الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Perioperative patients commonly dominate the care provided by hospitals and freestanding facilities. An increased understanding of how a surgical stress affects patient has occurred in the last 70 years with much evidence indicating that physiologic stress reduction decreases complications and improves perioperative outcomes.
Hypothermia is defined as a core temperature less than 36°C. Mild hypothermia is defined as ranging from 1°C to 2°C below body core temperature. Up to 20% of patients experience unintended perioperative hypothermia (UPH). Anaesthetic induced changes in the body’s regulatory heat mechanisms in combination with exposure to cold operating room will precipitate hypothermia in patients while undergoing both regional and general anaesthesia.
Hypothermia is associated with a multitude of physiologic organ system effects which can either be beneficial or detrimental depending on the surgery in which the event occurs, the desired effect needed for any given procedure under anaesthesia, and the degree of hypothermia. A number of physiologic changes are associated with hypothermia which includes cardiovascular, respiratory, hepatic, renal, neurologic, metabolic, hematologic, immunologic, drug pharmacology, shivering and wound healing. Many organs have poor reserve for hypothermia making a limited stressful anaesthetic or surgical episode potentially dangerous.
The aim of the present study was to evaluate the effect of mild perioperative hypothermia on surgical blood loss and need for transfusion, examine the relationship between body temperature and some neuroendocrinal responses and determine immune alterations that might be induced by perioperative hypothermia.in patients undergoing gastro-intestinal malignancy surgeries.
The present study was approved by the local ethics committee of Alexandria Main University hospital and an informed written consent was obtained from all participating patients. The study was carried out on 46 patients of both sexes classified according to the American Society of Anaesthesiology in relation to their clinical status into ASA II,III and they were scheduled for gastrointestinal malignancy surgery operation. Patients were randomly classified into control group receiving routine thermal care and study group receiving forced warm air blower to keep body temperature at or near 37°C.
All patients were followed up for the following:-
• Heart rate (beats/min),mean arterial blood pressure (mmHg) were continuously monitored and recorded before induction of anaesthesia, intraoperative at 15 minutes interval till end of operation, postoperative at (1,2,3,4,8,12,16,20,24,28,32,36,48) hours.
• Preoperative core temperature was measured using a tympanic membrane thermocouple probe and was recorded at 20 minutes interval starting before induction of anaesthesia, throughout the surgery and for the first three postoperative hours.
• Amount of blood loss intraoperatively through estimation of blood in the suction unit and estimation of the weight of blood soaked towels and sponges, postoperatively through cumulative estimation of blood in the drain at six hours and on the first and second postoperative days.
• Amount of blood transfusion intraoperative and cumulatively postoperative at six hours and on the first and second postoperative days.
• Total and differential leukocytic count were measured before induction of general anaesthesia, and at 24 and 48 hours after surgery.
• Serum concentrations of TNF α, IL-1β, IL-6 were measured before induction of general anaesthesia, and at 24 and 48 hours after surgery.
• Serum concentration of epinephrine nor-epinephrine and cortisol were measured before induction of general anaesthesia, at 60 and 180 minutes postoperatively and in the morning of the first postoperative day.
The results of the present study demonstrated that the heart rate and MABP were significantly higher in group I when compared to group II during the postoperative period. Patients in group I had significantly lower core temperatures when compared to group Ii patients. Blood loss and transfusion requirements were higher in group I when compared to group II both intraoperative and at 6 hours postoperative. Both groups showed leukocytosis, neutrophilia and lymphocytopoenia without significant difference in between. TNF-α didn’t change relative to the baseline values in the two groups, IL-1β increased significantly in both groups with a higher significant increase in in group I when compared to group II whereas IL-6 increased significantly in both groups postoperatively relative to baseline values with no significant difference between both groups. Adrenaline increased significantly in the intraoperative period returning to a non-significantly changed values on 1st day postoperative day without statistical difference between the two groups, noradrenaline increased significantly in the intraoperative period returning to a non-significantly changed values on 1st day postoperative day with a higher significant increase in group I when compared to group II whereas serum cortisol didn’t change relative to the baseline values in the two groups.