Anesth Pain Med.  2016 Jan;11(1):91-98. 10.17085/apm.2016.11.1.91.

Comparison of warming methods for core temperature preservation during total knee arthroplasty using a pneumatic tourniquet

• Kim HJ
• Oh JE
• Koh WU
• Ro YJ
• Yang HS

• KMID: 2169082
• DOI: http://doi.org/10.17085/apm.2016.11.1.91

Abstract

BACKGROUND
It is important to ensure that patients are normothermic during surgery. In total knee arthroplasty, the pneumatic tourniquet affects body temperature. We compared the ability of two warming devices to preserve core temperature in patients using a lower limb tourniquet under general anesthesia.
METHODS
We included 132 patients with American Society of Anesthesiologists physical status I-II who were scheduled to undergo total knee arthroplasty. The patients were randomly divided into four groups (n = 33): group 1, without any heating method; group 2, with fluid warming; group 3, with forced-air warming; and group 4, with a combination of the two heating methods. After the induction of anesthesia, the esophageal and urinary bladder temperatures were monitored and recorded every 5 min before tourniquet deflation and every 1 min after tourniquet deflation.
RESULTS
Before tourniquet deflation, compared with group 1, the odds ratios of groups 3 and 4 were less than 1. After tourniquet deflation, compared with group 1, the odds ratios of all groups using warming devices were less than 1. In particular, group 4 showed the largest hypothermia-preventive effect among the four groups. There was a significant correlation between esophageal temperature and bladder temperature before and after tourniquet deflation.
CONCLUSIONS
After tourniquet deflation, a combination of a fluid warmer and forced-air warmer is the most effective method to prevent hypothermia, although either a fluid warmer or forced-air warmer alone could help to prevent hypothermia. Urinary bladder temperature changes correlate well with esophageal temperature changes throughout this operation.

Keyword

Bladder temperature; Esophageal temperature; Total knee replacement; Tourniquet

MeSH Terms

Anesthesia
Anesthesia, General
Arthroplasty*
Arthroplasty, Replacement, Knee
Body Temperature
Heating
Hot Temperature
Humans
Hypothermia
Knee*
Lower Extremity
Methods*
Odds Ratio
Tourniquets*
Urinary Bladder

Figure

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  Fig. 1 Mean esophageal temperature of each group throughout the procedure under general anesthesia. Group 1, control group without any warming devices; group 2, the fluid-warmed group; group 3, the forced-air–warmed group; group 4, warmed using both warming devices. Itime, time elapsed from anesthesia induction; Dtime, time elapsed from tourniquet deflation.

• 

  Fig. 2 Pearson’s correlation between esophageal temperature and bladder temperature before tourniquet deflation. The Pearson’s correlation coefficient was calculated as 0.791.

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  Fig. 3 Pearson’s correlation between esophageal temperature and bladder temperature after tourniquet deflation. The Pearson’s correlation coefficient was calculated as 0.909.

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