The effect of body temperature changes on inflammation response and patients’ comfort in patients undergoing laparotomy with general anesthesia

Abstract

Background: Surgery and general anesthesia are responsible for disrupting the normal balance between heat production and loss. Inadvertent perioperative hypothermia is a common complication in patients undergoing surgery with general anesthesia. General anesthestic agents are known to cause suppression of thermoregulatory defense mechanisms during general anesthesia, which results in perioperative hypothermia. Hypothermia carries significant various adverse effects; patients’ discomfort and inflammatory stress response are the two variable which will be studied. Materials and Methods: This is a prospective observational analytic cohort study, conducted in the central operating theater of Sanglah Hospital, Bali over a period of 4 months. We included all eligible patients who underwent elective laparotomy and gave consent to the study. Body temperature was measured in three different locations: axilla, tympanic membrane, and nasopharynx, before, during, and after surgery. We measured C-reactive protein (CRP), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (PLR) before and after the surgery. Patients’ comfort level was obtained using the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) scoring system. Results: A total of 60 patients were included. There was a significant increase of inflammatory markers, CRP, PLR, and NLR, before and after the surgery (P < 0.001), as well as reduced body temperature during surgery (P < 0.01); however, there was no significant relationship between the two (P > 0.05). The changes of body temperature significantly affect patients’ comfort level (P < 0.001), whereas room temperature did not show significant impact on patients’ comfort level. On linear regression, there is no significant correlation between body temperature changes and inflammatory response escalation. The increase of CRP was significantly correlated with gender, women, and blood loss, whereas the increase of PLR was related significantly with blood loss and age. Conclusion: Surgery and general anesthesia are causing hypothermia and escalation of inflammatory response. This study result supports prior publication in which both surgery and general anesthesia are the cause of inadvertent perioperative hypothermia; yet, hypothermia does not induce significant rise in all of inflammatory responses measured in this study. It is believed that the major surgery stress response is the cause of significant increase in inflammatory responses.