title: Heated and humidified insufflation during laparoscopic gastric bypass surgery: effect on temperature, postoperative pain, and recovery outcomes.
abstract: BACKGROUND
  Controversy exists regarding the efficacy of heated and humidified intraperitoneal gases in maintaining core body temperature. We performed a sham-controlled study to test the hypothesis that active warming and humidification of the insufflation gas reduces intraoperative heat loss and improves recovery outcomes.
  
  
  METHODS
  Fifty morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass procedures using a standardized anesthetic technique were randomly assigned to either a control (sham) group receiving room temperature insufflation gases with an inactive Insuflow (Lexion Medical, St. Paul, MN) device, or an active (Insuflow) group receiving warmed and humidified intraperitoneal gases. Esophageal and/or tympanic membrane temperature was measured perioperatively. Postoperative pain was assessed at 15 minute intervals using an 11-point verbal rating scale, with 0 = none to 10 = maximal. In addition, postoperative opioid requirements, incidence of nausea and vomiting, as well as the quality of recovery, were recorded.
  
  
  RESULTS
  Use of the active Insuflow device was associated with significantly higher mean +/- standard deviation (SD) intraoperative core body temperatures (35.5 +/- 0.5 vs. 35.0 +/- 0.4 degrees C). Postoperative shivering (0 vs. 19%) and the requirement for morphine in the postanesthesia care unit (5 +/- 4 vs. 10 +/- 5 mg) were both significantly lower in the Insuflow vs. control groups. Patients in the Insuflow group also reported a higher quality of recovery 48 hours after surgery (15 vs. 13, P < 0.05).
  
  
  CONCLUSIONS
  The Insuflow device modestly reduced shivering and heat loss, as well as the need for opioid analgesics in the early postoperative period. However, it failed to improve laparoscopic visualization due to fogging, and provided improvement in the quality of recovery only on postoperative day 2.
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 5161 Harry Hines Boulevard, CS 2.282, Dallas, TX 75390, USA.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Hamza
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Schneider
authors.forename: Paul F
authors.initials: PF
authors.lastname: White
authors.forename: Alejandro
authors.initials: A
authors.lastname: Recart
authors.forename: Leonardo
authors.initials: L
authors.lastname: Villegas
authors.forename: Babatunde
authors.initials: B
authors.lastname: Ogunnaike
authors.forename: David
authors.initials: D
authors.lastname: Provost
authors.forename: Daniel
authors.initials: D
authors.lastname: Jones
mesh_terms: D001831:Body Temperature; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006358:Hot Temperature; D006801:Humans; D006813:Humidity; D007327:Insufflation / Q000379:methods*; D007432:Intraoperative Period; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009767:Obesity, Morbid / Q000601:surgery; D010149:Postoperative Pain / Q000517:prevention & control*; D011184:Postoperative Period; D012768:Shivering / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D009020:Morphine