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To compare the fluid warming capabilities of the Hotline and Flotem IIe devices in surgical patients, and whether warming intravenous (i.v.) fluids with the Hotline device resulted in less hypothermia and less need for other warming methods compared with the Flotem IIe device.Part 1. Prospective, nonrandomized. Part 2. Prospective, randomized.Teaching hospital, tertiary care center.Part 1. 24 adult patients undergoing elective surgery. Part 2. 49 adult patients scheduled for major elective orthopedic or gynecologic surgery of greater than 2 hours' duration with general anesthesia.Part 1. Insertion of sterile in-line thermistors along the path of fluids delivered using the Hotline or Flotem device. Part 2. Patients were randomly assigned to receive i.v. fluids via the Hotline (n = 21) or Flotem IIe (n = 18) warmers. Intervention for core hypothermia [lower esophageal temperature (Teso) less than 35.5 degrees C], was with forced air warming. Intervention for postoperative shivering was with meperidine by a nurse who was blinded to the treatment group.Part 1. Temperature of infused fluids before and after the warmer (T in and T out) and before the fluid entered the patient after insertion of a standard 84 cm extension set having a stopcock for injection of medications (T distal). Part 2. Tympanic (Ttym) was recorded before induction of anesthesia (baseline) and at 15-minute intervals after induction. Teso was recorded at 15-minute intervals after induction. The maximum intraoperative Ttym decline from baseline (delta Ttym max) was calculated.Part 1. Flow rates were between 1 and 33 ml/min. T out and T distal (mean +/- SEM) of fluids infused through the Hotline device were warmer compared with those infused via the Flotem IIe device (Hotline T out: 35.7 +/- 0.1 degrees C and Hotline T distal: 33.4 +/- 0.2 degrees C vs. Flotem IIe T out: 28.9 +/- 0.2 degrees C and Flotem IIe T distal: 28.3 +/- 0.2 degrees C; p0.001 between warmers). Part 2. Maximal decrease in Ttym from preoperative baseline (before intervention) was greater in the Flotem IIe compared with the Hotline group (delta Ttym max = -1.4 +/- 0.1 vs. -0.9 +/- 0.1 degree C, p = 0.01). Five patients in the Flotem IIe group required forced air warming for treatment of hypothermia versus none in the Hotline group (p0.01). Postoperatively, five patients in the Flotem IIe group required treatment with meperidine for severe shivering versus one patient in the Hotline group (p0.05).The Hotline device delivered fluids to the patient at consistently warmer temperatures compared with the Flotem IIe device during actual clinical conditions. This was associated with maintenance of near normal core temperatures throughout the procedure in the Hotline group, and a decreased need for interventions such as forced-air warming and treatment for severe shivering. more...

To determine the influence of anesthetic technique and primary drug on operating room (OR) exit time (time between end of surgery until time patient exists the OR) after addition of desflurane to the hospital formulary.Prospective study.Ambulatory surgery unit of a university hospital.1,568 outpatients requiring anesthesia.Addition of desflurane to the hospital formulary, and substitution of desflurane vaporizers for enflurane vaporizers in the ambulatory surgery unit.The following information was recorded for all anesthetic encounters over a six-month time interval: demographics, duration of surgery, primary anesthetic technique, primary anesthetic drug, and exit times. General anesthesia was used in 907 patients [desflurane: 209 patients, isoflurane: 429 patients, halothane: 192 patients, propofol: 72 patients, other intravenous (i.v.): 5 patients], major conduction anesthesia (spinal and epidural) in 43 patients, peripheral nerve blocks in 90 patients, and i.v. sedation in 528 patients. The exit time was significantly greater (0.05) in patients who received general anesthesia (mean +/- SEM 14 +/- 0.2 min) compared with spinal/epidural (8 +/- 0.7 min), nerve blocks (8 +/- 0.4 min) and i.v. sedation (7 +/- 0.2 min). Exit times were longer in older patients receiving general anesthesia (exit time = 12.3 + 0.04 x age, SE = 6.7 min, p0.0009), whereas exit times were shorter in older individuals receiving i.v. sedation (exit time = 8.97 - 0.038 x age, SE = 3.6 min, p0.0001). For patients receiving i.v. sedation, exit times were shorter as duration of surgery increased (exit time = 7.86 - 0.015 x duration of surgery, SE = 3.6 min, p0.0002). Primary anesthetic drug did not affect exit times.Regional anesthesia and i.v. sedation were associated with faster OR exit times compared with general anesthesia. Despite desflurane's shorter elimination kinetics and recovery characteristics, use of this drug did not result in shorter exit times. more...