Shortening the discharging time after total hip replacement under combined spinal/epidural anesthesia by actively warming the patient during surgery.
BACKGROUND
To compare passive thermal insulation by reflective blankets with forced-air active warming on the efficacy of normothermia maintenance and time for discharging from the recovery room after combined spinal/epidural anesthesia for total hip arthroplasty.


METHODS



METHODS
Prospective, randomized study.


METHODS
Inpatient anesthesia at three University Departments of orthopedic surgery.


METHODS
50 ASA physical status I-III patients, who were scheduled for elective total hip arthroplasty.


METHODS
Patients received combined spinal/epidural anesthesia (CSE) with intrathecal injection of 15 mg of 0.5% hyperbaric bupivacaine. All procedures started 8-10 a.m., and operating room temperature was maintained between 21-23 degrees C, with relative humidity ranging between 40-45%. As warming therapy patients received either passive thermal insulation of the trunk, the two upper limbs and the unoperated lower limb with reflective blankets (group passive, n = 25), or forced-air active warming of the two upper limbs (group active, n = 25). Core temperature was measured before CSE placement (baseline), and then every 30 min until recovery of normothermia.


RESULTS
Demographic data, duration of surgery, intraoperative blood losses, and crystalloid infusion were similar in the two groups. Arterial blood pressure decreased in both groups compared with baseline values, while no differences in heart rate were observed during the study. Core temperatures in passive group patients decreased more markedly than in actively warmed patients, with a 1 degree C difference between the two groups at the end of surgery (p < 0.0005). At recovery room entry seven patients in group active (24%) and 16 patients in group passive (64%) showed a core temperature < 36 degrees C (p < 0.01). Achievement of both discharging criteria and normothermia required 32 +/- 18 min in active group and 74 +/- 52 min in passive group (p < 0.0005).


CONCLUSIONS
Forced-air cutaneous warming allows the anesthesiologist to maintain normothermia during combined spinal/epidural anesthesia for total hip replacement even if the convective blanket is placed on a relatively small skin surface with reflex vasoconstriction. Maintaining core normothermia decreased the duration of postanesthesia recovery and may, therefore, reduce costs of care.
Casati
A
A
Istituto di Anestesiologia e Rianimazione, IRCCS H San Raffaele, Università degli Studi, Milano. casati.andrea@hsr.it
Fanelli
G
G
Ricci
A
A
Musto
P
P
Cedrati
V
V
Altimari
G
G
Baroncini
S
S
Pattono
R
R
Montanini
S
S
Torri
G
G
D000368:Aged; D000767:Anesthesia, Epidural; D000775:Anesthesia, Spinal; D019644:Arthroplasty, Replacement, Hip; D001831:Body Temperature / Q000502:physiology*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies