title: Aggressive warming reduces blood loss during hip arthroplasty.
abstract: We evaluated the effects of aggressive warming and maintenance of normothermia on surgical blood loss and allogeneic transfusion requirement. We randomly assigned 150 patients undergoing total hip arthroplasty with spinal anesthesia to aggressive warming (to maintain a tympanic membrane temperature of 36.5 degrees C) or conventional warming (36 degrees C). Autologous and allogeneic blood were given to maintain a priori designated hematocrits. Blood loss was determined by a blinded investigator based on sponge weight and scavenged cells; postoperative loss was determined from drain output. Results were analyzed on an intention-to-treat basis. Average intraoperative core temperatures were warmer in the patients assigned to aggressive warming (36.5 degrees +/- 0.3 degrees vs 36.1 degrees +/- 0.3 degrees C, P< 0.001). Mean arterial pressure was similar in each group preoperatively, but was greater intraoperatively in the conventionally warmed patients: 86+/-12 vs 80+/-9 mm Hg, P<0.001. Intraoperative blood loss was significantly greater in the conventional warming (618 mL; interquartile range, 480-864 mL) than the aggressive warming group (488 mL; interquartile range, 368-721 mL; P: = 0.002), whereas postoperative blood loss did not differ in the two groups. Total blood loss during surgery and over the first two postoperative days was also significantly greater in the conventional warming group (1678 mL; interquartile range, 1366-1965 mL) than in the aggressively warmed group (1,531 mL; interquartile range, 1055-1746 mL, P = 0.031). A total of 40 conventionally warmed patients required 86 units of allogeneic red blood cells, whereas 29 aggressively warmed patients required 62 units (P = 0.051 and 0.061, respectively). We conclude that aggressive intraoperative warming reduces blood loss during hip arthroplasty.
  
  
  CONCLUSIONS
  Aggressive warming better maintained core temperature (36.5 degrees vs 36.1 degrees C) and slightly decreased intraoperative blood pressure. Aggressive warming also decreased blood loss by approximately 200 mL. Aggressive warming may thus, be beneficial in patients undergoing hip arthroplasty.
authors.affiliation: Department of Anesthesia, General Intensive Care and Orthopedics, University of Vienna, Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Winkler
authors.forename: O
authors.initials: O
authors.lastname: Akça
authors.forename: B
authors.initials: B
authors.lastname: Birkenberg
authors.forename: H
authors.initials: H
authors.lastname: Hetz
authors.forename: T
authors.initials: T
authors.lastname: Scheck
authors.forename: C F
authors.initials: CF
authors.lastname: Arkiliç
authors.forename: B
authors.initials: B
authors.lastname: Kabon
authors.forename: E
authors.initials: E
authors.lastname: Marker
authors.forename: A
authors.initials: A
authors.lastname: Grübl
authors.forename: R
authors.initials: R
authors.lastname: Czepan
authors.forename: M
authors.initials: M
authors.lastname: Greher
authors.forename: V
authors.initials: V
authors.lastname: Goll
authors.forename: F
authors.initials: F
authors.lastname: Gottsauner-Wolf
authors.forename: A
authors.initials: A
authors.lastname: Kurz
authors.forename: D I
authors.initials: DI
authors.lastname: Sessler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal; D019644:Arthroplasty, Replacement, Hip; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001794:Blood Pressure / Q000502:physiology; D001803:Blood Transfusion; D001804:Blood Transfusion, Autologous; D001831:Body Temperature; D016009:Chi-Square Distribution; D017707:Erythrocyte Transfusion; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006400:Hematocrit; D006358:Hot Temperature / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D016037:Single-Blind Method