Hypothermia During Laparoscopic Nephrectomy

Abstract

The patient is a 38-year-old female (163 cm, 80 kg, body mass index [BMI] 30) presenting for laparoscopic nephrectomy for the purpose of donating a kidney to a relative. She had no signifi cant past medical history and was taking no medications. Prior to induction, she received 800 mL of normal saline (NS) and 2 mg of mid-azolam while monitors were placed. Following preoxygenation, anesthesia was induced with fentanyl 500 mcg, lidocaine 100 mg, propofol 150 mg, and vecuronium 7 mg. Immediately after induction, the patient's blood pressure dropped from 130/80 to 85/45 mmHg which was treated with an intravenous fl uid bolus of 500 ml NS and 200 mcg of phenylephrine. Intubation proceeded without incident, and the patient was placed in a lateral decubitus position. Over the hour following induction, 4 L of NS and a total of 600 mcg of phenyl-ephrine and 5 mg of ephedrine were given to maintain the blood pressure around 100/50 mmHg. The patient's temperature was also noted at this time to be 34.3 °C (L-1 , L-2 , L-3). Over the next hour, two more liters of NS were given, and the temperature gradually decreased to 33.6 °C (L-1 , L-2 , L-3). A forced-air warming blanket was placed on the patient, and the intravenous (IV) line was also connected to a fl uid warmer at this time (L-4). At the end of the case the patient's temperature was 34.5 °C. The patient was transported to the postanesthetic care unit (PACU) intu-bated. Her temperature rose to 36.0 °C within 30 min and she was extubated uneventfully. Her postoperative course was uncomplicated.