Warm and humidified insufflation gas during gynecologic laparoscopic surgery reduces postoperative pain in predisposed patients—a randomized, controlled multi-arm trial

Background Postoperative pain remains a common problem in gynecologic laparoscopy, especially in head zone-related regions, triggered by intra-abdominal pressure during capnoperitoneum. Humidified and prewarmed insufflation gas may ameliorate pain and be beneficial. Methods This prospective randomized controlled parallel group multi-arm single-center study investigated the effects of temperature and humidity of insufflation gas on postoperative pain during gynecologic laparoscopy with a duration ≥ 60 min. Female participants (18—70 years) were blinded and randomly assigned—computer generated—to either insufflation with dry cold CO2 with forced air warming blanket (“AIR”), humidified warm gas without forced air warming blanket (“HUMI”), or humidified warm gas with forced air warming blanket (“HUMI +”). We hypothesized that using humidified warm gas resulted in lower pain scores and less analgesic consumption. The primary endpoint postoperative pain was assessed for different pain localizations every 12 h during 7 days after surgery. Secondary endpoints were demand for painkillers and epidural anesthetics, length of stay in recovery room, and hospital stay. (Registration: ClinicalTrials.gov NCT02781194—completed). Results 150 participants were randomized. Compared to group “AIR” (n = 48), there was significantly less pain in group “HUMI +” (n = 48) in the recovery room (− 1.068; 95% CI − 2.08 to − 0.061), as well as significantly less ibuprofen use at day two (− 0.5871 g ± 0.258; p-value = 0.0471). Other variables did not change significantly. Stratification for presence of endometriosis or non-previous abdominal surgery in patient history revealed significantly less pain in both groups “HUMI” (n = 50) and “HUMI +” versus group “AIR.” Related side effects were not noted. Conclusion In the overall population, the use of warm, humidified insufflation gas did not yield clinically relevant effects; however, in predisposed patients with endometriosis and who could otherwise expect high pain levels, warm and humidified gas may be beneficial.

Effects of different thermal insulation methods on the nasopharyngeal temperature in patients undergoing laparoscopic hysterectomy: a prospective randomized controlled trial

Background This study explored the comparison of the thermal insulation effect of incubator to infusion thermometer in laparoscopic hysterectomy. Methods We assigned 75 patients enrolled in the study randomly to three groups: Group A: Used warming blanket; group B: Used warming blanket and infusion thermometer; group C: Used warming blanket and incubator. The nasopharyngeal temperature at different time points during the operation served as the primary outcome. Results The nasopharyngeal temperature of the infusion heating group was significantly higher than that of the incubator group 60 min from the beginning of surgery (T3): 36.10 ± 0.20 vs 35.81 ± 0.20 (P<0.001)90 min from the beginning of surgery (T4): 36.35 ± 0.20 vs 35.85 ± 0.17 (P<0.001). Besides, the nasopharyngeal temperature of the incubator group was significantly higher compared to that of the control group 60 min from the beginning of surgery (T3): 35.81 ± 0.20 vs 35.62 ± 0.18 (P<0.001); 90 min from the beginning of surgery (T4): 35.85 ± 0.17 vs 35.60 ± 0.17 (P<0.001). Regarding the wake-up time, that of the control group was significantly higher compared to the infusion heating group: 24 ± 4 vs 21 ± 4 (P = 0.004) and the incubator group: 24 ± 4 vs 22 ± 4 (P = 0.035). Conclusion Warming blanket (38 °C) combined infusion thermometer (37 °C) provides better perioperative thermal insulation. Hospitals without an infusion thermometer can opt for an incubator as a substitute. Trial registration This trial was registered with ChiCTR2000039162, 20 October 2020.

Effects of Different Thermal Insulation Methods on Nasopharyngeal Temperature in Patients Undergoing Laparoscopic Hysterectomy: A Prospective Randomized Controlled Trial

Background: The purpose of this study was to compare the thermal insulation effect of incubator and infusion thermometer in laparoscopic hysterectomy.Methods: 75 patients were enrolled and were assigned randomly to three groups: group A used warming blanket, group B used warming blanket and infusion thermometer, group C used warming blanket and incubator. The primary outcome was nasopharyngeal temperature at different time points during the operation.Results: The nasopharyngeal temperature of the infusion heating group was significantly higher than that of the incubator group 60min at the beginning of surgery(T3):36.10±0.20 vs 35.81±0.20(P＜0.001)；90min at the beginning of surgery(T4):36.35±0.20 vs 35.85±0.17(P＜0.001),and the incubator group was significantly higher than that of the control group 60min at the beginning of surgery(T3):35.81±0.20 vs 35.62±0.18(P＜0.001);90min at the beginning of surgery(T4):35.85±0.17 vs 35.60±0.17(P＜0.001).The wake-up time of the control group was significantly higher than that of the infusion heating group: 23.88±3.86 vs 20.56±3.80(P=0.004), and the incubator group:23.88±3.86 vs 21.52±4.02(P=0.035).Conclusion: Warming blanket (38°C) combined infusion thermometer (37°C) provides better perioperative thermal insulation, and in hospitals without infusion thermometer, an incubator can be used as a substitute.Trial registration: This trial was registered with http://www.chictr.org.cn/index.aspx,ChiCTR2000039162,20 October 2020.

Management of Shivering in Post-Spinal Anesthesia Using Warming Blankets and Warm Fluid Therapy

Hypothermia is a common and serious complication of spinal surgery and it is associated with many harmful perioperative outcomes. The aim of this study was to compare the effectiveness of warming blankets and warm fluid therapy to manage shivering. A quasi-experiment with a non-equivalent control group was applied as the research design. There were 60 patients involved in the study. The instrument of this study was a warmer fluid modification, a warming blanket and a cotton blanket. The data was analyzed using an applied paired t-test and independent t-test. After 60 minutes of the intervention, the mean and SD of body temperature of the patients receiving warm fluids was 36.71 ± 0.18, a warming blanket was 36.12 ± 0.35, and the control group was 35.76 ± 0.22. The p values were 0,000. Warm fluid therapy and warming blankets are significant in terms of increasing the body temperature of post-spinal anesthesia patients. Warm fluids are more effective than warming blanket. Warming blankets and warm fluid therapy can be used as a way to increase the body temperature of patients with hypothermia.

The impact of warmed and humidified CO2 insufflation during robotic radical prostatectomy: Results of a randomized controlled trial

Background: Cool and dry gas insufflation during laparoscopy induces hypothermia and cytokine increase, with significant perioperative morbidity. Our aim was to assess if warmed and humidified CO2 insufflation with HumiGard™ device can achieve significant benefits over standard insufflation in terms of risk of hypothermia, cytokine response, blood gases, and intra- and postoperative parameters, in the setting of robot-assisted radical prostatectomy (RARP). Methods: This was a prospective, randomized controlled clinical trial. Sixty-four patients with prostate cancer undergoing RARP were randomized to receive warmed and humidified CO2 insufflation with HumiGard device, plus hot air warming blanket (treatment group, H + WB), or standard CO2 insufflation, plus hot air warming blanket (control group, WB). Body core temperature (BCT), plasma levels of IL-6 and TNF-α, pain scores, and intraoperative parameters were recorded. The data were analyzed according to the Bayesian paradigm. Results: Intraoperative BCT increased in both groups during surgery, with a statistically significant difference favoring group H + WB, ending at 0.2°C higher on average than group WB. No difference across groups was shown for cytokine levels. Blood gas parameters were not affected by warmed CO2 insufflation. No statistical differences were noted for pain scores and the other intra- and postoperative parameters. Conclusions: During RARP, warm and humidified CO2 insufflation with the HumiGard device was more effective than the standard CO2 insufflation in maintaining the patient’s heat homeostasis, even if the difference was minimal. No imbalances were detected on blood gas analyses. No benefit could be shown in terms of cytokine levels and pain scores.

Insidious bleeding; the danger of complacency: Case Report

Background: A recent publication in the Journal of Trauma and Acute Care Surgery reported that patients who received a tourniquet (TQ) for severe extremity bleeding had a fourfold decrease in overall shock related mortality (Scerbo et al., 2017). A systematic review conducted in the United States (US) by Beaucreux, Vivian, Miles, Sylvain, and Pasquier (2018) showed that tourniquets are an effective tool for haemorrhage control in civilian populations with low levels of associated complications. Not a lot is known about the attitudes of Australian paramedics toward TQ’s or their use thereof, but anecdotal evidence suggests that their use is contentious. Case: We present a case of severe extremity haemorrhage involving a 90-year-old male who sustained a partial amputation to the lower aspect of the left leg proximal to the ankle whilst cutting a tree branch with a 5-inch toothed garden saw. Conclusion: In this case, the paramedics who attended to this patient believed that the use of a TQ was extreme. Standard trauma management and haemorrhage control measures that included a pressure bandage, vacuum splint and warming blanket served as confounding factors in obscuring an ongoing insidious bleed. Based on the injury profile, the patients advanced age, medications for comorbidities and associated decrease in physiological reserves this patient was a candidate for early TQ application. Failure to apply a TQ may have contributed to coagulopathy and the need for postoperative transfusions.

Insidious bleeding; the danger of complacency: Case Report

Background: A recent publication in the Journal of Trauma and Acute Care Surgery reported that patients who received a tourniquet (TQ) for severe extremity bleeding had a fourfold decrease in overall shock related mortality (Scerbo et al., 2017). A systematic review conducted in the United States (US) by Beaucreux, Vivian, Miles, Sylvain, and Pasquier (2018) showed that tourniquets are an effective tool for haemorrhage control in civilian populations with low levels of associated complications. Not a lot is known about the attitudes of Australian paramedics toward TQ’s or their use thereof, but anecdotal evidence suggests that their use is contentious. Case: We present a case of severe extremity haemorrhage involving a 90-year-old male who sustained a partial amputation to the lower aspect of the left leg proximal to the ankle whilst cutting a tree branch with a 5-inch toothed garden saw. Conclusion: In this case, the paramedics who attended to this patient believed that the use of a TQ was extreme. Standard trauma management and haemorrhage control measures that included a pressure bandage, vacuum splint and warming blanket served as confounding factors in obscuring an ongoing insidious bleed. Based on the injury profile, the patients advanced age, medications for comorbidities and associated decrease in physiological reserves this patient was a candidate for early TQ application. Failure to apply a TQ may have contributed to coagulopathy and the need for postoperative transfusions.