Efficacy of prewarming prophylaxis method for intraoperative hypothermia during thoracoscopic esophagectomy
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ORIGINAL ARTICLE
Efficacy of prewarming prophylaxis method for intraoperative hypothermia during thoracoscopic esophagectomy Naoya Okada1,2 · Takeo Fujita2 · Jun Kanamori1 · Ataru Sato1 · Daisuke Kurita1 · Yasumasa Horikiri2 · Takuji Sato2 · Hisashi Fujiwara2 · Hiroyuki Yamamoto3 · Hiroyuki Daiko1,2 Received: 2 October 2019 / Accepted: 26 April 2020 © The Japan Esophageal Society 2020
Abstract Background This study was performed to elucidate the clinical efficacy of the prewarming prophylaxis method for intraoperative hypothermia during thoracoscopic esophagectomy for esophageal cancer. Methods We enrolled 100 consecutive patients with esophageal cancer. Two patients in the prewarming group could not undergo thoracoscopic esophagectomy because of conversion to thoracotomy. The intraoperative core temperature was measured in 50 and 48 patients classified into the control and prewarming groups, respectively. Patients in the prewarming group wore a Bair Hugger warming gown (3 M, Maplewood, MN, USA) in the ward for 30 min before entering the operation room. The primary outcome measure was the difference in the intraoperative body core temperature between the control and prewarming groups, and the secondary outcome measure was the difference in postoperative infectious complications between the control and prewarming groups. Results The intraoperative core temperature was significantly different between the two groups at each 30-min time point from the starting of operation to the ending of the thoracic procedure (P 20 years 5. Eastern Cooperative Oncology Group performance status of 0, 1, or 2 6. Provision of written informed consent
Exclusion criteria Patients who fulfilled any of the following criteria were ineligible for this study: 1. Open thoracotomy or mediastinoscope-assisted esophagectomy 2. Other surgery for synchronous carcinoma 3. Infectious disease with an indication for systemic therapy 4. Body temperature of ≥ 38 °C 5. Continuous treatment with systemic steroid therapy or immune-suppressive drug therapy 6. Poorly controlled diabetes mellitus in spite of continuous use of insulin
Anesthesia and measurement of core temperature The standard institutional anesthetic practice for thoracic esophagectomy was modified to enable the development of intraoperative core hypothermia in this study. No patients were premedicated. In brief, upon patient arrival in the operating room, we applied routine monitoring including electrocardiography, noninvasive blood pressure measurement, pulse oximetry, and capnography. The core temperature was measured in the bladder every 5 min using a thermistor of a modern anesthesia workstation (Leon Plus; Löwenstein Medical, Hamburg, Germany) probe at room temperature. A 20-gauge catheter was inserted into a forearm vein for fluid and drug administration. Acetate Ringer’s solution at room temperature was administered at 500 mL/h during surgery. Before induction of anesthesia, an epidural catheter was inserted at the fifth-to-sixth thoracic interspace and placed 5 cm beyond the i
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