• Journal of Korean Biological Nursing Science
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• 제17권3호
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• pp.236-244
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• 2015

Purpose: The study was conducted to identify factors affecting the intraoperative core body temperature (CBT) of surgical patients under general anesthesia. Methods: This study was performed through a prospective descriptive research design. The sample consisted of 138 patients who had undergone elective laparotomy surgery. Age, weight, height, the basal preoperative CBT, blood pressure, and heart rate were collected. CBT was again measured at induction of anesthesia, 1 hour, 2 hours, and 3 hours following induction of general anesthesia. Results: Factors affecting intraoperative hypothermia < $36^{\circ}C$ at 1 hour following induction, were CBT at induction and total body fat (TBF) ($R^2=.569$, p<.001); at 2 hours after induction, CBT at induction and TBF ($R^2=.507$, p<.001); at 3 hours after induction, CBT at induction (${\beta}=0.34$), TBF, age and the ambient temperature in the operating room ($R^2=.449$, p<.001). Conclusion: CBT at induction and TBF appear to be factors affecting intraoperative CBT within 2 hours after induction of anesthesia; CBT at induction, TBF, advanced age and the ambient temperature after 3 hours following induction. We recommend keeping surgical patients warm before induction of anesthesia and providing intraoperative warming for surgical patients of advanced age with low TBF and when the duration of general anesthesia will last more than 3 hours.

• Journal of Chest Surgery
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• 제34권6호
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• pp.465-471
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• 2001

배경: 저체온은 뇌 대사를 억제하여 뇌를 보호한다고 알려져 있으며, 대동맥 질환 수술 시 완전 순환 정지전에 충분히 시행되고 있다. 일반적으로 임상에서 직장 또는 비인두 온도를 지표로 순환정지를 시행하고 있으나, 순환정지 시 적절한 저체온의 온도 범위나 순환정지 온도를 결정하는 객관적인 지표에 대해서는 아직 명확한 결론이 없다. 본 연구는 수술 중 뇌파검사를 이용해 완전 순환 정지 시 안전한 직장 및 비인두 온도의 적정 수준을 확인하고, 적절한 저체온의 지표로서 뇌파검사의 역할을 알아보고자 하였다. 대상 및 방법: 1999년 3월부터 2000년 8월 31일까지 대동맥 질환으로 대동맥 인조혈관 치환수술 동안 뇌파검사를 병행하면서 완전 순환 정지를 했던 27명의 환자를 대상으로 하였다. 직장 온도와 비인두 온도를 마취유도부터 계속 감시하였으며, 뇌파검사는 10개의 채널로 마취유도부터 뇌 전위 고요상태(electrocerebral silence) 가지 관찰하였다 결과: 뇌 전위 고요 상태에 도달했을 때의 직장 온도와 비인두 온도는 일정한 범위에 있지 않고 다양한 값(직장 11$^{\circ}C$~$25^{\circ}C$; 비인두 7.7$^{\circ}C$ ~23$^{\circ}C$)을 보였으며, 두 온도 사이에 서로 관련이 없었다(p=0.171). 체외순환을 시작하여 뇌 전위 고요상태에 이르기까지 냉각 시간은 25~127분으로 다양하였으며, 환자의 체표면적과 연관이 있었다(p=0.027). 결과: 뇌 전위 고요상태는 다양한 체온에서 발생했으며, 임상에서 일반적으로 적용되는 직장 및 비인두 온도는 뇌 전위 고요상태를 지적할 수 없었다. 그러므로 심혈관계 수술 시 체온에 근거한 저체온 완전 순환 정지는 뇌의 보호를 확신할 수 없으며, 수술 중 뇌파검사의 관찰은 안전한 순환정지를 위한 적절한 저체온의 수준을 확보하기 위해 필요하며 합리적인 방법이었다.

• Journal of Korean Biological Nursing Science
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• 제19권3호
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• pp.123-130
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• 2017

Purpose: This study aimed to identify factors influencing intra-operative core body temperature (CBT), and to develop a predictive model for intra-operative CBT in laparoscopic abdominal surgery. Methods: The prospective observational study involved 161 subjects, whose age, weight, and height were collected. The basal pre-operative CBT, pre-operative blood pressure, and heartbeat were measured. CBT was measured 1 hour and 2 hours after pneumoperitoneum. Results: Explanatory factors of intra-operative hypothermia (< $36^{\circ}C$) were weight (${\beta}=.361$, p< .001) and pre-operative CBT (${\beta}=.280$, p= .001) 1 hour after pneumoperitoneum (Adjusted $R^2=.198$, F= 7.56, p< .001). Weight was (${\beta}=.423$, p< .001) and pre-operative CBT was (${\beta}=.206$, p= .011) 2 hours after pneumoperitoneum (Adjusted $R^2=.177$, F= 5.93, p< .001). The researchers developed a predictive model for intra-operative CBT ($^{\circ}C$) by observing intra-operative CBT, body weight, and pre-operative CBT. The predictive model revealed that intra-operative CBT was positively correlated with body weight and pre-operative CBT. Conclusion: Influence of weight on intra-operative hypothermia increased over time from 1 hour to 2 hours after pneumoperitoneum, whereas influence of pre-operative CBT on intraoperative hypothermia decreased over time from 1 hour to 2 hours after pneumoperitoneum. The research recommends pre-warming for laparoscopic surgical patients to guard against intra-operative hypothermia.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권4호
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• pp.193-200
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• 2015

Background: During head and neck surgery including orthognathic surgery, mild intraoperative hypothermia occurs frequently. Hypothermia is associated with postanesthetic shivering, which may increase the risk of other postoperative complications. To improve intraoperative thermoregulation, devices such as forced-air warming blankets can be applied. This study aimed to evaluate the effect of supplemental forced-air warming blankets in preventing postanesthetic shivering. Methods: This retrospective study included 113 patients who underwent orthognathic surgery between March and September 2015. According to the active warming method utilized during surgery, patients were divided into two groups: Group W (n = 55), circulating-water mattress; and Group F (n = 58), circulating-water mattress and forced-air warming blanket. Surgical notes and anesthesia and recovery room records were evaluated. Results: Initial axillary temperatures did not significantly differ between groups (Group $W=35.9{\pm}0.7^{\circ}C$, Group $F=35.8{\pm}0.6^{\circ}C$). However, at the end of surgery, the temperatures in Group W were significantly lower than those in Group F ($35.2{\pm}0.5^{\circ}C$ and $36.2{\pm}0.5^{\circ}C$, respectively, P = 0.04). The average body temperatures in Groups W and F were, respectively, $35.9{\pm}0.5^{\circ}C$ and $36.2{\pm}0.5^{\circ}C$ (P = 0.0001). In Group W, 24 patients (43.6%) experienced postanesthetic shivering, while in Group F, only 12 (20.7%) patients required treatment for postanesthetic shivering (P = 0.009, odds ratio = 0.333, 95% confidence interval: 0.147-0.772). Conclusions: Additional use of forced-air warming blankets in orthognathic surgery was superior in maintaining normothermia and reduced the incidence of postanesthetic shivering.

• 임상간호연구
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• 제26권3호
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• pp.365-373
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• 2020

Purpose: The purpose of this study was to evaluate the effect of preoperative warming to prevent hypothermia in surgery for patients undergoing total hip replacement arthroplasty under spinal anesthesia. Methods: A randomized experimental study was conducted. Data were collected at an S University hospital in Gyeonggido from December 3, 2019 to March 31, 2020. A random allocation program was used to randomize participants into intervention and control groups. A total of 90 participants were assigned to the study: 30 people were randomized to a pre-warming group using Bair Hugger forced-air warming blankets(Model 505) 30 minutes before surgery, 30 to a pre-warming group 15 minutes before surgery, or 30 to a control group. The findings from 88 participants were analyzed. For data analysis, χ2 test and ANOVA were used utilizing the SPSS 21.0 program. Results: The pre-warming group 30 minutes before surgery had significantly higher body temperature than the control group, from 30 minutes after inducing anesthesia to the end of anesthesia. Body temperature over anesthesia time showed significant differences among the three groups, but there were no statistically significant differences in interactions between time and groups. Conclusion: Warming patients' body for 30 minutes before surgery was effective in maintaining normal body temperature while preventing intraoperative hypothermia.

• Journal of Chest Surgery
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• 제26권7호
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• pp.513-520
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• 1993

Surgical treatment of aneurysm or dissection involving the ascending aorta and aortic arch still poses one of the most complicated technical and tactical challenges in surgery. The use of total circulatory arrest[TCA] with profound hypothermia in the surgical treatment of aneurysmal dissection involving the ascending aorta and aortic arch has been reported as popular surgical methods. However, the safe period of prolonged circulatory arrest with hypothermia remains controversial and ischemic damage to the central nervous system and uncontrollable perioperative bleeding have been the major problem. We have found profound hypothermic circulatory arrest with retrograde cerebral perfusion via the superior vena cava to achieve cerebral protection. We experiment the aortic anastomosis in 7 adult mongrel dogs, using profound hypothermic circulatory arrest with continuous retrograde cerebral perfusion[RGCP] via superior vena cava. We also studied the extent of cerebral protection using above surgical methods, by gas analysis of retrograde cerebral perfusion blood and returned blood of aortic arch, preoperative, intraoperative and postoperative electroencephalography and microscopic findings of brain tissue. The results were as follows: 1. The cooling time ranged from 15 minutes to 24 minutes[19.71$\pm$ 3.20 minutes] ; Aorta cross clamp time ranged from 70 minutes to 89 minutes[79.86 $\pm$ 7.54 minutes] ; Rewarming time ranged from 35 minutes to 47 minutes[42.86$\pm$ 4.30 minutes] ; The extracorporeal circulation time ranged from 118 minutes to 140 minutes[128.43$\pm$ 8.98 minutes] [Table 2]. 2. The oxygen content in the oxygenated blood after RGCP was 12.66$\pm$ 1.25 ml/dl. At 5 minutes after the initiation of RGCP, the oxygen content of returnedlood was 7.58$\pm$ 0.21 ml/dl, and at 15 minutes 7.35$\pm$ 0.17 ml/dl, at 30 minutes 7.20$\pm$ 0.19 ml/dl, at 60 minutes 6.63$\pm$ 0.14 ml/dl [Table 3]. 3. Intraoperative electroencephalographic finding revealed low amplitude potential during hypothermia, and no electrical impulse throughout the period of circulatory arrest and RGCP. Electrical activity appeared after reperfusion, and the electroencephalographic reading also recovered rapidly as body temperature returned to normal [Fig. 2]. 4. The microscopic finding of brain tissue showed widening of the interfibrillar spaces. But there was no evidence of tissue necrosis or hemorrhage [Fig. 3]. We concluded the retrograde cerebral perfusion during hypothermic circulatory arrest is a simplified technique that may have a excellent brain protection.

• Journal of Chest Surgery
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• 제26권2호
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• pp.102-107
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• 1993

Human atria play an important role in extracellular homeostasis through release of atrial natriuretic peptide. To evaluate the relationship between plasma level of atrial natriuretic peptide (ANP) and many changes which can develop during extracorporeal circulation, we studied 16 patients undergoing, 12 cardiac operation and 4 thoracic operation. Plasma level of ANP in cardiac patients group was significantly higher and more changeable than thoracic patients group. After aortic cross clamp release, blood was filled at right atrium and right atrial pressure was rapidly increased. At the same time, plasma level of ANP was rised suddenly. Increase of ANP level was correlated (p<0.05) with the increase of total bypass time, but was not correlated statistical with aortic cross clamp time. ANP level did not fall rapidly after aortic cross clamp while both atria were completely empty. This result was explained by intraoperative hypothermia at that time, which can inactivate plasmal endopeptidase and catalytic receptors of ANP. The ANP level of atrial fibrillation group in cardiac patients were generally higher than normal sinus group, but there was no statistical correlation.

• Journal of Chest Surgery
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• 제18권4호
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• pp.718-731
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• 1985

Renal dysfunction is a common complication of open-heart surgery: a form of controlled hemorrhagic shock, and successful perioperative management of renal dysfunction depends on recognition of the risk factors and optimal management of factors influencing renal function, including cardiopulmonary bypass, and early detection of renal failure. Changes in renal functional parameters including Ccr, Cosm, CH2O, FENa, and RFI were observed prospectively in forty five patients operated on at Dept. of Thoracic and Cardiovascular Surgery, S.N.U.H., from April to June, 1985. They were 23 males and 22 females with 35 acquired and 10 congenital heart diseases and the mean age and body surface area of them were 38.010.3 years [22-63] and 1.5518 M2[1.151.92] respectively. Followings are the conclusion. 1. The Ccr, representative of renal function, is significantly improved from 90.231.3 ml/min/M2 preoperatively to 101.536.4 ml/min/M2 postoperative and day [P<0.05], and all patients were classified as postoperative renal functional class I of Abel, which representing adequate renal protection during our cardiopulmonary bypass. 2. The Cosm is significantly elevated at immediate postperfusion time and remained high at postoperative one day representing osmotic diuresis at that time, but CH2O shows no significant changes at immediate postperfusion period and is decreased significantly at postoperative one day, representing recovery of renal concentrating ability at that time with decreasing urine flow. 3. The absolute value and changing tendency in FENa and RFI during perioperative period shows no diagnostic reliability on these parameters, but those of CH2O appear to reveal future renal function more accurately than Ccr 4. The depth of hypothermia may be protective upon renal function against the ill effects of prolonged nonpulsatile cardiopulmonary bypass. 5. The depth of the hypothermia, pump time of more than 150 minutes, poor cardiac function, and intraoperative events such as embolism appear to be related with immediate postperfusion renal function. 6. Hemoglobinuria and hemolysis, poor preoperative renal function, history of cardiac surgery, and massive transfusion associated with bleeding appear not to be related with renal dysfunction.

• Journal of Veterinary Science
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• 제22권3호
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• pp.44.1-44.15
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• 2021

Background: Intraoperative fluids are still poorly studied in veterinary medicine. In humans the dosage is associated with significant differences in postoperative outcomes. Objectives: The aim of this study is to verify the influence of three different fluid therapy rates in dogs undergoing video-assisted ovariohysterectomy. Methods: Twenty-four female dogs were distributed into three groups: G5, G10, and G20. Each group was given 5, 10, and 20 mL·kg^-1·h^-1 of Lactate Ringer, respectively. This study evaluated the following parameters: central venous pressure, arterial blood pressure, heart rate, respiratory rate, temperature, acid-base balance, and serum lactate levels. Additionally, this study evaluated the following urinary variables: urea, creatinine, protein to creatinine ratio, urine output, and urine specific gravity. The dogs were evaluated up to 26 h after the procedure. Results: All animals presented respiratory acidosis during the intraoperative period. The G5 group evidenced intraoperative oliguria (0.80 ± 0.38 mL·kg^-1·h^-1), differing from the G20 group (2.17 ± 0.52 mL·kg^-1·h^-1) (p = 0.001). Serum lactate was different between groups during extubation (p = 0.036), with higher values being recorded in the G5 group (2.19 ± 1.65 mmol/L). Animals from the G20 group presented more severe hypothermia at the end of the procedure (35.93 ± 0.61℃) (p = 0.032). Only the members of the G20 group presented mean potassium values below the reference for the species. Anion gap values were lower in the G20 group when compared to the G5 and G10 groups (p = 0.017). Conclusions: The use of lactated Ringer's solution at the rate of 10 mL·kg^-1·h^-1 seems to be beneficial in the elective laparoscopic procedures over the 5 or 20 mL·kg^-1·h^-1 rates of infusion.

• Journal of Veterinary Science
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• 제21권1호
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• pp.8.1-8.11
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• 2020

This study reports the clinical use of two sevoflurane-based anesthetic techniques in dogs undergoing craniectomy. Twenty-one animals undergoing elective rostrotentorial or transfrontal craniectomy for brain tumor excision, anesthetized with sevoflurane, were enrolled in this retrospective, observational study. Anesthetic records were allocated to two groups: Sevo-Op (sevoflurane and short acting opioid infusion): 8 dogs and Sevo-Dex (sevoflurane and dexmedetomidine infusion): 13 dogs. Average mean arterial pressure (MAP), heart rate, end-tidal carbon dioxide, end-tidal sevoflurane and intraoperative infusion rates during surgery were calculated. Presence of intra-operative and post-operative bradycardia, tachycardia, hypotension, hypertension, hypothermia, hyperthermia was recorded. Time to endotracheal extubation, intraoperative occurrence of atrioventricular block, postoperative presence of agitation, seizures, use of labetalol and dexmedetomidine infusion were also recorded. Data from the two groups were compared with Fisher's exact test and unpaired t tests with Welch's correction. Odds ratio (OR) and 95% confidence interval (CI) were calculated for categorical variables. Intra-operatively, MAP was lower in Sevo-Op [85 (± 6.54) vs. 97.69 (± 7.8) mmHg, p = 0.0009]. Time to extubation was longer in Sevo-Dex [37.69 (10-70) vs. 19.63 (10-25), p = 0.0033]. No differences were found for the other intra-operative and post-operative variables investigated. Post-operative hypertension and agitation were the most common complications (11 and 12 out of 21 animals, respectively). These results suggest that the infusion of dexmedetomidine provides similar intra-operative conditions and post-operative course to a short acting opioid infusion during sevoflurane anesthesia in dogs undergoing elective rostrotentorial or transfrontal intracranial surgery.