[Non-therapeutic intraoperative hypothermia: prevention and treatment (part II)]. / Hipotermia intraoperatoria no terapéutica: prevención y tratamiento (parte II).

General and regional anesthesia alter the physiological mechanisms of thermoregulation, and unintentional intraoperative hypothermia develops during most surgical procedures that last more than 1 hour. Monitoring of central temperatures among other vital signs is advisable in such interventions in order to detect temperature changes and check the efficacy of measures to prevent or treat hypothermia. Passive insulation reduces heat loss through the skin but most patients require active warming to maintain a normal temperature. Various skin surface warming systems prevent hypothermia from developing and provide effective warming. The most often used are forced-air or warm water circulation devices. When large volumes of fluids must be infused intravenously, they must be warmed to body temperature to avoid heat loss.

[Non-therapeutic intraoperative hypothermia: causes, complications, prevention, and treatment (part I)]. / Hipotermia intraoperatoria no terapéutica: causas, complicaciones, prevención y tratamiento (I parte).

During the first hour of general anesthesia, a patient's body temperature can decrease between 1 and 1.5 degrees C; regional anesthesia also induces central hypothermia. Intraoperative hypothermia interferes with immunological function, particularly with the oxidative capacity of neutrophils. Cutaneous vasoconstriction occurs and blood flow is reduced in tissues subject to surgery. Oxygen transport is also reduced, increasing the risk of postoperative infection. Decreased platelet activity favors blood loss. Hypothermia increases the likelihood of shivering, and with enhanced central nervous system activation, there is increased cardiovascular morbidity. Currently, these effects can be attenuated or even avoided by applying various warming methods available. The efficacy and mechanisms of action of such methods are described in the second part of this review of the literature.

[Air-convection heater for abdominal surgery. Study of the relation between surgical time and the efficacy of body temperature maintenance]. / Calentador por convección de aire en cirugía abdominal. Estudio de la relación tiempo quirúrgico-eficacia del mantenimiento de la temperatura corporal.

OBJECTIVES: 1) To quantify the efficacy of forced air warming for maintaining body temperature during general anesthesia of adults, and 2) to study the relation between the duration of surgery and the level of thermal protection provided by the device used. PATIENTS AND METHODS: We studied 30 adult patients of both sexes who were scheduled for abdominal surgery involving laparotomy. After three patients were excluded because surgery was unfeasible, the remaining 27 were allocated randomly to a control group (n = 14) or a group (n = 13) to be warmed by a Bair Hugger (Augustine Medical Inc.) heater. Esophageal temperature was checked every 30 min by one probe of a modular thermometric channel (Mon-a-therm) 6510 Mallincrodt, while ambient temperature was monitored by the second probe. RESULTS: Significant differences in esophageal temperature were observed between the two groups from the second hour after start of surgery, and the differences increased over time. Differences were observed at the end of surgery (Bair group: 36.4 +/- 0.5 degrees C; control group: 34.7 +/- 1.1 degrees C) and upon admission to the intensive care recovery unit (Biar group: 36.3 +/- 0.6 degrees C; control 34.8 +/- 1.0 degrees C) (p < 0.0001). CONCLUSIONS: The Bair Hugger heater is effective during abdominal operations lasting two or more hours. The device not only prevented hypothermia from deepening during surgery, but also reversed hypothermia in spite of being used after anesthetic induction and in spite of the loss of heat produced by secondary vasodilation.

[Degrees of acceptance of local regional anesthetic techniques among hospital physicians]. / Grado de aceptación de las técnicas de anestesia locorregional entre los médicos hospitalarios.

We have evaluated the acceptance of local regional anesthetic techniques (LRA) among the physicians of our hospital by means of an anonymous questionnaire. The people addressed had to choose, as if they were hypothetical patients, the type of anesthesia (general or local regional anesthesia) in four clinical hypothetical situations: interventions on upper limb (UL), on lower limb (LL), in an emergency situation and in a scheduled situation. We obtained 109 answers: 58 from medical specialities (cardiology, gastroenterology, internal medicine, pneumology, and radiology) and 51 from surgical specialities (general surgery, gynecology, ear, nose and throat, and traumatology). Local regional anesthetic techniques were the most frequently selected (p less than 0.001) and the main reason for selection was safety. Surgeons choose LRA more frequently than medical specialists but the difference was not significant. More information on such techniques does contribute to an increase in its acceptance, a fact which is clearly reflected in the medical staff of our hospital.

[Malignant hyperthermia. Apropos of a case]. / Hipertermia maligna. A propósito de un caso.

We present the clinical case of a thirteen-year-old male patient who suffered a malignant hyperthermia syndrome after an adenoidectomy under general anaesthesia. The recovery of the patient was successful with the specific treatment of dantrolene. We believe it is interesting to publish all the cases of malignant hyperthermia in order to have a better knowledge of the real incidence in our country.