgery, with highest values recorded in non-warmed group (777,07?800,08 after vs 106,13?89,63 pg/mL before surgery for epinephrine and 1349,67?984,16 vs 580,53?465,38 for norepinephrine, p<0,000). Concentrations of cortisol and prolactine also showed significant increase at the same time point, with tendency to normalization after 48 hours. Contrary, testosterone concentrations showed decrease after 120 minutes without normalization throughout the entire period of observation. Except for testosterone, changes in all stress hormones were attenuated in warmed groups compared to controls. Conclusions. Regarding both features of surgical stress investigated in this study (hypothermia and stress hormone response), combination of endogenous amino acid-induced hermogenesis and external air warming mattress is most effective.

Download Full-text

Comparison of Three Intraoperative Patient Warming Systems

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-5650 ◽

2012 ◽

Vol 48 (1) ◽

pp. 18-24 ◽

Cited By ~ 3

Author(s):

Michelle A. Franklin ◽

Mark C. Rochat ◽

Mark E. Payton ◽

Kristyn D. Broaddus ◽

Kenneth E. Bartels

Keyword(s):

Clinical Trial ◽

Body Temperature ◽

Surgical Procedures ◽

Circulating Water ◽

Forced Air Warming ◽

Warming Blanket ◽

Significant Temperature ◽

Forced Air ◽

Warming Devices ◽

Over Time

The purpose of this randomized clinical trial was to compare the efficacy of three patient warming devices (i.e., circulating water blanket, forced-air, and warming panels) used either alone or in combination on patients undergoing surgeries lasting >60 min. In total, 238 dogs were included and divided into either the celiotomy or nonceliotomy group. Dogs in each group were further divided into one of three subgroups. Dogs in subgroup 1 (n=39) were placed on a circulating water blanket with a forced-air warming blanket placed over the trunk. Subgroup 2 dogs (n=40) were placed on a forced-air warming blanket only. Subgroup 3 dogs (n=40) were placed on warming panels. Significant temperature drops occurred from time of induction (38.1°C±0.64°C) to the start of surgical procedures (36.7°C±0.95°C). Although body temperature was maintained once the warming units were started in all groups, there were significant differences in temperatures for the type of surgical procedures (i.e., celiotomies versus nonceliotomies) performed over time except for subgroup 3. The warming panels and forced-air devices were equally effective in preserving body temperature in anesthetized patients.

Download Full-text

A psychological stressor conveyed by appetite-linked neurons

Science Advances ◽

10.1126/sciadv.aay5366 ◽

2020 ◽

Vol 6 (12) ◽

pp. eaay5366

Author(s):

Eun Jeong Lee ◽

Naresh K. Hanchate ◽

Kunio Kondoh ◽

Ai Phuong S. Tong ◽

Donghui Kuang ◽

...

Keyword(s):

Arcuate Nucleus ◽

Stress Hormones ◽

Physical Restraint ◽

Predator Odor ◽

Stress Hormone ◽

Hormone Response ◽

Receptor Ligands ◽

Appetite Suppression ◽

Cognate Receptor ◽

Psychological Stressor

Mammals exhibit instinctive reactions to danger critical to survival, including surges in blood stress hormones. Hypothalamic corticotropin-releasing hormone neurons (CRHNs) control stress hormones but how diverse stressors converge on CRHNs is poorly understood. We used sRNA profiling to define CRHN receptors for neurotransmitters and neuromodulators and then viral tracing to localize subsets of upstream neurons expressing cognate receptor ligands. Unexpectedly, one subset comprised POMC (proopiomelanocortin)–expressing neurons in the arcuate nucleus, which are linked to appetite suppression. The POMC neurons were activated by one psychological stressor, physical restraint, but not another, a predator odor. Chemogenetic activation of POMC neurons induced a stress hormone response, mimicking a stressor. Moreover, their silencing markedly reduced the stress hormone response to physical restraint, but not predator odor. These findings indicate that POMC neurons involved in appetite suppression also play a major role in the stress hormone response to a specific type of psychological stressor.

Download Full-text

Comparison of Two Different Uses of Underbody Forced-air Warming Blankets for the Prevention of Hypothermia in Patients Undergoing Arthroscopic Shoulder Surgery: a Prospective Randomized Study

10.21203/rs.3.rs-1235572/v1 ◽

2022 ◽

Author(s):

Wenchao Yin ◽

Qihai Wan ◽

Haibin Jia ◽

Xue Jiang ◽

Chunqiong Luo ◽

...

Keyword(s):

Core Body Temperature ◽

Randomized Study ◽

Shoulder Surgery ◽

Forced Air Warming ◽

Significant Difference ◽

Registration Number ◽

Arthroscopic Shoulder Surgery ◽

Clinically Significant ◽

Forced Air ◽

Core Body

Abstract Background: Forced-air warming (FAW) is an effective method of preventing inadvertent perioperative hypothermia (IPH). However, its warming effects can be influenced by the style and position of the FAW blanket. This study aimed to compare the effects of underbody FAW blankets being placed under or over patients in preventing IPH.Methods: Patients (n=100) undergoing elective arthroscopic shoulder surgery in the lateral decubitus position were randomized into either under body (UB) group or the over body (OB) group (50 per group). The core body temperature (CBT) of the patients was recorded from baseline to the end of anesthesia. The incidences of postoperative hypothermia and shivering were also collected.Results: A steady decline in the CBT was observed in both groups up to 60 minutes after the start of FAW. After 60 minutes of warming, the OB group showed a gradual increase in the CBT. However, the CBT still decreased in UB group until 75 minutes, with a low of 35.7℃ ± 0.4℃. Then the CBT increased mildly and reached 35.8℃ ± 0.4℃ at 90 minutes. After 45 minutes of warming, the CBT was significantly different (P < 0.05). The incidence of postoperative hypothermia in the UB group was significantly higher than that in the OB group (P = 0.023).Conclusions: The CBT was significantly better when the underbody FAW blanket was placed over patients compared with under the patients. However, there was not a clinically significant difference in CBT. The incidence of postoperative hypothermia was much lower in the OB group. Therefore, placing underbody FAW blankets over patients is recommended for the prevention of IPH in patients undergoing arthroscopic shoulder surgery.Trial registration: This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 13/1/2021 with the registration number ChiCTR2100042071. It was conducted from 14/1/2021 to 30/10/2021 as a single, blinded trial in Sichuan Provincial Orthopedic Hospital.

Download Full-text

Comparison of the EasyWarm® self-heating blanket with the Cocoon forced-air warming blanket in preventing intraoperative hypothermia

Anaesthesia and Intensive Care ◽

10.1177/0310057x19840264 ◽

2019 ◽

Vol 47 (2) ◽

pp. 169-174

Author(s):

Hosim Prasai Thapa ◽

Amanda J Kerton ◽

Philip J Peyton

Keyword(s):

Elective Surgery ◽

Controlled Trial ◽

Perioperative Period ◽

Ease Of Use ◽

Self Heating ◽

Intraoperative Hypothermia ◽

Forced Air Warming ◽

Significant Difference ◽

The Difference ◽

Forced Air

The importance of preventing hypothermia in the perioperative period cannot be overemphasised. The use of active warming devices is advocated and practised widely. The forced-air warming (FAW) blanket is currently a popular modality. The BARRIER® EasyWarm® (Mölnlycke Healthcare, Belrose, Australia) self-heating blanket, which does not require a power unit, has been proposed as an easy-to-use alternative to the FAW blanket. We conducted a single-centre, randomized controlled trial to compare the efficacy of the EasyWarm® self-heating blanket to the Cocoon blanket (Care Essentials, North Geelong, Australia), a conventional FAW blanket, in preventing intraoperative hypothermia. Forty patients undergoing elective surgery under general anaesthesia lasting >1 h were randomized in a 1:1 ratio. Prewarming was not allowed; 39 patients were analysed (19 EasyWarm® group and 20 Cocoon blanket group). There was no statistically significant difference between the two groups with regard to the mean (±standard deviation) final nasopharyngeal temperature (35.89 ± 0.82 °C versus 35.74 ± 0.77 °C; P = 0.72 in the Cocoon and EasyWarm® blanket groups, respectively). Similarly, the difference between average temperatures at 1, 2 and 3 h was not statistically significant. We found the EasyWarm® blanket to be as effective as the Cocoon FAW blanket in preventing intraoperative hypothermia. Due to its ease of use, the EasyWarm® blanket may have an additional benefit in preoperative warming of patients.

Download Full-text

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

Journal of Clinical Urology ◽

10.1177/2051415818816544 ◽

2018 ◽

Vol 12 (5) ◽

pp. 385-390

Author(s):

Fowz Azhar ◽

James E Dyer ◽

Laurence Clarke

Keyword(s):

Temperature Change ◽

Temperature Drop ◽

Absolute Temperature ◽

Sample Population ◽

Level Of Evidence ◽

Perioperative Hypothermia ◽

Forced Air Warming ◽

Significant Difference ◽

Added Benefit ◽

Forced Air

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

Download Full-text

Prospective-controlled assessment of stress hormones and pain in patients undergoing myomectomy as performed by laparoscopy against laparotomy

10.21203/rs.3.rs-26683/v1 ◽

2020 ◽

Author(s):

George Pados ◽

Konstantinos Katrantsiotis ◽

Dimitris Tsolakidis ◽

Kostantinos Almaloglou ◽

Spiros Gerou

Keyword(s):

Postoperative Pain ◽

Adrenocorticotropic Hormone ◽

Surgical Stress ◽

Stress Hormones ◽

Laparoscopic Group ◽

University Hospital ◽

Surgical Removal ◽

Analog Scale ◽

Significant Difference ◽

Assessment Of Stress

Abstract PurposeThe objective of the study is to prospectively assess surgical stress and postoperative pain after myomectomy performed by laparoscopy versus laparotomyMethodsThis prospective, matched, multi-center observational study, took place in the Gynecological Department of the “Papageorgiou" University Hospital and the Centre for Gynecological Endoscopy, “Diavalkaniko” Hospital. Sixty women with symptomatic growth of known uterine leiomyomas or leiomyomas compromising the shape of the uterus participated in the study. Thirty women underwent laparoscopic myomectomy, and another thirty had removal of leiomyomas through laparotomy from November 2016 to February 2018. Three venous samples were obtained from each patient to determine stress hormones (one before surgery, the second at the end of the surgical procedure, and the third on the morning of the first postoperative day), and a questionnaire was administered on the first postoperative day, in which patients indicated the level of pain through a Visual Analog Scale for Pain (VASP).ResultsAdrenocorticotropic hormone (ACTH) and noradrenalin were significantly lower in the laparoscopic group on the first postoperative day (12.68 ± 9.97 pg/ml vs 15.90 ± 9.02 pg/ml, p<0.025) and 20.7 ± 7.28 ng/ml vs 22.33 ± 5.82 ng/ml, p<0.027), respectively. There was no statistically significant difference in cortisol levels on the first postoperative day (11.71 ± 5.82 μg/dl vs 11.81 ± 7.61 μg/dl, p>0.94) and also for β-endorphin levels (4.88 ± 1.57 vs 4.91 ± ng/ml, p>0.61). The postoperative pain was significantly lower in the laparoscopic group on the VASP scale (3.3 ± 1.05 vs 5.67 ± 1.15, p<0.001, respectively).ConclusionLaparoscopy is superior to laparotomy for the surgical removal of leiomyomas in terms of postoperative pain and surgical stress.

Download Full-text

Time Course of Simulator Sickness in Asian Military Pilots

Aerospace Medicine and Human Performance ◽

10.3357/amhp.5674.2020 ◽

2020 ◽

Vol 91 (11) ◽

pp. 892-896

Author(s):

Janine En Qi Loi ◽

Magdalene Li Ling Lee ◽

Benjamin Boon Chuan Tan ◽

Brian See

Keyword(s):

Air Force ◽

Time Course ◽

Simulator Training ◽

Simulator Sickness ◽

Time Points ◽

True Prevalence ◽

Subjective Scale ◽

Significant Difference ◽

Simulator Sickness Questionnaire ◽

Military Pilots

INTRODUCTION: This study sought to determine the incidence, severity, and time-course of simulator sickness (SS) among Asian military pilots following flight simulator training.METHODS: A survey was conducted on Republic of Singapore Air Force pilots undergoing simulator training. Each subject completed a questionnaire immediately after (0H), and at the 3-h (3H) and 6-h (6H) marks. The questionnaire included the simulator sickness questionnaire (SSQ) and a subjective scale to rate their confidence to fly.RESULTS: In this study, 258 pilots with a median age of 31.50 yr (range, 2155 yr) and mean age of 32.61 6.56 yr participated. The prevalence of SS was 48.1% at 0H, 30.8% at 3H, and 16.4% at 6H. Based on a threshold of an SSQ score >10, the prevalence of operationally significant SS was 33.3% at 0H, 13.2% at 3H, and 8.1% at 6H. The most frequent symptoms were fatigue (38.1%), eye strain (29.0%), and fullness of head (19.9%). There was no significant difference in mean scores between rotary and fixed wing pilots. Older, more experienced pilots had greater scores at 0H, but this association did not persist. A correlation was found between SSQ score and self-reported confidence.DISCUSSION: To our knowledge, this study is the first to report the prevalence of operationally significant SS in Asian military pilots over serial time points. Most pilots with SS are able to subjectively judge their fitness to fly. Sensitivity analysis suggests the true prevalence of SS symptoms at 3H and 6H to be closer to 23.8% and 12.0%, respectively.Loi JEQ, Lee MLL, Tan BBC, See B. Time course of simulator sickness in Asian military pilots. Aerosp Med Hum Perform. 2020; 91(11):892896.

Download Full-text

Optimal Application of Forced Air Warming to Prevent Peri-Operative Hypothermia during Abdominal Surgery: A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052517 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2517

Author(s):

Yoonyoung Lee ◽

Kisook Kim

Keyword(s):

Systematic Review ◽

Abdominal Surgery ◽

Critical Appraisal ◽

Meta Analysis ◽

Upper Body ◽

Cochrane Library ◽

Randomized Controlled ◽

Forced Air Warming ◽

Forced Air ◽

Full Body

Patients who undergo abdominal surgery under general anesthesia develop hypothermia in 80–90% of the cases within an hour after induction of anesthesia. Side effects include shivering, bleeding, and infection at the surgical site. However, the surgical team applies forced air warming to prevent peri-operative hypothermia, but these methods are insufficient. This study aimed to confirm the optimal application method of forced air warming (FAW) intervention for the prevention of peri-operative hypothermia during abdominal surgery. A systematic review and meta-analysis were conducted to provide a synthesized and critical appraisal of the studies included. We used PubMed, EMBASE, CINAHL, and Cochrane Library CENTRAL to systematically search for randomized controlled trials published through March 2020. Twelve studies were systematically reviewed for FAW intervention. FAW intervention effectively prevented peri-operative hypothermia among patients undergoing both open abdominal and laparoscopic surgery. Statistically significant effect size could not be confirmed in cases of only pre- or peri-operative application. The upper body was the primary application area, rather than the lower or full body. These findings could contribute detailed standards and criteria that can be effectively applied in the clinical field performing abdominal surgery.

Download Full-text

Cytotoxicity assessment of different doses of ozonated water on dental pulp cells

BMC Oral Health ◽

10.1186/s12903-021-01392-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ferdiye Küçük ◽

Sibel Yıldırım ◽

Serap Çetiner

Keyword(s):

Cell Viability ◽

Repeated Measures ◽

Dental Pulp ◽

Control Group ◽

Dental Pulp Cells ◽

Time Points ◽

Significant Difference ◽

Pulp Cells ◽

Time Point ◽

Ozonated Water

Abstract Background The purpose of this study was to assess the cytotoxicity of various concentrations of ozonated water (OW) on human primary dental pulp cells. Methods Human primary dental pulp cells were isolated from exfoliated primary canine teeth of an 11-year-old patient with good systemic and oral health. Afterwards, cells were divided into 6 experimental groups; four groups of OW in concentrations of 2 mg/L, 4 mg/L, 8 mg/L, and 16 mg/L, untreated control group, and cell culture without cells. Cytotoxicity was evaluated after exposure for 5-min exposure using Mosmann’s Tetrazolium Toxicity (MTT) assay at 0 h and 48 h time points. Data were analyzed using a repeated measures analysis of variance and Post-hoc tests were performed using Bonferroni correction for multiple comparisons. Results All experimental groups showed proliferation at 0 h time point. However, all groups also experienced a decrease in overtime at 48 h time point (p < 0.05). At both time points 2 mg/L OW showed the highest cell viability as well as proliferation. At 0 h time point, the increase in cell viability for all experimental groups was found statistically significant when compared to positive control group (p < 0.05). At 48 h time point, although 8 mg/L and 16 mg/L OW showed statistically significant reduction in compare to 0 h time point, 2 mg/L and 4 mg/L OW groups didn’t experience any statistically significant difference (p < 0.05). Conclusion Considering our findings, due to ozonated water's induced a higher proliferation rate of dental pulp cells, indicating their biocompatibility and a possible adjuvant on irrigating agent in regenerative endodontic procedures.

Download Full-text

Is duodeno-jejunal bypass liner superior to pylorus preserving bariatric surgery in terms of complications and efficacy?

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02131-x ◽

2021 ◽

Author(s):

Istvan Bence Balint ◽

Ferenc Csaszar ◽

Krisztian Somodi ◽

Laszlo Ternyik ◽

Adrienn Biro ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Surgical Procedures ◽

Risk Level ◽

Jejunal Mucosa ◽

Complication Rates ◽

Pubmed Database ◽

Significant Difference ◽

Weight Loss Outcomes ◽

Jejunal Bypass

Abstract Purpose Based on recent scientific evidence, bariatric surgery is more effective in the management of morbid obesity and related comorbidities than conservative therapy. Pylorus preserving surgical procedures (PPBS) such as laparoscopic single-anastomosis duodeno-jejunal or duodeno-ileal bypass with sleeve gastrectomy are modified duodenal switch (DS) surgical techniques. The duodeno-jejunal bypass liner (DJBL) is a novel surgical method in the inventory of metabolism focused manual interventions that excludes duodeno-jejunal mucosa from digestion, mimicking DS procedures without the risk of surgical intervention. The aim of this article is to summarize and compare differences between safety-related features and weight loss outcomes of DJBL and PPBS. Methods A literature search was conducted in the PubMed database. Records of DJBL-related adverse events (AEs), occurrence of PPBS-related complications and reintervention rates were collected. Mean weight, mean body mass index (BMI), percent of excess of weight loss (EWL%), percent of total weight loss (TWL%) and BMI value alterations were recorded for weight loss outcomes. Results A total of 11 publications on DJBL and 6 publications on PPBS were included, involving 800 and 1462 patients, respectively. The baseline characteristics of the patients were matched. Comparison of DJBL-related AEs and PPBS-related severe complications showed an almost equal risk (risk difference (RD): −0.03 and confidence interval (CI): −0.27 to 0.21), despite higher rates among patients having received endoscopic treatment. Overall AE and complication rates classified by Clavien-Dindo showed that PPBS was superior to DJBL due to an excess risk level of 25% (RD: 0.25, CI: 0.01–0.49). Reintervention rates were more favourable in the PPBS group, without significant differences in risk (RD: −0.03, CI: −0.27 to 0.20). However, PPBS seemed more efficient regarding weight loss outcomes at 1-year follow-up according to raw data, while meta-analysis did not reveal any significant difference (odds ratio (OR): 1.08, CI: 0.74–1.59 for BMI changes). Conclusion Only limited conclusions can be made based on our findings. PPBS was superior to DJBL with regard to safety outcomes (GRADE IIB), which failed to support the authors’ hypothesis. Surgical procedures showed lower complication rates than the incidence of DJBL-related AEs, although it should be emphasized that the low number of PPBS-related mild to moderate complications reported could be the result of incomplete data recording from the analysed publications. Weight loss outcomes favoured bariatric surgery (GRADE IIB). As the DJBL is implanted into the upper gastrointestinal tract for 6 to 12 months, it seems a promising additional method in the inventory of metabolic interventions.

Download Full-text