Total-body oxygen consumption after isoflurane anesthesia: Effects of mild hypothermia and combined epidural-general anesthesia

doi:10.1016/S0952-8180(97)00144-X

Journal of Clinical Anesthesia

Volume 9, Issue 7, November 1997, Pages 559-563

https://doi.org/10.1016/S0952-8180(97)00144-X Get rights and content

Abstract

Study Objectives: To determine the effects of epidural anesthesia and avoidance of intraoperative heat loss on the increase in total-body oxygen consumption in the immediate postoperative period after major intraabdominal surgery.

Design: Prospective, randomized (with regard to temperature management) study.

Setting: University medical center.

Patients: 24 ASA physical status I, II, and III adults.

Interventions: All patients received either isoflurane-nitrous oxide (N₂O)-opioid general anesthesia or combined epidural-general anesthesia; patients were randomly assigned to active intraoperative warming or routine thermal care.

Measurements and Main Results: VO₂ was measured by indirect calorimetry preoperatively (T₀), immediately postoperatively (T₁), and 60 to 90 minutes later (T₂). For all patients, VO₂ was 57 ± 45% (mean ± SD) greater at T₁ than at T₀ (p < 0.05). After isoflurane-N₂O-opioid general anesthesia, VO₂ increased 15 ± 20% in normothermic patients (core temperature, 36.4 ± 0.2 °C) compared with 69 ± 52% in hypothermic patients (35.0 ± 0.5 °C). After combined epidural-general anesthesia, VO₂ increased 86 ± 39% on emergence in normothermic (36.4 ± 0.2 °C) and 58 ± 11% in hypothermic (35.1 ± 0.4 °C) patients.

Conclusions: Total-body VO₂ was increased in the immediate postoperative period. After general anesthesia, the magnitude of the increase in VO₂ was significantly less in normothermic patients than in hypothermic patients. After combined epidural-general anesthesia, VO₂ was increased in normothermic and in hypothermic patients.

References (19)

J Bay et al.
Factors influencing arterial PO₂ during recovery from anaesthesia
Br J Anaesth
(1968)
P Christensen et al.
Influence of extradural morphine on the adrenocortical and hyperglycaemic response to surgery
Br J Anaesth
(1982)
JM Bernard et al.
Effects of systemic morphine and epidural bupivacaine on postoperative oxygen consumption during rewarming
J Clin Anesth
(1988)
L Delaunay et al.
Clonidine decreases postoperative oxygen consumption in patients recovering from general anaesthesia
Br J Anaesth
(1991)
MJ Ciofolo et al.
Changes in ventilation, oxygen uptake, and carbon dioxide output during recovery from isoflurane anesthesia
Anesthesiology
(1989)
PE MacIntyre et al.
Effect of meperidine on oxygen consumption, carbon dioxide production, and respiratory gas exchange in postanesthesia shivering
Anesth Analg
(1987)
B Just et al.
Oxygen uptake during recovery following naloxone. Relationship with intraoperative heat loss
Anesthesiology
(1992)
CF Roe et al.
The influence of body temperature on early postoperative oxygen consumption
Surgery
(1966)
SM Frank et al.
Multivariate determinants of early postoperative oxygen consumption in elderly patients. Effects of shivering, body temperature, and gender
Anesthesiology
(1995)

There are more references available in the full text version of this article.

Cited by (11)

Clinical practice guideline. Unintentional perioperative hypothermia
2018, Revista Espanola de Anestesiologia y Reanimacion
La importancia de la seguridad de nuestros pacientes en el entorno quirúrgico ha impulsado multitud de proyectos dirigidos al mejor control y actuación clínica de las variables que intervienen o modulan los resultados de los procesos quirúrgicos y que tienen relación directa sobre los mismos.
La Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor –SEDAR– mantiene una constante preocupación por una variable que determina claramente los resultados de nuestros procesos clínicos, la hipotermia no intencionada que se desarrolla en todos los pacientes sometidos a un procedimiento anestésico-quirúrgico.
SEDAR ha promovido, en colaboración con otras sociedades científicas y asociaciones de pacientes, la elaboración de esta guía de práctica clínica, que pretende dar respuesta a cuestiones clínicas no resueltas aun y para las cuales no existen hasta ahora documentos basados en la mejor evidencia científica disponible.
Con metodología GRADE y la asistencia técnica de la oficina de Colaboración Cochrane Iberoamericana, esta guía de práctica clínica presenta 3 recomendaciones (débil a favor) para los métodos activos de calentamiento para la prevención de la hipotermia (cutáneos, de líquidos o gases); 3 para la priorización de las estrategias de prevención de la hipotermia (2 débil a favor y una fuerte a favor); 2 para las estrategias de precalentamiento previas a la inducción anestésica (2 débil a favor); y 2 para investigación.
The importance of the safety of our patients in the surgical theatre, has driven many projects. The majority of them aimed at better control and clinical performance; mainly of the variables that intervene or modulate the results of surgical procedures, and have a direct relationship with them.
The Spanish Society of Anesthesiology, Critical Care and Therapeutic Pain (SEDAR), maintains a constant concern for a variable that clearly determines the outcomes of our clinical processes, “unintentional hypothermia” that develops in all patients undergoing an anesthetic or surgical procedure.
SEDAR has promoted, in collaboration with other scientific Societies and patient Associations, the elaboration of this clinical practice guideline, which aims to answer clinical questions not yet resolved and for which, up to now, there are no documents based in the best scientific evidence available.
With GRADE methodology and technical assistance from the Ibero-American Cochrane Collaboration office, this clinical practice guideline presents three recommendations (weak in favor) for active heating methods for the prevention of hypothermia (skin, fluid or gas); three for the prioritization of strategies for the prevention of hypothermia (too weak in favor and one strongly in favor); two of preheating strategies prior to anesthetic induction (both weak in favor); and two for research.
Effect of laparoscopy and laparotomy on energy and protein metabolism in children: A randomized controlled trial
2010, Journal of Pediatrics
Citation Excerpt :
A larger sample would be needed to investigate this tendency further. There is an increase in REE for as long as 7 to 10 days postoperatively in adults.2,3,21 In contrast, neonates have only a short-lived increase in REE 4 hours after abdominal surgery.4
To compare the effects of surgery on energy and protein metabolism in children randomized to undergo laparoscopic and open surgery.
We randomized 41 patients to open or laparoscopic Nissen fundoplication. Anesthesia and postoperative management were standardized. We recorded core temperature, respiratory gas exchange preoperatively, intraoperatively, and 4 and 24 hours postoperatively and calculated resting energy expenditure (REE). Protein breakdown was measured by using stable isotopic leucine infusion preoperatively and 4 hours postoperatively.
Intraoperative core temperature and oxygen consumption increased in the laparoscopic group compared with the open group. REE decreased in the early postoperative period in the open group, but did not decrease after laparoscopy. REE at 4 hours was higher after laparoscopy. Protein breakdown also decreased in the early postoperative period; the pattern of change between open and laparoscopic groups was of borderline significance.
Laparoscopy in children may alter the changes in energy metabolism observed after open surgery. These differences may be partially caused by alterations in intraoperative thermoregulation and protein breakdown during laparoscopy in children.
A Systematic Review of Intraoperative Warming to Prevent Postoperative Complications
2006, AORN Journal
Citation Excerpt :
Results favored treatment (RR = 0.37, CI 0.27 = 0.51, ARR = 13%) (Figure 2). Three studies involving patients undergoing colorectal procedures examined whether pain levels would be reduced if the patient's temperature were maintained.20,50,52 Overall results showed that the prevention of hypothermia through the use of warming therapy during surgery does not have an effect on pain levels.
- •
  THIS SYSTEMATIC REVIEW examines whether preventing hypothermia during surgery prevents postoperative complications and thereby improves outcomes for patients. Twenty-six randomized controlled trials were identified, and data extraction and assessment of study quality were carried out by two researchers independently. The results of studies with similar patients, surgical procedures, and outcomes were pooled.
- •
  OUTCOMES MEASURED included postoperative pain levels, thermal comfort, and treatment costs. Postoperative complications identified were shivering, cardiac events, need for blood transfusion, wound infections, and pressure ulcers. The majority of studies favored treatment. AORN J 83 (May 2006) 1090–1113.
Respiratory gas exchange and hemodynamics during lumbar epidural anesthesia: Effects of lidocaine with and without epinephrine
2000, Regional Anesthesia and Pain Medicine
Background and Objectives: Epinephrine modifies the hemodynamic response to epidural local anesthetic; effects on respiratory gas exchange are not known. We hypothesized that epidural epinephrine would increase oxygen consumption and carbon dioxide production. Methods: Twelve healthy patients (age, 22 to 46 years) undergoing surgery on the knee were randomly assigned to receive either 2% lidocaine (group L) or 2% lidocaine with epinephrine 5 μg · mL⁻¹ (group E), approximately 20 mL, over 10 minutes via lumbar epidural catheter. Total-body oxygen consumption (VO₂) and carbon dioxide production (VCO₂) were determined by indirect calorimetry; hemodynamic measurements were obtained by noninvasive thoracic electrical bioimpedance. Values of VO₂, VCO₂, heart rate (HR), cardiac index (CI), and mean arterial blood pressure (MAP) were determined every minute and averaged every 5 minutes for 30 minutes. Comparisons were made with analysis of variance (ANOVA) (within groups) and t-tests (between groups). Differences were considered statistically significant if P < .05. Results: VO₂ did not change in either group, while VCO₂ increased significantly by 22% at 20 minutes in group E. Increases in HR were apparent in both groups, with significantly greater increases in group E (group L, 13%; group E, 21%). CI did not change in group L, but increased by 41% in group E. MAP decreased significantly by 11% in group E, but did not change in group L. Conclusions: The addition of epinephrine, 5 μg · mL⁻¹, to the epidural injection of 2% lidocaine is associated with changes not only in hemodynamics, but also in respiratory gas exchange. Reg Anesth Pain Med 2000;25:380-384.
Monitoring of mitochondrial oxygen tension in the operating theatre: An observational study with the novel COMET<sup>®</sup> monitor
2023, PLoS ONE
Anaesthetic implications of free-flap microvascular surgery for head and neck malignancies-A relook
2021, Journal of Anaesthesiology Clinical Pharmacology

View all citing articles on Scopus

^∗: Assistant Professor of Anaesthesia, Harvard Medical School.

^†: Resident in Anesthesia.

View full text

Original contributionTotal-body oxygen consumption after isoflurane anesthesia: Effects of mild hypothermia and combined epidural-general anesthesia

Abstract

Br J Anaesth

Br J Anaesth

J Clin Anesth

Br J Anaesth

Changes in ventilation, oxygen uptake, and carbon dioxide output during recovery from isoflurane anesthesia

Anesthesiology

Effect of meperidine on oxygen consumption, carbon dioxide production, and respiratory gas exchange in postanesthesia shivering

Anesth Analg

Oxygen uptake during recovery following naloxone. Relationship with intraoperative heat loss

Anesthesiology

The influence of body temperature on early postoperative oxygen consumption

Surgery

Multivariate determinants of early postoperative oxygen consumption in elderly patients. Effects of shivering, body temperature, and gender

Anesthesiology

Original contribution
Total-body oxygen consumption after isoflurane anesthesia: Effects of mild hypothermia and combined epidural-general anesthesia