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CARDIOVASCULAR ANESTHESIA

Forced-Air Warming Decreases Vasodilator Requirement After Coronary Artery Bypass Surgery

Hossam K. El-Rahmany, MD^*, Steven M. Frank, MD^*, Giselle M. Schneider, BS, Nader A. El-Gamal, MD, Carole A. Vannier, MD^*, Ramadan Ammar, MD, and Ahmed S. Okasha, MD

*Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland; University of Louisville, School of Medicine, Louisville, Kentucky; and Department of Anesthesiology and Intensive Care, Alexandria University, Alexandria, Egypt

Address correspondence and reprint requests to Steven M. Frank, MD, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Carnegie 280, 600 N. Wolfe St., Baltimore, MD 21287. Address e-mail to sfrank{at}welch.jhu.edu

Postoperative hypothermia is common and associated with adverse hemodynamic consequences, including adrenergically mediated systemic vasoconstriction and hypertension. Hypothermia is also a known predictor of dysrhythmias and myocardial ischemia in high-risk patients. We describe a prospective, randomized trial designed to test the hypothesis that forced-air warming (FAW) provides improved hemodynamic variables after coronary artery bypass graft. After institutional review board approval and written informed consent, 149 patients undergoing coronary artery bypass graft were randomized to receive postoperative warming with either FAW (n = 81) or a circulating water mattress (n = 68). Core temperature was measured at the tympanic membrane. A weighted mean skin temperature was calculated. Heart rate, mean arterial blood pressure, central venous pressure, cardiac output, and systemic vascular resistance were monitored for 22 h postoperatively. Mean arterial blood pressure was maintained by protocol between 70 and 80 mm Hg by titration of nitroglycerin and sodium nitroprusside. The two groups had similar demographic characteristics. Tympanic and mean skin temperatures were similar between groups on intensive care unit admission. During postoperative rewarming, tympanic temperature was similar between groups, but mean skin temperature was significantly greater in the FAW group (P < 0.05). Heart rate, mean arterial pressure, central venous pressure, cardiac output, and systemic vascular resistance were similar for the two groups. The percent of patients requiring nitroprusside to achieve the hemodynamic goals was less (P < 0.05) in the FAW group. In conclusion, aggressive cutaneous warming with FAW results in a higher mean skin temperature and a decreased requirement for vasodilator therapy in hypothermic patients after cardiac surgery. This most likely reflects attenuation of the adrenergic response or opening of cutaneous vascular beds as a result of surface warming.

Implications: Forced-air warming after cardiac surgery decreases the requirement for vasodilator drugs and may be beneficial in maintaining hemodynamic variables within predefined limits.

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