If you wish to respond to a paper or other item already published in the BJA, please go to the abstract/full text version of that item and click on the link "E-Letters: Submit a response to the article".
Electronic Letters to:
|
|
E-letters: Electronic letters published:
-
![[Read E-letter]](/icons/misc/sectionDOWN.gif)
Hypothermia during laparotomy can be prevented by locally applied warm water and pulsating negative
- C MARK HARPER (29 May 2007)
|
|
|||
|
C MARK HARPER, Consultant Anaesthetist Brighton and Sussex Universities Hospital
Send letter to journal:
|
Dear Sir, I would like to congratulate Dr Rein and his colleagues on the successful translation of theory into practice in the construction and successful utilisation of their novel warming device.[1] There are however a few issues with their paper that I would like to highlight. First is that of access. Although for straightforward cases this may not be a problem, it appears that the arm in the device cannot be used for intravenous or arterial access or monitoring. Second is the complexity and cost of the system. With regard to the former this seems greater than that of forced-air warming or electric mattresses, and that is likely to translate in commercial production to increased costs. In our institution the forced-air warmer is applied prior to washing and draping, and if necessary even during induction of anaesthesia. This would prevent the extra 0.2 ºC drop found in the warming blanket group. My final point is that nowhere is hypothermia defined. In fact there is no definitive consensus on this matter but the evidence points to a figure of <36 ºC as being associated with higher complication rates [2]. A more clinically relevant end-point would then have been a comparison of the number of patients arriving in recovery with a temperature of <36 ºC. Without an actual definition of peri-operative hypothermia it is not appropriate to conclude that “pulsating negative pressure was significantly better at treating hypothermia.” In the peri-operative period, warming should be (and in this case was) used to prevent hypothermia, but it is not clear from the results as to whether any of the patients (in either arm) actually were hypothermic. Of course it would also be extremely interesting to see how effective this device was at treating hypothermia either in the PACU or the Emergency room. Yours sincerely, C Mark Harper Consultant Anaesthetist mark.harper@doctors.org.uk References: 1. Rein, E.B., et al., Hypothermia during laparotomy can be prevented by locally applied warm water and pulsating negative pressure. Br J Anaesth, 2007. 98(3): p. 331-6. 2. Sessler, D.I., Mild perioperative hypothermia. N Engl J Med, 1997. 336(24): p. 1730-7. Conflict of Interest:None declared |
|||