Influência da combinação de métodos de aquecimento no intraoperatório na temperatura central em pacientes obesas e não obesas durante anestesia venosa total
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Data
2011-02-16
Autores
Fernandes, Luciano Augusto [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O obeso tem menor incidência de hipotermia intraoperatória em relação ao não obeso por apresentar limiar de vasoconstrição termorregulatória mais elevado. A combinação de métodos de aquecimento no intraoperatório parece ser melhor do que o uso isolado na prevenção de hipotermia. O objetivo da pesquisa foi avaliar se a combinação de permutador de calor e umidade (PCU) no circuito inspiratório com ar forçado aquecido ou aquecimento das soluções parenterais previne a ocorrência de hipotermia no período intraoperatório em obesas (OB) e não obesas (NOB) submetidas à anestesia venosa total. Quarenta pacientes submetidas à cirurgia abdominal ginecológica foram anestesiadas com propofol e remifentanil em infusão alvocontrolada. Todas as pacientes tinham um PCU acoplado no circuito inspiratório. As pacientes foram distribuídas aleatoriamente em 4 grupos de acordo com o índice de massa corporal (IMC) e com o manejo termal. Em 10 obesas (IMC de 30 a 34,9 kg.m-2) e 10 não obesas (IMC de 18,5 a 24,9 kg.m-2), utilizou-se ar forçado aquecido nos membros inferiores (WB). Dez obesas e 10 não obesas receberam aquecimento das soluções infundidas (HF). A temperatura central foi registrada nos momentos controle (0) e 15, 30, 60 90 e 120 minutos após instalação do circuito respiratório, e no final da cirurgia. Na Sala de Recuperação Pós-Anestésica (SRPA), a temperatura central das pacientes foi registrada durante o período de 1 hora. O IMC e a temperatura central foram correlacionados nos grupos que receberam o mesmo tratamento termal da hipotermia. O grupo OB/WB apresentou temperatura central intraoperatória mais alta em relação aos outros grupos (p<0,001). A proporção de pacientes normotérmicos no final da cirurgia e na admissão da SRPA foi mais alta em OB/WB do que nos outros grupos (p<0,05). Houve correlação positiva entre o IMC e a temperatura central no...
Obese individuals show less intraoperative (IOP) hypothermia than non-obese ones due to higher vasoconstriction threshold. A combination of warming methods may be better than an isolated one in preventing IOP hypothermia. Our aim was to evaluate whether the combination of a heat and moisture exchanger (HME) on inhaled gas with IOP forced air warming blanket (WB) or warming intravenous (IV) fluids (HF) prevents IOP hypothermia in obese (OB) and non-obese (NOB) women under intravenous anesthesia. Forty patients scheduled for gynecological abdominal surgery were anesthetized with propofol and remifentanil in a target controlled infusion. All patients had a HME on the inhaled gas. Patients were randomly distributed into 4 groups according to body mass index (BMI) and IOP thermal management. Ten OB grade I (BMI between 30 and 34.9 kg.m-2) and 10 NOB (BMI between 18.5 and 24.9 kg.m-2) had WB on the lower limbs. Ten OB and 10 NOB patients received IV HF. Core temperatures were recorded at baseline, after 15, 30, 60, 90, and 120 minutes of ventilatory system installation, and at the end of surgery. Core temperature was also followed for 60 minutes in the Post Anesthetic Care Unit (PACU). Core temperature and BMI were correlated in the groups with the same hypothermia treatment method. OB/WB group presented a higher IOP core temperature higher than the other groups (P<0.001). The proportion of normothermic patients at end of surgery and in PACU admission was higher in OB/WB than the other groups (P<0.05). There was a positive correlation between BMI and core temperature in the skin-surface warming groups (P<0.001). The combination of IOP skin-surface warming with HME on the inhaled gas in female obese patients, but not in non-obese ones, minimizes hypothermia. The combination of warming IV fluids and HME does not avoid IOP hypothermia in female obese or non-obese patients
Obese individuals show less intraoperative (IOP) hypothermia than non-obese ones due to higher vasoconstriction threshold. A combination of warming methods may be better than an isolated one in preventing IOP hypothermia. Our aim was to evaluate whether the combination of a heat and moisture exchanger (HME) on inhaled gas with IOP forced air warming blanket (WB) or warming intravenous (IV) fluids (HF) prevents IOP hypothermia in obese (OB) and non-obese (NOB) women under intravenous anesthesia. Forty patients scheduled for gynecological abdominal surgery were anesthetized with propofol and remifentanil in a target controlled infusion. All patients had a HME on the inhaled gas. Patients were randomly distributed into 4 groups according to body mass index (BMI) and IOP thermal management. Ten OB grade I (BMI between 30 and 34.9 kg.m-2) and 10 NOB (BMI between 18.5 and 24.9 kg.m-2) had WB on the lower limbs. Ten OB and 10 NOB patients received IV HF. Core temperatures were recorded at baseline, after 15, 30, 60, 90, and 120 minutes of ventilatory system installation, and at the end of surgery. Core temperature was also followed for 60 minutes in the Post Anesthetic Care Unit (PACU). Core temperature and BMI were correlated in the groups with the same hypothermia treatment method. OB/WB group presented a higher IOP core temperature higher than the other groups (P<0.001). The proportion of normothermic patients at end of surgery and in PACU admission was higher in OB/WB than the other groups (P<0.05). There was a positive correlation between BMI and core temperature in the skin-surface warming groups (P<0.001). The combination of IOP skin-surface warming with HME on the inhaled gas in female obese patients, but not in non-obese ones, minimizes hypothermia. The combination of warming IV fluids and HME does not avoid IOP hypothermia in female obese or non-obese patients
Descrição
Palavras-chave
Anestesiologia, Hipotermia, Obesidade, Core temperature, Hypothermia, Obesity
Como citar
FERNANDES, Luciano Augusto. Influência da combinação de métodos de aquecimento no intraoperatório na temperatura central em pacientes obesas e não obesas durante anestesia venosa total. 2011. 212 f. Tese (doutorado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2011.