Süleyman GANİDAĞLI, Pınar TÜMTÜRK, Berna KAYA UĞUR

Effects of Two Decurarization Methods on Thermoregulation of Patients Under General Anesthesia

Objective: Evaluate the effects of two decurarization methods on thermoregulation of patients who received general anesthesia. Method: Sixty-six male patients that are over 18 years of age with an ASA physical status I-III and scheduled for elective thoracotomy. Patients were warmed with ( 38 ° C at medium setting ) air blowing blankets. Decurarization was achieved with 0.02-0.05 mg/kg neostigmine in group N and 3 mg/kg sugammadex in group S after train of four (TOF) value obtained at the end of the operation. Results: Core temperatures of tympanic membrane and peripheral skin temperatures of sternum and 1/3 upper part of the arm were measured and recorded at 15th, 30th, 45th, 60th, 90th and 120th minutes after extubation. Core temperature of the tympanic membrane and skin temperatures measured at the chest and arm in the first two hours after extubation were similar between the groups. Conclusions: Decurarization agents had no effect on spontaneous central and skin temperatures in the actively heated postoperative patients that had previously equal intraoperative temperatures. Whereas the temperatures of the peripheral skin surface of the patients who received sugammadex returned to preoperative control levels earlier than that of patients receiving neostigmine.

PDF

___

1. Fujita Y, Tokunaga C, Yamaguchi S, Nakamura K, Horiguchi Y, Kaneko M. Effect of intraoperative amino acids with or without glucose infusion on body temperature, insulin, and blood glucose levels in patients undergoing laparoscopic colectomy. Acta Anaesthesiologica Taiwanica 2014; 52: 101-106
2. Bock M, Müller J, Bach A, Böhrer H, Martin E, Motsch J. Effects of preinduction and intraoperative warming during major laparotomy. BJA 1998; 80: 159-163
3. Suzuki M, Osumi M, Shimada H, Bito H. Perioperative very low-dose ketamine infusion actually increases the incidence of postoperative remifentanil induced shivering double-blind randomized trial. Acta Anaesthesiologica Taiwanica 2013; 51: 149-154
4. Sessler DI. Perianesthetic thermoregulation and heat balance in humans. FASEB J. 1993; 7: 638-44.
5. Sessler DI, Complications and Treatment of Mild Hypothermia. Anesthesiology. 2001; 95: 531–43
6. De Mattia LA, Barbosa HM, Rocha De MA, Farias LH, Santos AC, Santos MD. Hypothermia in patients during the perioperave period. Rev Es Enform USP. 2012; 46: 58-64.
7. Cobbe KA, Di Staso R, Duff J, Walker K, Draper N. Preventing inadvertent hypothermia: comparing two protocols for preoperative forcedair warming. J Perianesth Nurs. 2012; 27: 18-24.
8. Buggy DJ, Crossley AWA. Thermoregulation, mild perioperative hypothermia and post-anaesthetic shivering. Br J Anaesth. 2000; 84: 615-628.
9. Naguib M. Sugammadex: Another milestone in clinical neuromuscular pharmacology. Anesth Analg. 2007; 104: 575-81.
10. Khuenl-Brady KS, Wattwil M, Vanacker BF, Lora-Tamayo JI. Sugammadex provides faster reversal of vecuronium induced neuromuscular blockade compared with neostigmine: a multicenter, randomized, controlled trial, Anesth Analg. 2010; 110: 64-73.
11. Cattaneo CG, Frank SM, Hesel TW, El-Rahmany HK, Kim LJ, Tran KM. The accuracy and precision of body temperature monitoring methods during regional and general anesthesia. Anesth Analg. 2000; 90: 938-945.
12. Lenhardt R, Sessler DI. Estimation of Mean Body Temperature from Mean Skin and Core Temperature. Anesthesiology. 2006; 105: 1117–21
13. Srivastava A, Hunter JM. Reversal of neuromuscular block. BJA. 2009; 103: 115-129
14. Jung KT, Kim SH, Lee HY, Jung JD, Yu BS, Lim KJ, So KY, Lee JY, An TH. Effect on thermoregulatory responses in patients undergoing a tympanoplasty in accordance to the anesthetic techniques during PEEP: a comparison between inhalation anesthesia with desflrane and TIVA. Korean Society of Anesthesiologists 2014; 67: 32-37
15. Sessler DI. Thermoregulatory defence mechanisms. Crit Care Med . 2009; 37: 203-10.
16. Horosz B, Malec-Milewska M. Inadvertent intraoperative hypothermia. Anaesthesiology Intensive Therapy. 2013, 45; 38–43
17. Mirakhur R. H, Dundee JW. A comparison of the effects of atropine and glycopyrrolate on various end organs. J. Roy. Soc. Med. 1980; 73: 727-730.
18. Sımpson KH, Green JH, Ellıs FR. Effect of glycopyrrolate and atropine on thermoregulation after exercise. Br. J. clin. Pharmac. 1986; 22: 579-586
19. Frank SM, El-HK, Cattaneo CG, Barnes RA. Predictors of Hypothermia during Spinal Anesthesia. Anesthesiology. 2000; 92: 1330-1334.
20. Washington DE, Sessler DI, McGuire J, Hynson J, Schroeder M, Moayeri A. Painful stimulation minimally increases the thermoregulatory threshold for vasoconstriction during enflurane anesthesia in humans. Anesthesiology 1992; 77: 286–90.