Does Laminar Airflow in the Operating Room During Total Knee Arthroplasty Lead to More Perioperative Hypothermia Compared to Conventional Airflow?: A Randomized Clinical Trial

Year 2024, Volume: 8 Issue: 2, 134 - 143, 27.08.2024

Recai Dağlı , Fatma Çelik , Mehmet Yetiş , Zafer Ünveren

https://doi.org/10.46332/aemj.1288834

Abstract

Purpose: Spinal anesthesia disrupts the body's thermoregulatory response, often leading to undesired perioperative hypothermia (<36ºC), especially in major surgeries such as total knee arthroplasty (TKA). In operating rooms with a laminar airflow system (LAS-OR), the airflow direction differs from conventional airflow systems (CAS-OR) by being directed directly onto the surgical table. The aim of this study is to answer the question, "Does laminar airflow in the operating room during total knee arthroplasty lead to more perioperative hypothermia compared to conventional airflow?"

Materials and Methods: This study is a prospective, randomized controlled trial. Patients were divided into two groups, Group L (operated in LAS-OR) (n=110) and Group C (operated in CAS-OR) (n=110), using simple randomization with sealed envelope method. The frequencies of perioperative hypothermia (IPH) were compared between the groups. (Clinical trial registration number/date: IRCT20180324039145N4 / 2018.10.31)

Results: In Group L, data from 94 patients and in Group C, data from 89 patients were evaluated. During TKA, the frequency of perioperative hypothermia (IPH) was 56.8% (104 out of 183 patients), with no statistical difference found between Group L and Group C (62.8% (59 out of 94 patients) vs. 50.6% (45 out of 89 patients), p=0.096). At the 105th minute, Group L experienced a temperature decrease of 0.76 (±0.47) ºC (95% CI: 0.61 to 0.91), whereas Group C had a temperature decrease of 0.74 (±0.51) ºC (95% CI: 0.58 to 0.90), with no significant difference observed (p=0.823).

Conclusion: There is no difference in the frequency of perioperative hypothermia (IPH) between operating rooms with laminar and conventional airflow during total knee arthroplasty under spinal anesthesia.

Keywords

intraoperative hypothermia, knee arthroplasty, laminar airflow, spinal anaesthesia, patient safety

Total Diz Artroplastisi Sırasında Ameliyathanedeki Laminar Havaakımı Klasik Havaakımından Daha Fazla Perioperatif Hipotermiye Neden Olur Mu? Randomize Klinik Araştırma

Abstract

Amaç: Spinal anestezi vücudun termoregülatuar yanıtını bozar, sıklıkla özellikle total diz artroplastisi (TKA) gibi major cerrahilerde istenmeyen perioperatif hipotermi (İPH) (<36ºC) gelişmesine neden olur. Laminar havaakım sistemli ameliyat odalarındaki (LAS-OR) hava akımının yönü, konvensiyonel havaakım sistemli ameliyat odalarındakinin (CAS-OR) aksine, doğrudan ameliyat masasına doğrudur. Bu araştırmadaki amacımız “ Total diz artroplastisi sırasında ameliyathanedeki laminar havaakımı klasik havaakımından daha fazla perioperatif hipotermiye neden olur mu?” sorusunu cevaplamaktır.

Araçlar ve Yöntem: Bu çalışma prospektif, randomize kontrollü bir araştırmadır. Hastalar grup L (LAS-OR’ da ameliyat edilenler) (n=110) ve grup C (CAS-OR’da ameliyat edilenler) (n=110) basit randomizasyonla, kapalı zarf metodu kullanılarak iki gruba ayrıldı. İPH frekansları karşılaştırıldı. (Clinical trial kayıt numarası/tarih: IRCT20180324039145N4 / 2018.10.31)

Bulgular: Grup L’de 94 hastanın grup C’de 89 hastanın verileri değerlendirildi. TKA sırasında İPH frekansı %56.8 ‘iken (183 hastanın 104’ünde), grup L ve grup C arasında istatiksel fark bulunmamıştır ( %62.8(94 hastanın 59’u) & %50.6 (89 hastanın 45’i), p=.096). Yüz beşinci dakikada, grup L’de 0.76 (±0.47) ºC (95%CI (0.61 to 0.91)) sıcaklık azalması varken buna karşı grup C’de 0.74 (±0.51) ºC ( 95%CI (0.58 to 0.90), p=.823) sıcaklık azalması bulunmuştur.

Sonuç: Spinal anestezi altında total diz artroplastisi sırasında laminar ve konvensiyonel hava akımlı odalardaki İPH frekansları arasında fark yoktur.

Keywords

diz artroplastisi, hasta güvenliği, intraoperatif hipotermi, laminar hava akımı, spinal anestezi

References

• 1. Sessler DI. Complications and treatment of mild hypothermia. Anesthesiology. 2001;95(2):531-543.
• 2. Riley C, Andrzejowski J. Inadvertent perioperative hypothermia. BJA Education. 2018;18(8):227-233.
• 3. Billeter AT, Hohmann SF, Druen D, Cannon R, Polk HC, Jr. Unintentional perioperative hypothermia is associated with severe complications and high mortality in elective operations. Surgery. 2014;156(5):1245-1252.
• 4. ASA(CSPP). Standards for Basic Anesthetic Monitoring. https://www.asahq.org/standards-and-guidelines/standards-for-basic-anesthetic-monitoring. Accessed date 03 January, 2021,2020.
• 5. TARS. The Turkish Anaesthesiology and Reanimation Society Guidelines for the prevention of inadvertent perioperative hypothermia. Turk J Anaesthesiol Reanim. 2013;41(5):188-190.
• 6. Allen MW, Jacofsky DJ. Normothermia in Arthroplasty. J Arthroplasty. 2017;32(7):2307-2314.
• 7. Scholten R, Leijtens B, Kremers K, Snoeck M, Koeter S. The incidence of mild hypothermia after total knee or hip arthroplasty: A study of 2600 patients. J Orthop. 2018;15(2):408-411.
• 8. Frisch NB, Pepper AM, Rooney E, Silverton C. Intraoperative Hypothermia in Total Hip and Knee Arthroplasty. Orthopedics. 2017;40(1):56-63.
• 9. Hart SR, Bordes B, Hart J, Corsino D, Harmon D. Unintended perioperative hypothermia. Ochsner J. 2011;11(3):259-270.
• 10. Cannistraro G, Cannistraro M. Hypothermia Risk, Monitoring and Environment Control in Operating Rooms. Int. J. Heat Technol. 2016;34(2):165-171.
• 11. Weiser MC, Moucha CS. Operating-Room Airflow Technology and Infection Prevention. J Bone Joint Surg Am. 2018;100(9):795-804.
• 12. Kirkbride DA, Buggy DJ. Thermoregulation and mild peri‐operative hypothermia. Bja Cepd Reviews. 2003;3(1):24-28.
• 13. Yang L, Huang CY, Zhou ZB, et al. Risk factors for hypothermia in patients under general anesthesia: Is there a drawback of laminar airflow operating rooms? A prospective cohort study. Int J Surg. 2015;21:14-17.
• 14. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-191.
• 15. Deren ME, Machan JT, DiGiovanni CW, Ehrlich MG, Gillerman RG. Prewarming operating rooms for prevention of intraoperative hypothermia during total knee and hip arthroplasties. J Arthroplasty. 2011;26(8):1380-1386.
• 16. Steelman VM, Chae S, Duff J, Anderson MJ, Zaidi A. Warming of Irrigation Fluids for Prevention of Perioperative Hypothermia During Arthroscopy: A Systematic Review and Meta-analysis. Arthroscopy. 2018;34(3):930-942.
• 17. Giuliano KK, Hendricks J. Inadvertent Perioperative Hypothermia: Current Nursing Knowledge. AORN J. 2017;105(5):453-463.
• 18. Toyota K, Sakura S, Saito Y, Ozasa H, Uchida H. The effect of pre-operative administration of midazolam on the development of intra-operative hypothermia. Anaesthesia. 2004;59(2):116-121.
• 19. Sessler DI. Temperature monitoring and perioperative thermoregulation. Review. Anesthesiology. 2008;109 (2):318-338.
• 20. Torossian A, Brauer A, Hocker J, Bein B, Wulf H, Horn EP. Preventing inadvertent perioperative hypothermia. Dtsch Arztebl Int. 2015;112(10):166-172.
• 21. Munday J, Hines SJ, Chang AM. Evidence utilisation project: Management of inadvertent perioperative hypothermia. The challenges of implementing best practice recommendations in the perioperative environment. Int J Evid Based Healthc. 2013;11(4): 305-311.
• 22. Leijtens B, Koeter M, Kremers K, Koeter S. High incidence of postoperative hypothermia in total knee and total hip arthroplasty: a prospective observational study. J Arthroplasty. 2013;28(6):895-898.
• 23. Williams M, El-Houdiri Y. Inadvertent hypothermia in hip and knee total joint arthroplasty. J Orthop. 2018;15(1):151-158.
• 24. Matos JR, McSwain JR, Wolf BJ, Doty JW, Wilson SH. Examination of intra-operative core temperature in joint arthroplasty: a single-institution prospective observational study. Int Orthop. 2018;42(11):2513-2519.
• 25. Calvo Vecino JM, Casans Frances R, Ripolles Melchor J, et al. Clinical practice guideline. Unintentional perioperative hypothermia. Rev Esp Anestesiol Reanim. 2018;65(10):564-588.
• 26. Pei L, Huang Y, Xu Y, et al. Effects of Ambient Temperature and Forced-air Warming on Intraoperative Core Temperature. Anesthesiology. 2018;128(5):903-911.
• 27. Aganovic A, Cao G, Stenstad L-I, Skogås JG. Impact of surgical lights on the velocity distribution and airborne contamination level in an operating room with laminar airflow system. Build Environ. 2017;126:42-53.
• 28. Perez P, Holloway J, Ehrenfeld L, et al. Door openings in the operating room are associated with increased environmental contamination. Am J Infect Control. 2018;46(8):954-956.
• 29. Sessler DI. Temperature monitoring: the consequences and prevention of mild perioperative hypothermia. South. Afr. J. Anaesth. Analg. 2014;20(1):25-31.
• 30. Uścinowicz P, Chludzińska M, Bogdan A. Thermal environment conditions in Polish operating rooms. Building and Environment. 2015;94:296-304.
• 31. Katz JD. Control of the Environment in the Operating Room. Anesth Analg. 2017;125(4):1214-1218.
• 32. Alsved M, Civilis A, Ekolind P, et al. Temperature-controlled airflow ventilation in operating rooms compared with laminar airflow and turbulent mixed airflow. J Hosp Infect. 2018;98(2):181-190.