Effects Of CO₂ Pneumoperitioneum In Pediatric Laparoscopic Surgery On Body Temperature

Background In clinical anesthesia,the attention for blood pressure,pulse,respiration and other vital signs is more,and the emphasis on body temperature is less.Pediatrics have a high incidence of hypothermia due to their own anatomical characteristics,therefore,the protection of pediatric intraoperative temperature is an important issue.Recently,the proportion of laparoscopic surgery in children's abdominal surgery has gradually increased,while laparoscopic surgery has its own particularities compared to conventional laparotomy,therefore,the management should pay attention to body temperature,prevent hypothermia while avoid excessive heat in pediatric laparoscopy.There are many studies on warming pneumoperitoneum in adult surgery,while the effect of warming pneumoperitoneum in laparoscopic pediatric surgery is not clear.Objective This experiment is aimed at pediatric laparoscopic surgery,we use warming pneumoperitoneum or fan heater to insulate the child,observe the effect of different thermal insulation measures and the impact on children's heart rate and comfort.Method We selected 120 children who underwent laparoscopic surgery in our hospital from February 2018 to June 2018,the age of the children ranged from 6 months to 6 years.They were randomly divided into a conventional insulation group,forced-air warming group and warming pneumoperitoneum group.After entering the operating room,children use the same basic insulation measures,including adjusting the room temperature at 24 ?,use 37 ° C rinse solution and disinfectant and cover the same number of surgical towel.Based on this,the conventional insulation group uses a conventional pneumoperitoneum machine and the temperature of CO₂ pneumoperitoneum is 21 ?;The warming pneumoperitoneum group uses a warming pneumoperitoneum machine and the temperature of CO₂ pneumoperitoneum is 38 ?;The forced-air warming group uses conventional pneumoperitoneum machine while turning on the heater with a temperature of 38 ?.Record the children's body temperature and heart rate at the time of admission to the operating room?T1?,establishment of pneumoperitoneum?T2?,establishment of pneumoperitoneum for 0.5h?T2?,and end of surgery?T4?.At the same time,record the preoperative temperature,age,body surface area,body weight,comfort and length of operation for three groups,meanwhile the incidence of hypothermia,postoperative shivering and postoperative sweating during the operation were recorded.Result 1.There was no significant difference in preoperative temperature,age,weight,body surface area,length of operation,number of cases of hypothermia and sex ratio among the three groups of children?P>0.05?.2.Temperature comparison between groups,thetemperature of children in the conventional insulation group is lower than warming pneumoperitoneum group and forced-air warming group at the time of T3 and T4,the difference was statistically significant?P<0.05?.There was no significant difference in body temperature between the warming pneumoperitoneum group and forced-air warming group at various time points from entering the operating room?T1?to the end of the operation?T4??P>0.05?.Comparison within groups,in the conventional insulation group,the body temperature at T3 and T4 was lower than the body temperature at T1.In the warming pneumoperitoneum group and forced-air warming group,the body temperature at T4 was higher than the body temperature at T1-T3,the difference was statistically significant?P<0.05?.3.Heart rate comparison between groups,at the end of the operation,the heart rate of the warming pneumoperitoneum group was slower than the conventional insulation group and the forced-air warming group,the difference was statistically significant?P<0.05?.Comparison within groups,at the time of anesthesia induction,the heart rate of the three groups was slower than when entering the room,and the difference was statistically significant?P<0.05?.At the end of the surgery,the heart rate of the conventional insulation group and the forced-air warming group is faster than the heart rate of admission to the operating room,and the difference was statistically significant?P<0.05?.4.Comparison of adverse reactions and comfort,the number of postoperative shivering in the conventional insulation group was higher than other two groups,and the incidence of postoperative sweating in the forced-air warming group was higher than the other two groups.The EDIN score of warming pneumoperitoneum group at the time of leaving the PACU was lower than the conventional insulation group and the forced-air warming group,and the differences were statistically significant?P <0.05?.Conclusion In pediatric laparoscopic surgery,it is necessary to take insulation measures to prevent intraoperative hypothermia.Among them,warming pneumoperitoneum can avoid lowering body temperature,at the same time,it is conducive to maintain a stable rate in children,reduce the stimulation of the pneumoperitoneum to the body and improve the perioperative comfort,so as to protect the perioperative safety of the children.