Forced-air warming maintains normothermia during orthotopic liver transplantation

We evaluated the efficacy of forced-air warming to maintain normothermia during liver transplantation. In a prospective, clinical trial 20 patients were randomly assigned to routine thermal management (circulating-water mattress set at 42 degrees C, intravenous fluid warming to 37 degrees C and passive insulation) or routine management with additional forced-air warming of head, chest, and arms. Core temperature was measured in the pulmonary artery. Morphometric and demographic characteristics were similar in each group, as was total administered fluid volume replacement. Core temperatures in each group decreased by about 0.6 degrees C during the first 70 min of anaesthesia and then by 0.9 degree C within 90 to 120 min in the patients given routine thermal management, but only by 0.4 degree C in those warmed with forced-air. Subsequently, core temperatures in the control group increased to only 35.7, SD 0.25 degree C whereas those in the patients given forced-air warming increased to 36.5, SD 0.2 degree C. Despite the relatively high ambient temperature, patients warmed only with a circulating-water mattress and passive insulation became hypothermic during surgery. In contrast, when forced-air warming was added to this routine thermal management, patients were normothermic at the end of surgery. Forced-air warming prevented intra-operative hypothermia during liver transplantation.