The Factors Affecting Body Temperature Changes During Retograde Intrarenal Surgery

Year 2020, Volume: 15 Issue: 3, 207 - 213, 27.10.2020

Vahit Güzelburç , Mustafa Soytaş , M.can Kiremit , Bülent Erkurt , Bülent Altay Kamil Darçın Ziya Akbulut Selami Albayrak

https://doi.org/10.33719/yud.685177

Abstract

Objectives: When compared to other endourologic operations, irrigation fluid with lower flow rate and volume is used during retrograde intrarenal surgery (RIRS). In our study, body temperature changes occurring due to irrigation fluid and factors affecting these were assessed.

Materials and Methods: One hundred and twenty-eight patients were prospectively included in the study. During operations, a standart izotonic irrigation fluid kept in the operating room at 21 °C was used. Active heating was not applied to any patient. Body temperature of patients was measured peripherally before anesthesia induction and before recovery. Relationship of body temperature differences with patient characteristics, operation time, irrigation fluid volüme and stone size was evaluated.

Results: Mean tympanic body temperature was 36,3±0,35°C at the start of operation and 35,8±0,5°C at the end. Post-operative fall in body temperature (0,67±0,47°C) was recorded in 102 patients (79.7%). When body tempertaure values before and after the operation were compared, a significant reduction was found (p<0,0001). No statistically significant correlation was obtained between this reduction and patient and operative data.

Conclusion: Body temperature falls after RIRC however, no relation was found between temperature change and patient and operative data other than operating room temperature.

Keywords

Intraoperative hypothermia , irrigation solutions , retrograde intrarenal surgery , thermoregulation

Retrograd İntrarenal Cerrahi Esnasında Oluşan Vücut Sıcaklık Değişikliklerini Etkileyen Faktörler

Abstract

Amaç: Retrograd intrarenal cerrahi (RIRC) esnasında diğer endoürolojik operasyonlardan farklı olarak daha düşük debi ve hacimde irrigasyon sıvısı kullanılmaktadır. Çalışmamızda kullanılan irrigasyon sıvısına bağlı olarak vücutta oluşan sıcaklık değişiklikleri ve buna etki eden faktörler incelendi.

Gereç ve Yöntemler: Prospektif olarak çalışmaya 128 hasta dahil edildi. Operasyonlarda standart olarak 21°C ameliyathane odasında bulundurulan izotonik irrigasyon sıvısı kullanıldı. Hiçbir hastaya aktif ısıtma uygulanmadı. Hastaların ateşi anestezi indüksiyonu öncesinde ve uyandırma öncesinde periferik yoldan ölçüldü. Ölçülen vücut sıcaklık farklarının hasta özellikleri, operasyon süresi, kullanılan irrigasyon sıvısı hacmi ve taş büyüklüğüyle ilişkisi değerlendirildi.

Bulgular: Operasyona girişte timpanik ortalama vücut sıcaklığı 36,3±0,35°C iken operasyon sonunda 35,8±0,5°C hesaplandı. Hastaların 102’sinde (%79,7) post-op vücut sıcaklık düşüşü (0,67±0,47°C) kaydedildi. Operasyon öncesi ve sonrasındaki vücut sıcaklık değerleri karşılaştırıldığında anlamlı düşüş saptandı (p<0,0001). Bu düşüş ile hasta ve operatif veriler arasında istatistiksel anlamlı bir ilişki saptanmadı.

Sonuç: RIRC sonrasında vücut sıcaklığı düşmektedir ancak ameliyathane oda sıcaklığı dışındaki hasta ve operatif verilerle ateş değişimi arasında ilişki kurulamamıştır.

Keywords

İntraoperatif hipotermi , irrigasyon sıvıları , retrograd intrarenal cerrahi , termoregülasyon

References

• Referans1. Abe R, Etori K, Kato T, Sato K: Experience with transurethral uretero-nephrolithotripsy using flexible nephro-ureteroscope. Nihon Hinyokika Gakkai Zasshi 1990; 81:1667–1674.
• Referans2. Puppo P, Bottino P, Germinale F, Caviglia C, Ricciotti G, Giuliani L: Flexible antegrade and retrograde nephroscopy: review of 50 cases. Eur Urol 1990;17:193–199.
• Referans3. Fuchs GJ, Fuchs AM: Flexible endoscopy of the upper urinary tract. A new minimally invasive method for diagnosis and treatment. Urologe A 1990;29:313–320.
• Referans4. Lim SH, Jeong BC, Seo SI, Jeon SS, Han DH: Treatment outcomes of retrograde intrarenal surgery for renal stones and predictive factors of stone-free. Korean J Urol 2010;51:777–782.
• Referans5. Cansino Alcaide JR, Reinoso Elbers J, López Sánchez D, Pérez González S, Rodriguez, Aguilera Bazán A, Rando Tous A, Hidalgo Togores L, De La Peña Barthel J: Flexible ureterorenoscopy: technique and results. Arch Esp Urol 2010; 63: 862–870.
• Referans6. Resorlu B, Unsal A, Gulec H, Oztuna D: A new scoring system for predicting stone-free rate after retrograde intrarenal surgery: the ‘Resorlu-Unsal stone score’. Urology 2012; 80: 512–518.
• Referans7. Schoenthaler M, Wilhelm K, Katzenwadel A, Ardelt P, Wetterauer U, Traxer O, Miernik A: Retrograde intrarenal surgery in treatment of nephrolithiasis: is a 100% stone-free rate achievable? J Endourol 2012; 26: 489–493.
• Referans8. Oguz U, Resorlu B, Ozyuvali E, Bozkurt OF, Senocak C, Unsal A. Categorizing intraoperative complications of retrograde intrarenal surgery. Urol Int. 2014;92(2):164-8.
• Referans9. Sessler DI, McGuire, J, Moayeri A, Hynson J: Isoflurane-induced vasodilation minimally increases cutaneous heat loss. Anesthesiology 1991;74:226-232.
• Referans10. Bickler P, Sessler DI: Efficiency of airway heat and moisture exchangers in anesthetized humans. Anesth Analg 1990;71:415-418.
• Referans11. Rajeev Singh, Veena Asthana, Jagdish P. Sharma, Shobha Lal. Effect of irrigation fluid temperature on core temperature and hemodynamic changes in transurethral resection of prostate under spinal anesthesia. Anesthesia: Essays and Researches; 8(2); May-Aug 2014.
• Referans12. Moore SS, Green CR, Wang FL, Pandit SK, Hurd WW. The role of irrigation in the during laparoscopic surgery development of hypothermia. Am J Obstet Gynecol. 1997 Mar;176(3):598-602.
• Referans13. Mackowiak PA, Wasserman SS, Levine MM: A critical appraisal of 98,6°F, the upper limit of the normal body temperature, and other legacies of Carl Reinhold August Wunderlich. JAMA 1992; 268:1578–1580.
• Referans14. NICE. Inadvertent perioperative hypothermia: The management of inadvertent perioperative hypothermia in adults. London: National Institute for Health and Clinical Excellence Guideline 65, 2008.
• Referans15. Heier T, Caldwell JE, Sessler DI, Miller RD: Mild intraoperative hypothermia increases duration of action and spontaneous recovery of vecuronium blockade during nitrous oxide-isoflurane anesthesia in humans. Anesthesiology 1991; 74:815-9
• Referans16. Leslie K, Sessler DI, Bjorksten AR, Moayeri A: Mild hypothermia alters propofol pharmacokinetics and increases the duration of action of atracurium. Anesth Analg 1995; 80:1007-14.
• Referans17. Reed L, Johnston TD, Hudson JD, Fischer RP: The disparity between hypothermic coagulopathy and clotting studies. J Trauma 1992;33:465-70
• Referans18. Staab DB, Sorensen VJ, Fath JJ, Raman SBK, Horst HM, Obeid, F N: Coagulation defects resulting from ambient temperature-induced hypothermia. J Trauma 1994;36:634-8
• Referans19. Carli F, Emery PW, Freemantle CAJ: Effect of peroperative normothermia on postoperative protein metabolism in elderly patients undergoing hip arthroplasty. Br J Anaesth 1989;63:276-82
• Referans20. Kurz A, Sessler DI, Narzt E, Bekar A, Lenhardt R, Huemer G: Postoperative hemodynamic and thermoregulatory consequences of intraoperative core hypothermia. J Clin Anesth 1995;7:359-66
• Referans21. Sessler DI: A proposal for new temperature monitoring and thermal management guidelines. Anesthesiology 1998;89:1298–1300.
• Referans22. Yinghui Jin, Jinhui Tian, Mei Sun and Kehu Yang. A systematic review of randomised controlled trials of the effects of warmed irrigation fluid on core body temperature during endoscopic surgeries. J Clin Nurs 2011;20(3-4):305-16.
• Referans23. Bajwa SJ, Gupta S, Kaur J, Singh A, Parmar S. Reduction in the incidence of shivering with perioperative dexmedetomidine: a randomized prospective study. J Anaesthesiol Clin Pharmacol. 2012;28(1):86–91.
• Referans24. Kranke P, Eberhart LH, Roewer N, Tramèr MR. Pharmacological treatment of postoperative shivering: A quantitative systematic review of randomized controlled trials. Anesth Analg 2002; 94:453.
• Referans25. Jamıson s. Jaffe, t. Casey mccullough, rıchard c. Harkaway, and phıllıp c. Gınsberg Effects of ırrıgatıon fluıd temperature on core Body temperature durıng transurethral Resectıon of the prostate.
• Referans26. Roberts S, Bolton DM, Stoller ML. Hypothermia associated with percutaneous nephrolithotomy. Urology. 1994;44(6):832–5.
• Referans27. Lloyd SN, Kirk D, Deane RF, Kyle KF. Effect of percutaneous nephrolithotomy on thermoregulation. Br J Urol. 1992;69(2):132–6.
• Referans28. Mirza S, Panesar S, AuYong KJ, French J, Jones D, Akmal S. The effects of irrigation fluid on core temperature in endoscopic urological surgery. J Perioper Pract. 2007;17(10):494–7.
• Referans29. Morley-Forster PK. Unintentional hypothermia in the operating room. Can Anaesth Soc J 1986; 33:515-28.
• Referans30. Russell D, Royston D, Rees PH, Gupta SK, Kenny GN. Effect of temperature and cardiopulmonary bypass on the pharmacokinetics of remifentanyl. Br J Anaesth. 1997;79(4):456–9.
• Referans31. Zeki Tuncel Tekgul, Sinan Pektas, Umit Yildirim, Yücel Karaman, Meltem Cakmak, Huseyin Ozkarakas, Mustafa Gonullu. A prospective randomized double-blind study on the effects of the temperature of irrigation solutions on thermoregulation and postoperative complications in percutaneous nephrolithotomy
• Referans32. Clemente Ramos LM, Ramasco Rueda F, Platas Sancho A et al. - [Reabsorption syndrome after transurethral resection (TUR) of the prostate: review of physiologic, diagnostic, and therapeutic features]. Actas Urol Esp, 2001;25:14-31.
• Referans33. Karabulut I, Koc E, Yilmaz AH, Ahiskali EO, Keskin E, Adanur S, Resorlu B. Could spinal anesthesia be a choice for retrograde intrarenal surgery. Urologia. 2018;85(4):169-173.
• Referans34. Zeng G, Zhao Z, Yang F, Zhong W, Wu W, Chen W. Retrograde intrarenal surgery with combined spinal-epidural vs general anesthesia: a prospective randomized controlled trial. J Endourol. 2015;29(4):401-5.
• Referans35. Bosio A, Dalmasso E, Alessandria E, Agosti S, Pizzuto G, Peretti D, Palazzetti A, Bisconti A, Destefanis P, Fop F, Gontero P. Retrograde intra-renal surgery under spinal anesthesia: the first large series. Minerva Urol Nefrol. 2018;70(3):333-339.
• Referans36. Leslie K, Sessler DI: Reduction in the shivering threshold is proportional to spinal block height. Anesthesiology 1996;84:1327–1233.
• Referans37. Frank SM, Beattie C, Christopherson R, et al.: Epidural versus general anesthesia, ambient operating room temperature, and patient age as predictors of inadvertent hypothermia. Anesthesiology 1992;77:252–257.
• Referans38. Guzelburc V, Balasar M, Colakogullari M, Guven S, Kandemir A, Ozturk A, Karaaslan P, Erkurt B, Albayrak S. Comparison of absorbed irrigation fluid volumes during retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of kidney stones larger than 2 cm. Springerplus. 2016;5:1707.
• Referans39. Moran DS, Mendal L. Core temperature measurement: methods and current insights. Sports Med. 2002;32:879–85.
• Referans40. Mahoney CB, Odom J. Maintaining intraoperative normothermia: A meta-analysis of outcomes with costs. AANA J 1999;67:155.