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Background  General (GA)- and epidural-anesthesia may cause a drop in body-core-temperature (BCT drop ), and hypothermia, which may alter tissue oxygenation (StO 2 ) and microperfusion after cytoreductive surgery for ovarian cancer. Cell metabolism of subcutaneous fat- or skeletal muscle cells, measured in microdialysis, may be affected. We hypothesized that forced-air prewarming during epidural catheter placement and induction of GA maintains normothermia and improves microperfusion.    Methods  After ethics approval 47 women scheduled for cytoreductive surgery were prospectively enrolled. Women in the study group were treated with a prewarming of 43 °C during epidural catheter placement. BCT (Spot on®, 3 M) was measured before (T 1 ), after induction of GA (T 2 ) at 15 min (T 3 ) after start of surgery, and until 2 h after ICU admission (T ICU2h ). Primary endpoint was BCT drop  between T 1  and T 2 . Microperfusion-, hemodynamic- and clinical outcomes were defined as secondary outcomes. Statistical analysis used the Mann-Whitney-U- and non-parametric-longitudinal tests.    Results  BCT drop  was 0.35 °C with prewarming and 0.9 °C without prewarming ( p  < 0.005) and BCT remained higher over the observation period (ΔT 4  = 0.9 °C up to ΔT 7  = 0.95 °C,  p  < 0.001). No significant differences in hemodynamic parameters, transfusion, arterial lactate and dCO 2  were measured. In microdialysis the ethanol ratio was temporarily, but not significantly, reduced after prewarming. Lactate, glucose and glycerol after PW tended to be more constant over the entire period. Postoperatively, six women without prewarming, but none after prewarming were mechanical ventilated ( p  < 0.001).    Conclusion  Prewarming at 43 °C reduces the BCT drop  and maintains normothermia without impeding the perioperative routine patient flow. Microdialysis indicate better preserved parameters of microperfusion.    Trial registration   ClinicalTrials.gov ; ID:  NCT02364219 ; Date of registration: 18-febr-2015.

bmc anesthesiology

Impact of brief prewarming on anesthesia-related core-temperature drop, hemodynamics, microperfusion and postoperative ventilation in cytoreductive surgery of ovarian cancer: a randomized trial