Mikael Persson1, Håkan Elmqvist, Jan van der Linden. 1. Division of Medical Engineering, Department of Laboratory Medicine, Karolinska University Hospital, Karolinska Institute, SE-141 86 Stockholm, Sweden.
Abstract
BACKGROUND: Perioperative hypothermia is common in open surgery and is associated with increased rates of wound infection. This is a result of decreased wound tissue oxygenation, which can be normalized by local warming. Recently, a technique has been developed to establish a carbon dioxide atmosphere in an open surgical wound. Therefore, the authors studied the possible "greenhouse effect" of carbon dioxide insufflation and operation lamps on wound temperature. METHODS: In a fully ventilated operating room surface temperature was measured at steady state in a model of an open surgical wound containing blood agar. The wound model was randomized to either no insufflation or insufflation of dry and humidified carbon dioxide or air, respectively, at a flow of 5 l/min via a gas diffuser. The surface temperature was measured with operation lamps switched on and off, respectively. Evaporation rates were also measured. RESULTS: With the operation light off, the surface temperature in the control was 31.8 degrees C, and with the operation light on, the temperature increased by 1.5 degrees C (P < 0.001). Additional insufflation of dry carbon dioxide increased the surface temperature another 1.9 degrees C (P < 0.001). When the carbon dioxide was humidified, the evaporation rate was lowest and the surface temperature increased further to 35.6 degrees C (P = 0.002). In contrast, insufflation of dry and humidified air did not have a significant effect on the evaporation rate and only marginally increased the wound temperature in comparison with the control. CONCLUSIONS: Insufflation of humidified carbon dioxide in combination with light from the operation lamps may help to keep the open wound warm during surgery.
RCT Entities:
BACKGROUND: Perioperative hypothermia is common in open surgery and is associated with increased rates of wound infection. This is a result of decreased wound tissue oxygenation, which can be normalized by local warming. Recently, a technique has been developed to establish a carbon dioxide atmosphere in an open surgical wound. Therefore, the authors studied the possible "greenhouse effect" of carbon dioxide insufflation and operation lamps on wound temperature. METHODS: In a fully ventilated operating room surface temperature was measured at steady state in a model of an open surgical wound containing blood agar. The wound model was randomized to either no insufflation or insufflation of dry and humidified carbon dioxide or air, respectively, at a flow of 5 l/min via a gas diffuser. The surface temperature was measured with operation lamps switched on and off, respectively. Evaporation rates were also measured. RESULTS: With the operation light off, the surface temperature in the control was 31.8 degrees C, and with the operation light on, the temperature increased by 1.5 degrees C (P < 0.001). Additional insufflation of drycarbon dioxide increased the surface temperature another 1.9 degrees C (P < 0.001). When the carbon dioxide was humidified, the evaporation rate was lowest and the surface temperature increased further to 35.6 degrees C (P = 0.002). In contrast, insufflation of dry and humidified air did not have a significant effect on the evaporation rate and only marginally increased the wound temperature in comparison with the control. CONCLUSIONS: Insufflation of humidified carbon dioxide in combination with light from the operation lamps may help to keep the open wound warm during surgery.
Authors: Joana M K Frey; Martin Janson; Monika Svanfeldt; Peter K Svenarud; Jan A van der Linden Journal: World J Surg Date: 2012-11 Impact factor: 3.352
Authors: Laurence Weinberg; Andrew Huang; Daniel Alban; Robert Jones; David Story; Larry McNicol; Brett Pearce Journal: BMC Surg Date: 2017-01-23 Impact factor: 2.102