Effect of irrigation fluid temperature on core temperature and hemodynamic changes in transurethral resection of prostate under spinal anesthesia

Abstract

Background:Hypothermia is a frequent observation in elderly males undergoing transurethral resection of prostate (TURP) under spinal anesthesia. The use of irrigating fluids at room temperature results in a decrease body temperature. Warmed irrigating solutions have shown to reduce heat loss and the resultant shivering. Such investigation was not much tried in low resource settings.Aim:To compare the resultant change in core temperature and hemodynamic changes among patients undergoing TURP surgery under spinal anesthesia using warm and room temperature irrigation fluids.Settings and Design:Randomized prospective study at a tertiary care center.Methods:This study was conducted on 40 male patients aged 50-85 years undergoing TURP under spinal anesthesia. Of which, 20 patients received irrigation fluid at room temperature 21°C and 20 patients received irrigation fluid at 37°C after random allocation. Core temperatures and hemodynamic parameters were assessed in all patients at preoperative, intra-operative, and postoperative periods. Intra-operative shivering was also noted in both groups.Statistical Analysis:Unpaired and Paired Student's t-test.Results:For patients who underwent irrigation with fluid at room temperature Core temperature drop from 36.97°C in preoperative to 34.54°C in postoperative period with an effective difference of 2.38°C. Among patients who received warmed irrigation fluid at 37°C had core temperature drop from 36.97°C to 36.17°C and the effect of fall was 0.8°C. This difference was statistically significant (P < 0.001). Shivering of Grades 1 and 2 was observed in nine patients, of Group 1 while only three patients had Grades 1 and 2 shivering in Group 2. The hemodynamic parameters were similar in the two groups and did not reach significant difference.Conclusion:Use of warm irrigation fluid during TURP reduces the risk of perioperative hypothermia and shivering.

Perioperative Hypothermia after Transurethral Surgeries: Is it Necessary to Heat the Irrigation Fluids?

“…Anaesthesia literature has shown that the management of core body temperatures is vital to limit iatrogenic outcomes in patients, especially in the hospital setting ( 2 , 10 ). According to these findings, advanced age, length of procedure and implementation of room temperature irrigation fluids during endoscopic procedures each increased the risk of perioperative hypothermia ( 3 , 5 , 6 ). Numerous studies also showed that decreased body temperatures increased the risk of postoperative complications ( 2 , 10 ).…”

“…As a result, many investigators have suggested that protocols such as warmed irrigation fluids should be considered when managing patients in the operating room. Few studies have evaluated this specifically in urologic patients and related procedures ( 6 ).…”

“…Although similar studies have evaluated the risk of hypothermia in within high-risk patients from the perspective of both anaesthesiologists and urologists, our study demonstrated a positive statistical effect with no clinical significance in terms of implementation of heated irrigation fluids when monitoring for postoperative complications ( 2 , 15 ). Several studies have focused on the risks for specific medical complications due to the temperature drops during the perioperative period specifically in the urologic patient population; however, such results may have been influenced due to evaluating smaller sample sizes ( 1 , 6 ). This trial further supports the previously identified hypotheses in the setting of a large sample size.…”

“…Data that were not normally distributed were analysed using the non-parametric Mann–Whitney U test for intergroup comparison. A sample size of 278 patients was calculated using the power analysis based on results of the incidence of hypothermia from another study ( 6 ), in which the overall incidence of hypothermia after the implementation of warmed irrigating fluids was 15%. To detect a drop in the rate of hypothermia to 10%, 232 patients with Type I error (an alpha error of 0.05) and a Type II error (a beta error of 0.2) were required.…”

“…Of note, patients undergoing endoscopic urology procedures were often aged >65 years and received irrigation fluids. Advanced age was shown to be a risk factor for perioperative hypothermia in several studies including a review performed by Blatteis et al ( 3 , 4 ) By studying patients undergoing transurethral procedures, Pit and Singh demonstrated the increased risk of a low body temperature with room temperature irrigation fluids ( 5 , 6 ).…”