A prospective randomized study of the efficacy of continuous active warming in patients undergoing laparoscopic gastrectomy

A prospective randomized study of the efficacy of continuous active warming in patients undergoing laparoscopic gastrectomy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article A prospective randomized study of the efficacy of continuous active warming in patients undergoing laparoscopic gastrectomy Mengjia Luo, Xiangying Feng, Yanran Dai, Yujie Wang, Xin Guo, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4785274/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Despite evidence has shown that the core temperature below 36℃ under surgery would lead to a sequence of adverse complications, and active warming measures are taken in order to reduce the incidence of the intraoperative hypothermia, core temperature disturbance during laparoscopic gastrectomy is common. The purpose of this research was to determine if a significant difference between continuous active warming (CAW) and active warming when body temperature is below 36℃ (BAW) in terms of incidence of intraoperative hypothermia and clinical rehabilitation in patients undergoing laparoscopic gastrectomy surgery. Patients assigned to CAW group were warmed immediately since the surgical incision procedure, the others were warmed while the body bladder temperature dropped to 36℃. The bladder temperature of the patient was recorded every 30 minutes during the operation. The primary outcome was the incidence of intraoperative hypothermia. Secondary outcomes included presence of shivering and agitation after operation, the time from end of surgery to tracheal extubation, postoperative pain score, the time to first postoperative flatus, postoperative complications, and the inflammatory markers. The overall incidence of hypothermia was 16.13% in 62 patients who underwent elective total laparoscopic radical gastrectomy. The incidence of shivering and agitation after operation was both 3.23% in CAW group, and it was 32.26% and 29.03% in BAW group. Time from end of surgery to tracheal extubation in CAW group was significantly lower than BAW group. In addition, continuous active warming could shorten time to first postoperative flatus of patients and relieve postoperative pain. In general, continuous active warming in patients undergoing laparoscopic gastrectomy decreased the incidence of intraoperative hypothermia and contributed to postoperative rehabilitation. Clinical trial registration: Registered at Chinese Clinical Trial Registry (ChiCTR) on 20/07/2024. Biological sciences/Cancer/Gastrointestinal cancer/Gastric cancer Health sciences/Health care Health sciences/Medical research/Study design/Randomized controlled trials Figures Figure 1 Figure 2 Introduction Normally, the body core temperature is jointly regulated by the hypothalamic thermoregulatory center and the neurohumour, in order to maintain a dynamic balance between the heat production and dissipation [1] . However, autonomic thermoregulation has been upsetted and the threshold for vasoconstriction or tremors have been descreased by the application of anesthetic drugs under general anesthesia(GA) [2] . In addition, the risk factors including the duration of surgery, a significant portion of patient’s surface area is exposure to the cold ambient environment of operation rooms (ORs), the volume of intravenous fluid or irrigation and the patient’s nutritional status are by far the most common reasons of the core temperature disturbance. Thus, intraoperative hypothermia is the most widespread complication undergoing long-duration surgeries, especially the abdominal surgery. Intraoperative hypothermia, defined as the core temperature below 36℃ during the surgery, the incidence up to 25%~70% [3, 4] . According to the degree of decrease, it can be classified as mild (35.5 ~ 35.9℃), moderate (35.0 ~ 35.4℃) and severe (< 35.0℃) [5] . Gastric cancer is the fifth most common cancer worldwide and the third most common cause of cancer death [6] . At present, China as the biggest developping country, gastric cancer has the third highest incidence and mortality of all cancer types, accounting for 44.0% of new cases and 48.6% of gastric cancer-related deaths worldwide, respectively [7] . Nowadays, laparoscopic gastrectomy (LG) has shown a series of advantages over open gastrectomy (OG) in treatment of gastric cancer in view of the implemented gradually of Enhanced Recovery after Surgery (ERAS) protocols [8] . The studies report that laparoscopic gastrectomy can reduce the loss of blood, decrease the analgesic dosage, shorten the first defecation time and et al. [9–11] , in the meantime, there is no significant difference in overall survival rate, death related to gastric cancer and death due to other causes [12] . However, dry and cold carbon dioxide (CO 2 ) insufflation in laparoscopic gastrectomy results in increasing the incidence of intraoperative hypothermia [13] . Evidence has shown that the core temperature below 36℃ under surgery would lead to cardiovascular adverse events, prolonged recovery time of general anethesia, increased infection rate of incisions, and a sequence of other complications [14] . These complications can be catastrophic for patients undergoing laparoscopic gastrectomy [15] . Active warming measures are often taken by the OR staff in order to reduce the incidence of the intraoperative hypothermia, with preventing the redistribution of heat from core to periphery. However, the Randomized Controlled Trial (RCT) studies on the effectiveness of continuous active warming during laparoscopic gastrectomy is scarce. Therefore, we hypothesized that continuous active warming (CAW) will be superior than active warming when body temperature is below 36℃ (BAW) in terms of decreasing the incidence of intraoperative hypothermia. As secondary objectives included presence of shivering and agitation after operation, the time from end of surgery to tracheal extubation, postoperative pain score, the time to first postoperative flatus, postoperative complications, and the inflammatory markers. Materials and methods Subjects. This trial was a prospective randomized controlled study designed to explore the best strategy for the prevention measure of intraoperative hypothermia, and it was permitted by the Ethics Committee of Xijing Hospital, Air Force Military Medical University, China(reference NO. KY20202116-C-1). Meanwhile, it was rigistered at Chinese Clinical Trial Registry (ChiCTR) on 20/07/2024. This study strictly abided by all legal requirements, regulations and general principles formulated by international agencies concerning ethical conduct in human biomedical research and by the Declaration of Helsinki and the International Ethical Guidelines for Biomedical Research Involving Human Beings. The original protocol was complied strictly by the trial and it could be obtained from the authors upon request. 62 participants were enrolled in the clinial study who underwent elective total laparoscopic radical gastrectomy from November 2021 to March 2022 in the Department of Gastrointestinal Surgery in our hospital. These patients aged 39 to 83 years, with a median age of 63 years, included 52 males and 10 female. The patients with aged 18 to 85 years, ASA physical classification score Ⅰ to Ⅲ grades (ASA score was assessed by the American Society of Anesthesiologists Physical Status Classification Scale [16] ), preoperative temperature > 36℃ were included. We excluded patients with preoperative temperature > 37.5℃, duration of surgery below 1 h, emergency surgery, suffer from hyperthyroidism or hypothyroidism. In addition, the exclusion of criteria included that the treatment changed to open radical gastrectomy and the patients were transfered to intensive care unit (ICU). A sample size was based on the data from our retrospective and observational study, the incidence of the intraoperative hypothermia in which non-continuous active warming patients was 40%, and we assumed that the incidence of continuous active warming patients was 5%. In order to detect the difference between the two groups in bladder temperature, 30 patients had to be recruited in each group with an alpha level of 0.05 and 0.9 power. (Fig. 1 ). Intervention. A computer-generated randomized number approach was used to allocate patients into two groups, continuous active warming group (CAW) and active warming when body temperature was below 36℃ group (BAW). Furthermore, patients were blinded by numbered, sealed, opaque envelopes prepared by a study group member a day in advance. The risks and benefits of the study were explained to the patients by doctors and obtained informed consent before proceeding. The operating room temperature was adjusted to 22 ~ 25℃, and the humidity was 40%~60% in advance. An effective and safe venous channel was established for patients and intravenous infusion of sodium lactate ringer injection was given at 37 ~ 41℃ once in the operation rooms. The patient was covered with a large surgical sheet and cotton quilt, and the shoulder pad was placed. The abdominal irrigation fluid was heated to 37 ~ 41℃ during the operation. A No. 14 urethral catheter with temperature monitoring probe was inserted into the urethra immediately after the patient underwent general anesthesia. The bladder temperature of the patient was continuously monitored during the operation and used as the core body temperature. As well as, the air outlet pipe of the inflatable thermal blanket was placed between the two layers of shoulder pads before the operation. Significantly, patients assigned to CAW group were warmed immediately since the surgical incision procedure, the others were warmed while the body bladder temperature dropped to 36℃. The temperature was set at 44℃, and the heating machine was stopped when the body temperature rose to 37.5℃. The bladder temperature of the patient was recorded every 30 minutes during the operation, in the meantime, abnormal conditions such as sweating were observed and appropriate treatment was taken at any time. Anesthetic induction and temperature monitoring. Due to the guidance of enhanced recovery after surgery (ERAS), all patients who underwent laparoscopic radical gastrectomy quit smoking for two weeks before surgery, and gastric tube or enema treatment were no longer taken before surgery. Patients were required preoperative fasting for 8 hours, and water abstinence for 4 hours before surgery to minimise the risk of pulmonary aspiration of gastric contents. During the anaesthesia procedure, left upper extremity venous puncture and invasive arterial puncture were performed for the sake of monitoring vital signs. All patients were administered by intravenous anesthesia, dexamethasone 0.15 ~ 0.2 mg/kg, sufentanil 0.4 ~ 0.6 µg/kg, etomidate 0.2 ~ 0.3 mg/kg, rocuronium bromide 0.9 mg/kg were conducted during induction phase of anesthesia. Tracheal intubation was performed with the a visual laryngoscope, and a 7.5 tracheal catheter was routinely used for men and a 7 tracheal catheter for women. Target-controlled infusion of propofol was used for 2 ~ 3 µg/ml, and remifentanil was used for constant rate infusion of 0.1 ~ 0.2 µg/kg/min during maintenance phase of anesthesia. Timely and accurate treatment while the patient's vital signs fluctuated during the whole procedure. The first body bladder temperature (T0) as the baseline temperature was recorded while the patient's urinary tube was inserted at the induction stage of anethesia. Then, temperature at the start of surgery was considered as T1. Next, temperature was recorded every 30 minutes until 3 hours after surgery (T2 ~ T8), as well as patients were transferred to PACU after surgery (T9). Variables and statistics. SPSS Statistics Software 27.0 (IBM, New York) was used to analyse the data. Count data were represented by example (n) or percentage (%), and measurement data were represented by mean ± standard deviation (¯x ± s). General data were analyzed by t -test, chi-square test according to the data type or Fisher's exact test when the frequency was < 5. One-way ANOVA and ANOVA with repeated measures were used for comparisons between multiple groups, independent samples t -test for pair-wise comparisons, and non-parametric tests was used when homogeneity of variance was not met. P < 0.05 indicated a statistical significance. In this study, the independent variable was the various heating methods ( CAW, BAW), the dependent variable was the patients’ core temperature. Age (years), body mass index (kg/m 2 ), ambient temperature (℃), duration of surgery (mins), flushing fluid (ml), volume of crystalloid administered (ml), volume of colloidal administered (ml), hemoglobin (g/L), albumin(g/L) were all continuous variables, the categorical variables were gender (male/female) and the grade of ASA (Ⅰ, Ⅱ, Ⅲ). Result 3.1 Comparison of patient’s characteristics between the two groups A total of 80 patients undergoing elective total laparoscopic radical gastrectomy were eligible for the study, of whom 18 were excluded. Thus, 62 patients were randomised, as demonstrated in Fig. 1 . The patient’s characteristics including age, body mass index (BMI), ambient temperature, duration of surgery, flushing fluid, volume of crystalloid administered, volume of colloidal administered, hemoglobin, albumin, gender and the grade of ASA were comparable between the two groups. (Table 1 ). Table 1 Patient characteristics (n = 62). Characteristic groups χ 2 / t P CAW(n = 31) BAW(n = 31) Gender 0.000 1.000 male 26 26 female 5 5 Grade of ASA 1.217 0.544 Ⅰ 0 1 Ⅱ 28 26 Ⅲ 3 4 Age (years) 62.52 ± 8.15 62.74 ± 9.20 -0.102 0.919 BMI (kg/m 2 ) 23.60 ± 2.65 25.66 ± 5.70 -1.824 0.073 Ambient temperature (℃) 24.00 ± 0.82 23.97 ± 0.85 0.154 0.878 Duration of surgery (mins) 356.74 ± 551.05 250.48 ± 61.49 1.067 0.290 Flushing fluid (ml) 948.39 ± 699.46 848.39 ± 717.34 0.556 0.580 Volume of crystalloid administered (ml) 2054.84 ± 608.19 2022.58 ± 492.42 0.230 0.819 Volume of colloidal administered (ml) 698.71 ± 322.78 635.48 ± 256.32 0.854 0.396 Hemoglobin (g/L) 135.00 ± 22.88 143.55 ± 23.44 -1.453 0.151 Albumin (g/L) 44.54 ± 3.85 44.56 ± 3.18 -0.029 0.977 3.2 Comparison of core temperature at different time points between the two groups Initially, there was no significant difference between the CAW group and the BAW group at the T0, T1, T2 ( P > 0.05). One hour after the surgery, the core temperature of the CAW group showed a continuous rising trend until patients were transfered to ward. Besides, the core temperature at each time point was higher than the baseline of the patient. Howerver, a downward trend was showed at one hour after the surgery in the BAW group, and the minimum was reached at 3 hours of surgery, although it rose slightly at end of the operation. There was a significant difference between the two groups when we comparing the core temperature in the 1 hour after the operation( P < 0.05). (Fig. 2 ). Furthermore, according to the analysis of repeated measures ANOVA, the sphericity test results showed Machly W < 0.001, P < 0.001, did not fit the spherical test. Therefore, the corrected results in the "Greenhouse-Geisser" are more reliable in the study. Table 2 shows that from the beginning of the operation to 60 min (T0 ~ T2) after the operation, there was no significant difference in the two groups ( P > 0.05). However, since 90 min (T3) after the operation, the core temperature of the CAW group was significantly higher than BAW group ( P < 0.05). Table 2 Core temperature at different time points in two groups from repeated measures model (n = 62) Time CAW group (M ± SD) BAW group (M ± SD) Repeated measures F test F P ɧ2 T0 36.50 ± 0.40 36.55 ± 0.37 T1 36.63 ± 0.38 36.56 ± 0.35 T2 36.71 ± 0.34 36.53 ± 0.42 T3 36.71 ± 0.34 36.46 ± 0.43 T4 36.77 ± 0.34 36.42 ± 0.40 T5 36.83 ± 0.35 36.40 ± 0.41 T6 36.90 ± 0.37 36.43 ± 0.45 T7 36.97 ± 0.39 36.47 ± 0.45 T8 37.06 ± 0.36 36.52 ± 0.46 T9 37.13 ± 0.35 36.59 ± 0.44 Group main effect 16.52 < 0.001 0.22 Time main effect 10.85 < 0.001 0.15 Group*Time 10.84 < 0.001 0.15 3.3 Comparison of the incidence of hypothermia versus time between the two groups The overall incidence of hypothermia was 16.13% in our study. Among them, the incidence of hypothermia in the BAW group was 32.26%, and none of the patient developed hypothermia in the CAW group. Table 3 shows that the incidence was increasing from the beginning of the operation (T1), until up to 22.58%. Table 3 Incidence of hypothermia versus time between the two groups (n = 62) Time CAW group (H/N) BAW group (H/N) P T0 0/31 0/31 — T1 0/31 1/30 1.000* T2 0/31 5/26 0.053* T3 0/31 5/26 0.053* T4 0/31 5/26 0.053* T5 0/31 7/24 0.011* T6 0/31 6/25 0.024* T7 0/31 7/24 0.011* T8 0/31 5/26 0.053* T9 0/31 4/27 0.113* Table annotation: H, Number of patients of hypothermia; N, Number of patients of normal temperature; * Fisher’s test。 3.4 Comparison of the recovery quality after surgery between the two groups The incidence of shivering and agitation after operation was both 3.23% in CAW group, accordingly, it was 32.26% and 29.03% in BAW group, respectively. Time from end of surgery to tracheal extubation in CAW group was significantly lower than BAW group. In addition, continuous active warming could shorten time to first postoperative flatus of patients and relieve postoperative pain, but had no effect on decreasing the incidence of postoperative complications. These results of the recovery quality after surgery are shown in Table 4 . Table 4 The recovery quality after surgery between the two groups CAW group BAW group χ 2 / t P Grade of shivering — 0.006* 0 30 21 1 1 3 2 0 3 3 0 4 Grade of agitation — 0.012* 0 30 22 1 0 5 2 1 3 3 0 1 Postoperative complications — 0.053* Anastomotic leakage 0 3 Gastroparesis 0 1 Intestinal intussusception 0 1 Time to extubation(min) 11.81 ± 8.07 22.68 ± 8.44 5.185 < 0.001 Immediate postoperative pain score 4.45 ± 1.21 5.52 ± 1.48 3.103 0.003 Time to first postoperative flatus (d) 3.23 ± 0.81 5.55 ± 2.87 4.334 < 0.001 Table annotation: * Fisher’s test。 3.5 Comparison of the inflammatory markers of perioperative period Inflammatory markers including PT, APTT, IL-6, SAA, hs-CRP, and PCT in the study. Table 5 shows that levels of the inflammatory markers in preoperative period were comparable. Table 6 and Table 7 show that the parameters displayed a significant surge on the postoperative day, followed by a marginal decline on the 3 day after surgery, yet they remained elevated above baseline levels. Table 5 Preoperative inflammatory markers CAW group BAW group t P PT(s) 11.92 ± 1.13 12.53 ± 1.38 1.850 0.068 APTT(s) 28.49 ± 7.19 31.45 ± 5.94 1.769 0.082 IL-6(pg/ml) 5.45 ± 3.12 9.25 ± 15.45 1.343 0.184 SAA(mg/L) 5.66 ± 5.12 5.31 ± 3.59 -0.316 0.753 hs-CRP(mg/L) 1.97 ± 1.44 1.87 ± 1.87 -0.252 0.802 PCT(ng/ml) 0.04 ± 0.01 0.04 ± 0.03 0.564 0.575 Table 6 Inflammatory markers on 1 day after surgery CAW group BAW group t P PT(s) 12.66 ± 0.56 14.40 ± 1.02 8.317 < 0.001 APTT(s) 35.36 ± 2.40 37.65 ± 3.93 2.768 0.007 IL-6(pg/ml) 55.76 ± 38.32 75.56 ± 32.67 2.189 0.032 SAA(mg/L) 232.99 ± 223.10 384.06 ± 232.21 2.612 0.011 hs-CRP(mg/L) 42.71 ± 36.50 69.71 ± 25.77 3.365 0.001 PCT(ng/ml) 0.31 ± 0.29 0.54 ± 0.31 2.886 0.005 Table 7 Inflammatory markers on 3 day after surgery CAW group BAW group t P PT(s) 12.25 ± 0.56 13.65 ± 0.87 7.539 < 0.001 APTT(s) 34.09 ± 5.62 36.40 ± 3.08 2.010 0.049 IL-6(pg/ml) 35.55 ± 33.85 60.70 ± 38.04 2.750 0.008 SAA(mg/L) 276.75 ± 135.88 392.92 ± 212.56 2.564 0.013 hs-CRP(mg/L) 52.60 ± 35.23 72.82 ± 37.23 2.197 0.032 PCT(ng/ml) 0.21 ± 0.24 0.40 ± 0.43 2.187 0.033 Discussion The high incidence of intraoperative hypothermia is an important cause of morbidity in various types of cancer surgeries , and an independent risk preditor for the overall survival of cancer patients [17] . Actually, the incidence of intraoperative hypothermia of radical tumor resection is still high, the possible reason is considered that operators spend more time in lymph node dissection, complying with the principle of no-touch and block resection in order to avoid tumor dissemination. In addition, in recent years, open abdominal surgery has gradually transformed into laparoscopic procedure within an enhanced recovery after surgery (ERAS) programme, and carbon dioxide (CO 2 ) insufflation subsequently become into an important factor affecting the decrease of core temperature. However, there are few studies on the effectiveness of continuous active warming during laparoscopic gastrectomy and the association with postoperative rehabilitation. This is the first research to compare continuous active warming and active warming when body temperature was below 36℃ and associate intraoperative hypothemia with recovery after laparoscopic gastrectomy surgery. The results of this study showed that the overall incidence of hypothermia was 16.13% in 62 patients. Reduction of body temperature were divided into three stages according to the characteristics of the change in the perioperative core temperature: ① Redistribution period, it occurs within 1 hour after the induction of anesthesia. The peripheral blood vessels expansion under the taking effect of anesthetic drugs leads to the heat transfers from the center to the periphery, and the core body temperature can be reduced by 1.0 to 1.5℃; ② Linear reduction period, it occurs within 2 to 3 hours after general anesthesia. Due to anesthetic drugs, surgical factors and ambient temperature et al., the heat production and heat dissipation unbalanced under anesthesia; ③ Plateau period, it occurs 3 to 4 hours after anesthesia, the core temperature no longer decreases continuously, but gradually stabilizes [18] . The forced-air warming blanket can form a thermal environment arround the patient's body, prevent the transfer of heat from the core to the peripheral and effectively elevate core body temperature after anesthesia induction [19] . Therefore, although the forced-air warming blanket was applied to the patients in the BAW group, it is difficult to elevate the core body temperature above 36℃ because the core body temperature has decreased within the first hour after the induction of anesthesia. Dan et al. [20] showed that the incidence of intraoperative hypothemia in patient undergoing elective open abdominal surgery was at least 34.1%. However, their study included patients undergoing all abdominal surgery and did not focus on patients with gastric cancer. Thus, the incidence of hypothermia was higher than that in our study. Ninht et al. [21] Showed that the prevalence of perioperative hypothermia was up to 41%, the possible explaination was the different temperature measurements, esophageal temperature probe was placed to monitor core temperature after induction of anesthesia and abdominal temperature was placed intraabdominally next to one of the trocars in their study, and bladder temperature cather was used in our research. In addition, the subjects of their study underwent open abdominal surgery which with prolonged exposure of large surfaces of skin. In present study, intraoperative hypothermia was associated with more presence of postoperative shivering and agitation, more time from end of surgery to tracheal extubation and time to first postoperative flatus, as well as higher immediate postoperative pain score. The results of this study were consistent with those of previous studies, Madrid et al. [22] indicated that the risk of postoperative shivering in surgical patients undergoing active warming was about one-third of patients who did not be supplied of the forced air warming. Most narcotic drugs impair thermoregulation mechanisms in a dose-dependent manner, the patient's sensitivity to hypothermia was reduced by lowering the shivering threshold and impairing the body's ability to regulate temperature. The results showed that the incidence of postoperative shivering in patients under general anesthesia was up to 65%, and shivering can increase the risk of complications by increasing the body’s demand for oxygen [23, 24] . Agitation after anesthesia and prolonged postoperative extubation time were common complications in the previous study [23, 25] , the result of the present study suggested that the difference in the incidence of agitation and time to extubation between the two groups, which is consistent with the findings of Huniler H C et al. [26] . Most cellular functions and enzyme activity are temperature-dependent. Therefore, it is unsurprising that even mild hypothermia prolongs the actions of various drugs. By affecting drug metabolism, perioperative hypothermia is associated with delayed emergence from anesthesia [27] . The results of Luke Reynolds et al. suggested that only 1.9℃ core hypothermia triples the incidence of surgical wound infection following colon resection and increases the duration of hospitalization by 20% [28] , which was contrast with the present study. This may be due to various subjects and different statistical methods. Rongjuan et al. [29] showed that introperative normothermia coule enhance the return of intestinal motility and forced-air warmer set to 38°C during insufflations in laporascopic colorectal patients could significantly reduce the day to first flatus, which was consist with our study. Yeh et al. [30] showed that the passage of flatus was more delayed on the use of heated and humidified CO 2 in patients undergoing laparoscopic colorectal surgery. However, the day to first flatus was relatedy to much more risk factors, such as enema, perioperative care in accordance with the enhanced recovery after surgery (ERAS) guidelines, et al. Furthermore, the study was limited to the colorectal surgery. In our study, intraoperative hypothermia resulted in higher immediate postoperative pain score that was clinically significant. Persson et al [31] studied the relationship between hypothermia and the disposition of opioids in patients undergoing subtotal hysterectomy. However, the conclusion of the study was that the requirements of opioid did not seem to be influenced by intraoperative hypothermia in a clinical setting which was contrast with us. This may be due to the timing of postoperative pain assessment is inconsistent. David et al [32] showed that humidified and heated laparoscopy significantly decreased immediate postoperative pain scores compared to standard laparoscopy. Whereas, whether intraoperative hypothermia lower the immediate postoperative pain score still need to be confirmed. We observed that hypothermia prolonged the proinflammatory response whereas normothermia enhanced the anti-inflammatory response were consistent with those of previous studies [33, 34] . It has been shown that the expression of proinflammatory cytokines such as TNF-ɑ and IL-6 is significantly increased when the body is stimulated by hypothermia [35] . Intraoperative hypothermia, as an acute stressor, could cause obvious neuroendocrine changes in the body, and the immune system cells release a large number of immune factors into the body, which could participate in the regulation of immune and inflammatory responses of the body. Intraoperative hypothermia suppresses the initial phase of thrombin production, thereby reducing the coagulant activity and inhibiting the coagulation reaction. Studies have confirmed that there is a slight delay in thrombin production at mild hypothermia, and a significant delay at 32~34℃. This was consistent with the results of our study. We found that patients with intraoperative hypothermia lost more blood during surgery, although there was no significant difference. We acknowledge that the study has several limitations. First of all, this study was only conducted for patients undergoing laparoscopic gastric cancer surgery, and its applicability to other populations needs to be further verified. In addition, bladder temperature seems to have a good reliability and not to be inferior to the other assessment site currently used [36] . However, the gold standard for measuring core temperature remains the pulmonary artery catheter [37] , therefore, the quality need to be verified by more temperature measurement methods in the future. However, it is notable that the patients with same surgical procedure, the same surgeon, and the same treatment plan were included in the study. In conclusion, continuous active warming can effectively prevent intraoperative hypothermia in patients with gastric cancer, and improve the quality of postoperative rehabilitation. Operating room nurses and anesthesiologists should pay more attention to perioperative core body temperature changes and take targeted preventive measures. Declarations Competing interests The authors declare that they have no known competing financial interests or personal relationships that could influence the work reported in this article. Additional information Correspondence and requests for materials should be addressed to Mengjia Luo. Funding This trial did not receive any external funding. Author Contribution Conception of the study: Mengjia Luo, Hongjuan Lang, Yanran Dai; Literature review and design of trial: Mengjia Luo, Hongjuan Lang, Xiangying Feng; Data analysis and Statistics: Yujie Wang, Xin Guo; Manuscript editing and review: Mengjia Luo, Hongjuan Lang, Juan Du, Gang Ji; The final version of the manuscript has been approved by all authors. Acknowledgement We would like to thank nurses at Department of Gastrointestinal Surgery of Xijing Hospital for being in-charge of recording data and measures of active warming. We also would like to thank operating room nursing supervisor for supporting of implement of the trial. Data Availability All data generated or analysed during this study are included in the supplementary information files. References Osilla E V, Marsidi J L, Shumway K R, et al. Physiology, Temperature Regulation[M]. 2023.Jul,30. Sessler D I. Perioperative thermoregulation and heat balance[J]. 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Comparative effects of warming systems applied to different parts of the body on hypothermia in adults undergoing abdominal surgery: A systematic review and network meta-analysis of randomized controlled trials[J]. J Clin Anesth, 2023,89:111190. Jiang D, Li Q, Wang H, et al. Effect of a Forced-Air Warming Blanket on Different Parts of the Body on Core Temperature of Patients Undergoing Elective Open Abdominal Surgery: A Randomized Controlled Single-Blind Trial[J]. J Perianesth Nurs, 2024,5:S1089-9472(24) 00040-6 . Nguyen N T, Fleming N W, Singh A, et al. Evaluation of core temperature during laparoscopic and open gastric bypass[J]. Obesity surgery, 2001,11(5):570-575. Madrid E, Urrutia G, Roque I F M, et al. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults[J]. Cochrane Database Syst Rev, 2016,4(4):CD9016. Ji J, Gu X, Xiao C. Comparison of Perioperative Active or Routine Temperature Management on Postoperative Quality of Recovery in PACU in Patients Undergoing Thoracoscopic Lobectomy: A Randomized Controlled Study[J]. Int J Gen Med, 2022,15:429-436. Akbarpour R M, Jafarpoor H, Shamsalinia A, et al. Effects of a forced-air warming system and warmed intravenous fluids on hemodynamic parameters, shivering, and time to awakening in elderly patients undergoing open cardiac surgery[J]. Ann Card Anaesth, 2023,26(4):386-392. Zhao J, Le Z, Chu L, et al. Risk factors and outcomes of intraoperative hypothermia in neonatal and infant patients undergoing general anesthesia and surgery[J]. Ann Card Anaesth, 2023,11:1113627. Huniler H C, Deniz M N, Gunisen I, et al. Effects of Perioperative Hypothermia on Extubation, Recovery Time, and Postoperative Shivering in Breast Surgery[J]. Ther Hypothermia Temp Manag, 2024,14(2):110-117. Ruetzler K, Kurz A. Consequences of perioperative hypothermia[J]. Handb Clin Neurol, 2018,157:687-697. Reynolds L, Beckmann J, Kurz A. Perioperative complications of hypothermia[J]. Best Pract Res Clin Anaesthesiol, 2008,22(4):645-657. Jiang R, Sun Y, Wang H, et al. Effect of different carbon dioxide (CO2) insufflation for laparoscopic colorectal surgery in elderly patients: A randomized controlled trial[J]. Medicine (Baltimore), 2019,98(41):e17520. Yeh C H, Kwok S Y, Chan M K, et al. Prospective, case-matched study of heated and humidified carbon dioxide insufflation in laparoscopic colorectal surgery[J]. Colorectal Dis, 2007,9(8):695-700. Persson K, Lundberg J. Perioperative hypothermia and postoperative opioid requirements[J]. Eur J Anaesthesiol, 2001,18(10):679-686. Balayssac D, Pereira B, Bazin J E, et al. Warmed and humidified carbon dioxide for abdominal laparoscopic surgery: meta-analysis of the current literature[J]. Surg Endosc, 2017,31(1):1-12. Billeter A T, Rice J, Druen D, et al. Warming to 39 degrees C but Not to 37 degrees C Ameliorates the Effects on the Monocyte Response by Hypothermia[J]. Ann Surg, 2016,263(3):601-607. Eskla K L, Porosk R, Reimets R, et al. Hypothermia augments stress response in mammalian cells[J]. Free Radic Biol Med, 2018,121:157-168. Sun M, Chu F, Zhang L, et al. Effect of medium with moderate temperature on patient's body temperature during percutaneous endoscopic lumbar discectomy[J]. J Orthop Surg Res, 2022,17(1):336. Buccione E, Chiavaroli V, Scarponcini F D, et al. Bladder Temperature During Neonatal Targeted Temperature Management: A Case Report[J]. Adv Neonatal Care, 2023,23(5):418-424. Verheyden C, Neyrinck A, Laenen A, et al. Clinical evaluation of a cutaneous zero-heat-flux thermometer during cardiac surgery[J]. J Clin Monit Comput, 2022,36(5):1279-1287. Additional Declarations No competing interests reported. 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University","correspondingAuthor":false,"prefix":"","firstName":"Xiangying","middleName":"","lastName":"Feng","suffix":""},{"id":345424743,"identity":"db687efe-89b8-45c3-94c2-58ead5f1f962","order_by":2,"name":"Yanran Dai","email":"","orcid":"","institution":"Xijing Hospital, Air Force Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yanran","middleName":"","lastName":"Dai","suffix":""},{"id":345424744,"identity":"26b78586-232e-4d7c-afb6-773214c5211f","order_by":3,"name":"Yujie Wang","email":"","orcid":"","institution":"986 Hospital , Air Force Military Medical University, China","correspondingAuthor":false,"prefix":"","firstName":"Yujie","middleName":"","lastName":"Wang","suffix":""},{"id":345424745,"identity":"87319c55-da1f-4b13-bf1c-5e16a9034772","order_by":4,"name":"Xin Guo","email":"","orcid":"","institution":"986 Hospital , Air Force Military Medical University, China","correspondingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Guo","suffix":""},{"id":345424746,"identity":"e8f2ff34-95b3-46e4-86f0-ee123b9de74d","order_by":5,"name":"Juan Du","email":"","orcid":"","institution":"Air Force Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"","lastName":"Du","suffix":""},{"id":345424747,"identity":"f0b037e2-a3eb-44bf-87ae-c247b58cf442","order_by":6,"name":"Gang Ji","email":"","orcid":"","institution":"Xijing Hospital, Air Force Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Gang","middleName":"","lastName":"Ji","suffix":""},{"id":345424748,"identity":"6e5948ea-0d06-4623-b901-a7b52fb7f5f4","order_by":7,"name":"Hongjuan Lang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvUlEQVRIiWNgGAWjYFAD9sbGhx9I08JzuNlYgjQtEultAjzEKJSfkXvsMe8em8R+yYdtDBIMdnK6DQS0GNzISzfmeZaWOHN2YtuDAoZkY7MDhLRI5JhJ8xw4nLvhdmK7gQTDgcRthLTIz4Bq2X/zYJsEDzFaGG7AbJFgJFKLwZk3ZpJzDqTVzziTCAxkAyL8It+eYybx5oCNMX/78YcPP1TYyRHUAgJMiOgwIEI5CDD+IFLhKBgFo2AUjFAAAIhPQgbU8IxdAAAAAElFTkSuQmCC","orcid":"","institution":"Air Force Military Medical University","correspondingAuthor":true,"prefix":"","firstName":"Hongjuan","middleName":"","lastName":"Lang","suffix":""}],"badges":[],"createdAt":"2024-07-23 03:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4785274/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4785274/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":64143087,"identity":"28895c82-41e2-492a-8d10-7541038c3bf5","added_by":"auto","created_at":"2024-09-08 19:29:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":55925,"visible":true,"origin":"","legend":"\u003cp\u003eConsort flowchart diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4785274/v1/2d96dbb8b077a7ba79dc7031.png"},{"id":64143089,"identity":"cd381179-4825-4643-ab1e-c11093b70eed","added_by":"auto","created_at":"2024-09-08 19:29:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":106317,"visible":true,"origin":"","legend":"\u003cp\u003eMean temperature between the two groups\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4785274/v1/f983c93b82482167a64cdf96.png"},{"id":64144664,"identity":"a7638a9f-2472-4f31-855b-d92ef996e11d","added_by":"auto","created_at":"2024-09-08 19:45:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":841520,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4785274/v1/c26d064a-1d59-415a-9f36-c72bb0bf0ccd.pdf"},{"id":64143088,"identity":"ecaff3ce-cfe5-4311-93a3-5b6b41842bcd","added_by":"auto","created_at":"2024-09-08 19:29:00","extension":"zip","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":46111,"visible":true,"origin":"","legend":"","description":"","filename":"rawdata.zip","url":"https://assets-eu.researchsquare.com/files/rs-4785274/v1/a95b7630a4bb70955986f537.zip"}],"financialInterests":"No competing interests reported.","formattedTitle":"A prospective randomized study of the efficacy of continuous active warming in patients undergoing laparoscopic gastrectomy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNormally, the body core temperature is jointly regulated by the hypothalamic thermoregulatory center and the neurohumour, in order to maintain a dynamic balance between the heat production and dissipation\u003csup\u003e[1]\u003c/sup\u003e. However, autonomic thermoregulation has been upsetted and the threshold for vasoconstriction or tremors have been descreased by the application of anesthetic drugs under general anesthesia(GA)\u003csup\u003e[2]\u003c/sup\u003e. In addition, the risk factors including the duration of surgery, a significant portion of patient\u0026rsquo;s surface area is exposure to the cold ambient environment of operation rooms (ORs), the volume of intravenous fluid or irrigation and the patient\u0026rsquo;s nutritional status are by far the most common reasons of the core temperature disturbance. Thus, intraoperative hypothermia is the most widespread complication undergoing long-duration surgeries, especially the abdominal surgery. Intraoperative hypothermia, defined as the core temperature below 36℃ during the surgery, the incidence up to 25%~70%\u003csup\u003e[3, 4]\u003c/sup\u003e. According to the degree of decrease, it can be classified as mild (35.5\u0026thinsp;~\u0026thinsp;35.9℃), moderate (35.0\u0026thinsp;~\u0026thinsp;35.4℃) and severe (\u0026lt;\u0026thinsp;35.0℃)\u003csup\u003e[5]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eGastric cancer is the fifth most common cancer worldwide and the third most common cause of cancer death\u003csup\u003e[6]\u003c/sup\u003e. At present, China as the biggest developping country, gastric cancer has the third highest incidence and mortality of all cancer types, accounting for 44.0% of new cases and 48.6% of gastric cancer-related deaths worldwide, respectively\u003csup\u003e[7]\u003c/sup\u003e. Nowadays, laparoscopic gastrectomy (LG) has shown a series of advantages over open gastrectomy (OG) in treatment of gastric cancer in view of the implemented gradually of Enhanced Recovery after Surgery (ERAS) protocols\u003csup\u003e[8]\u003c/sup\u003e. The studies report that laparoscopic gastrectomy can reduce the loss of blood, decrease the analgesic dosage, shorten the first defecation time and et al.\u003csup\u003e[9\u0026ndash;11]\u003c/sup\u003e, in the meantime, there is no significant difference in overall survival rate, death related to gastric cancer and death due to other causes\u003csup\u003e[12]\u003c/sup\u003e. However, dry and cold carbon dioxide (CO\u003csub\u003e2\u003c/sub\u003e) insufflation in laparoscopic gastrectomy results in increasing the incidence of intraoperative hypothermia\u003csup\u003e[13]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEvidence has shown that the core temperature below 36℃ under surgery would lead to cardiovascular adverse events, prolonged recovery time of general anethesia, increased infection rate of incisions, and a sequence of other complications\u003csup\u003e[14]\u003c/sup\u003e. These complications can be catastrophic for patients undergoing laparoscopic gastrectomy\u003csup\u003e[15]\u003c/sup\u003e. Active warming measures are often taken by the OR staff in order to reduce the incidence of the intraoperative hypothermia, with preventing the redistribution of heat from core to periphery. However, the Randomized Controlled Trial (RCT) studies on the effectiveness of continuous active warming during laparoscopic gastrectomy is scarce. Therefore, we hypothesized that continuous active warming (CAW) will be superior than active warming when body temperature is below 36℃ (BAW) in terms of decreasing the incidence of intraoperative hypothermia. As secondary objectives included presence of shivering and agitation after operation, the time from end of surgery to tracheal extubation, postoperative pain score, the time to first postoperative flatus, postoperative complications, and the inflammatory markers.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cb\u003eSubjects.\u003c/b\u003e This trial was a prospective randomized controlled study designed to explore the best strategy for the prevention measure of intraoperative hypothermia, and it was permitted by the Ethics Committee of Xijing Hospital, Air Force Military Medical University, China(reference NO. KY20202116-C-1). Meanwhile, it was rigistered at Chinese Clinical Trial Registry (ChiCTR) on 20/07/2024. This study strictly abided by all legal requirements, regulations and general principles formulated by international agencies concerning ethical conduct in human biomedical research and by the Declaration of Helsinki and the International Ethical Guidelines for Biomedical Research Involving Human Beings. The original protocol was complied strictly by the trial and it could be obtained from the authors upon request.\u003c/p\u003e \u003cp\u003e 62 participants were enrolled in the clinial study who underwent elective total laparoscopic radical gastrectomy from November 2021 to March 2022 in the Department of Gastrointestinal Surgery in our hospital. These patients aged 39 to 83 years, with a median age of 63 years, included 52 males and 10 female.\u003c/p\u003e \u003cp\u003eThe patients with aged 18 to 85 years, ASA physical classification score Ⅰ to Ⅲ grades (ASA score was assessed by the American Society of Anesthesiologists Physical Status Classification Scale\u003csup\u003e[16]\u003c/sup\u003e), preoperative temperature\u0026thinsp;\u0026gt;\u0026thinsp;36℃ were included. We excluded patients with preoperative temperature\u0026thinsp;\u0026gt;\u0026thinsp;37.5℃, duration of surgery below 1 h, emergency surgery, suffer from hyperthyroidism or hypothyroidism. In addition, the exclusion of criteria included that the treatment changed to open radical gastrectomy and the patients were transfered to intensive care unit (ICU). A sample size was based on the data from our retrospective and observational study, the incidence of the intraoperative hypothermia in which non-continuous active warming patients was 40%, and we assumed that the incidence of continuous active warming patients was 5%. In order to detect the difference between the two groups in bladder temperature, 30 patients had to be recruited in each group with an alpha level of 0.05 and 0.9 power. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eIntervention.\u003c/b\u003e A computer-generated randomized number approach was used to allocate patients into two groups, continuous active warming group (CAW) and active warming when body temperature was below 36℃ group (BAW). Furthermore, patients were blinded by numbered, sealed, opaque envelopes prepared by a study group member a day in advance. The risks and benefits of the study were explained to the patients by doctors and obtained informed consent before proceeding.\u003c/p\u003e \u003cp\u003eThe operating room temperature was adjusted to 22\u0026thinsp;~\u0026thinsp;25℃, and the humidity was 40%~60% in advance. An effective and safe venous channel was established for patients and intravenous infusion of sodium lactate ringer injection was given at 37\u0026thinsp;~\u0026thinsp;41℃ once in the operation rooms. The patient was covered with a large surgical sheet and cotton quilt, and the shoulder pad was placed. The abdominal irrigation fluid was heated to 37\u0026thinsp;~\u0026thinsp;41℃ during the operation. A No. 14 urethral catheter with temperature monitoring probe was inserted into the urethra immediately after the patient underwent general anesthesia. The bladder temperature of the patient was continuously monitored during the operation and used as the core body temperature. As well as, the air outlet pipe of the inflatable thermal blanket was placed between the two layers of shoulder pads before the operation. \u003cb\u003eSignificantly, patients assigned to CAW group were warmed immediately since the surgical incision procedure, the others were warmed while the body bladder temperature dropped to 36℃. The temperature was set at 44℃, and the heating machine was stopped when the body temperature rose to 37.5℃.\u003c/b\u003e The bladder temperature of the patient was recorded every 30 minutes during the operation, in the meantime, abnormal conditions such as sweating were observed and appropriate treatment was taken at any time.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAnesthetic induction and temperature monitoring.\u003c/b\u003e Due to the guidance of enhanced recovery after surgery (ERAS), all patients who underwent laparoscopic radical gastrectomy quit smoking for two weeks before surgery, and gastric tube or enema treatment were no longer taken before surgery. Patients were required preoperative fasting for 8 hours, and water abstinence for 4 hours before surgery to minimise the risk of pulmonary aspiration of gastric contents. During the anaesthesia procedure, left upper extremity venous puncture and invasive arterial puncture were performed for the sake of monitoring vital signs. All patients were administered by intravenous anesthesia, dexamethasone 0.15\u0026thinsp;~\u0026thinsp;0.2 mg/kg, sufentanil 0.4\u0026thinsp;~\u0026thinsp;0.6 \u0026micro;g/kg, etomidate 0.2\u0026thinsp;~\u0026thinsp;0.3 mg/kg, rocuronium bromide 0.9 mg/kg were conducted during induction phase of anesthesia. Tracheal intubation was performed with the a visual laryngoscope, and a 7.5 tracheal catheter was routinely used for men and a 7 tracheal catheter for women. Target-controlled infusion of propofol was used for 2\u0026thinsp;~\u0026thinsp;3 \u0026micro;g/ml, and remifentanil was used for constant rate infusion of 0.1\u0026thinsp;~\u0026thinsp;0.2 \u0026micro;g/kg/min during maintenance phase of anesthesia. Timely and accurate treatment while the patient's vital signs fluctuated during the whole procedure.\u003c/p\u003e \u003cp\u003eThe first body bladder temperature (T0) as the baseline temperature was recorded while the patient's urinary tube was inserted at the induction stage of anethesia. Then, temperature at the start of surgery was considered as T1. Next, temperature was recorded every 30 minutes until 3 hours after surgery (T2\u0026thinsp;~\u0026thinsp;T8), as well as patients were transferred to PACU after surgery (T9).\u003c/p\u003e \u003cp\u003e \u003cb\u003eVariables and statistics.\u003c/b\u003e SPSS Statistics Software 27.0 (IBM, New York) was used to analyse the data. Count data were represented by example (n) or percentage (%), and measurement data were represented by mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u0026macr;x\u0026thinsp;\u0026plusmn;\u0026thinsp;s). General data were analyzed by \u003cem\u003et\u003c/em\u003e-test, chi-square test according to the data type or \u003cem\u003eFisher's\u003c/em\u003e exact test when the frequency was \u0026lt;\u0026thinsp;5. One-way ANOVA and ANOVA with repeated measures were used for comparisons between multiple groups, independent samples \u003cem\u003et\u003c/em\u003e-test for pair-wise comparisons, and non-parametric tests was used when homogeneity of variance was not met. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated a statistical significance.\u003c/p\u003e \u003cp\u003eIn this study, the independent variable was the various heating methods ( CAW, BAW), the dependent variable was the patients\u0026rsquo; core temperature. Age (years), body mass index (kg/m\u003csup\u003e2\u003c/sup\u003e), ambient temperature (℃), duration of surgery (mins), flushing fluid (ml), volume of crystalloid administered (ml), volume of colloidal administered (ml), hemoglobin (g/L), albumin(g/L) were all continuous variables, the categorical variables were gender (male/female) and the grade of ASA (Ⅰ, Ⅱ, Ⅲ).\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003e3.1 Comparison of patient\u0026rsquo;s characteristics between the two groups\u003c/p\u003e\n\u003cp\u003eA total of 80 patients undergoing elective total laparoscopic radical gastrectomy were eligible for the study, of whom 18 were excluded. Thus, 62 patients were randomised, as demonstrated in Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The patient\u0026rsquo;s characteristics including age, body mass index (BMI), ambient temperature, duration of surgery, flushing fluid, volume of crystalloid administered, volume of colloidal administered, hemoglobin, albumin, gender and the grade of ASA were comparable between the two groups. (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePatient characteristics (n\u0026thinsp;=\u0026thinsp;62).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003egroups\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e / t\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCAW(n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBAW(n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade of ASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅠ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅢ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.52\u0026thinsp;\u0026plusmn;\u0026thinsp;8.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.74\u0026thinsp;\u0026plusmn;\u0026thinsp;9.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.919\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.66\u0026thinsp;\u0026plusmn;\u0026thinsp;5.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmbient temperature (℃)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.878\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of surgery (mins)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e356.74\u0026thinsp;\u0026plusmn;\u0026thinsp;551.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e250.48\u0026thinsp;\u0026plusmn;\u0026thinsp;61.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.290\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFlushing fluid (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e948.39\u0026thinsp;\u0026plusmn;\u0026thinsp;699.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e848.39\u0026thinsp;\u0026plusmn;\u0026thinsp;717.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.580\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVolume of crystalloid administered (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2054.84\u0026thinsp;\u0026plusmn;\u0026thinsp;608.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2022.58\u0026thinsp;\u0026plusmn;\u0026thinsp;492.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.819\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVolume of colloidal administered (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e698.71\u0026thinsp;\u0026plusmn;\u0026thinsp;322.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e635.48\u0026thinsp;\u0026plusmn;\u0026thinsp;256.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.854\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.396\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHemoglobin (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135.00\u0026thinsp;\u0026plusmn;\u0026thinsp;22.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e143.55\u0026thinsp;\u0026plusmn;\u0026thinsp;23.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlbumin (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.54\u0026thinsp;\u0026plusmn;\u0026thinsp;3.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.56\u0026thinsp;\u0026plusmn;\u0026thinsp;3.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.977\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e3.2 Comparison of core temperature at different time points between the two groups\u003c/p\u003e\n\u003cp\u003eInitially, there was no significant difference between the CAW group and the BAW group at the T0, T1, T2 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). One hour after the surgery, the core temperature of the CAW group showed a continuous rising trend until patients were transfered to ward. Besides, the core temperature at each time point was higher than the baseline of the patient. Howerver, a downward trend was showed at one hour after the surgery in the BAW group, and the minimum was reached at 3 hours of surgery, although it rose slightly at end of the operation. There was a significant difference between the two groups when we comparing the core temperature in the 1 hour after the operation(\u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.05). (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eFurthermore, according to the analysis of repeated measures ANOVA, the sphericity test results showed Machly W\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, did not fit the spherical test. Therefore, the corrected results in the \u0026quot;Greenhouse-Geisser\u0026quot; are more reliable in the study. Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e shows that from the beginning of the operation to 60 min (T0\u0026thinsp;~\u0026thinsp;T2) after the operation, there was no significant difference in the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, since 90 min (T3) after the operation, the core temperature of the CAW group was significantly higher than BAW group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCore temperature at different time points in two groups from repeated measures model (n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCAW group\u003c/p\u003e\n \u003cp\u003e(M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eBAW group\u003c/p\u003e\n \u003cp\u003e(M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eRepeated measures F test\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eɧ2\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGroup main effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTime main effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGroup*Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e3.3 Comparison of the incidence of hypothermia versus time between the two groups\u003c/p\u003e\n\u003cp\u003eThe overall incidence of hypothermia was 16.13% in our study. Among them, the incidence of hypothermia in the BAW group was 32.26%, and none of the patient developed hypothermia in the CAW group. Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e shows that the incidence was increasing from the beginning of the operation (T1), until up to 22.58%.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eIncidence of hypothermia versus time between the two groups (n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCAW group (H/N)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBAW group (H/N)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.053*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.053*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.053*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7/24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.011*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.024*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7/24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.011*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.053*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.113*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eTable annotation: H, Number of patients of hypothermia; N, Number of patients of normal temperature; * \u003cem\u003eFisher\u0026rsquo;s\u003c/em\u003e test。\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e3.4 Comparison of the recovery quality after surgery between the two groups\u003c/p\u003e\n\u003cp\u003eThe incidence of shivering and agitation after operation was both 3.23% in CAW group, accordingly, it was 32.26% and 29.03% in BAW group, respectively. Time from end of surgery to tracheal extubation in CAW group was significantly lower than BAW group. In addition, continuous active warming could shorten time to first postoperative flatus of patients and relieve postoperative pain, but had no effect on decreasing the incidence of postoperative complications. These results of the recovery quality after surgery are shown in Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe recovery quality after surgery between the two groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCAW group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBAW group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e / \u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade of shivering\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.006*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade of agitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.012*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostoperative complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.053*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnastomotic leakage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGastroparesis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntestinal intussusception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTime to extubation(min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.81\u0026thinsp;\u0026plusmn;\u0026thinsp;8.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.68\u0026thinsp;\u0026plusmn;\u0026thinsp;8.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImmediate\u0026nbsp;postoperative pain score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTime to first postoperative flatus (d)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eTable annotation: * \u003cem\u003eFisher\u0026rsquo;s\u003c/em\u003e test。\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e3.5 Comparison of the inflammatory markers of perioperative period\u003c/p\u003e\n\u003cp\u003eInflammatory markers including PT, APTT, IL-6, SAA, hs-CRP, and PCT in the study. Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e shows that levels of the inflammatory markers in preoperative period were comparable. Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e and Table \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e show that the parameters displayed a significant surge on the postoperative day, followed by a marginal decline on the 3 day after surgery, yet they remained elevated above baseline levels.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePreoperative inflammatory markers\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCAW group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBAW group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePT(s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAPTT(s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28.49\u0026thinsp;\u0026plusmn;\u0026thinsp;7.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.45\u0026thinsp;\u0026plusmn;\u0026thinsp;5.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.769\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIL-6(pg/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.45\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.25\u0026thinsp;\u0026plusmn;\u0026thinsp;15.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSAA(mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.66\u0026thinsp;\u0026plusmn;\u0026thinsp;5.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.31\u0026thinsp;\u0026plusmn;\u0026thinsp;3.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.753\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ehs-CRP(mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.802\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCT(ng/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.575\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eInflammatory markers on 1 day after surgery\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCAW group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBAW group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePT(s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAPTT(s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.36\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.65\u0026thinsp;\u0026plusmn;\u0026thinsp;3.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIL-6(pg/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55.76\u0026thinsp;\u0026plusmn;\u0026thinsp;38.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75.56\u0026thinsp;\u0026plusmn;\u0026thinsp;32.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSAA(mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e232.99\u0026thinsp;\u0026plusmn;\u0026thinsp;223.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e384.06\u0026thinsp;\u0026plusmn;\u0026thinsp;232.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.612\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ehs-CRP(mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42.71\u0026thinsp;\u0026plusmn;\u0026thinsp;36.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e69.71\u0026thinsp;\u0026plusmn;\u0026thinsp;25.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.365\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCT(ng/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.886\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab7\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eInflammatory markers on 3 day after surgery\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCAW group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBAW group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePT(s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.539\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAPTT(s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.09\u0026thinsp;\u0026plusmn;\u0026thinsp;5.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.40\u0026thinsp;\u0026plusmn;\u0026thinsp;3.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIL-6(pg/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.55\u0026thinsp;\u0026plusmn;\u0026thinsp;33.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60.70\u0026thinsp;\u0026plusmn;\u0026thinsp;38.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.750\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSAA(mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e276.75\u0026thinsp;\u0026plusmn;\u0026thinsp;135.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e392.92\u0026thinsp;\u0026plusmn;\u0026thinsp;212.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ehs-CRP(mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52.60\u0026thinsp;\u0026plusmn;\u0026thinsp;35.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72.82\u0026thinsp;\u0026plusmn;\u0026thinsp;37.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCT(ng/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe high incidence of intraoperative hypothermia is an important cause of morbidity in various types of cancer surgeries , and an independent risk preditor for the overall survival of cancer patients\u003csup\u003e[17]\u003c/sup\u003e. Actually, the incidence of intraoperative hypothermia of radical tumor resection is still high, the possible reason is considered that operators spend more time in lymph node dissection, complying with the principle of no-touch and block resection in order to avoid tumor dissemination. In addition, in recent years, open abdominal surgery has gradually transformed into laparoscopic procedure within an enhanced recovery after surgery (ERAS) programme, and carbon dioxide (CO\u003csub\u003e2\u003c/sub\u003e) insufflation subsequently become into an important factor affecting the decrease of core temperature. However, there are few studies on the effectiveness of continuous active warming during laparoscopic gastrectomy and the association with postoperative rehabilitation. This is the first research to compare continuous active warming and active warming when body temperature was below 36℃ and associate intraoperative hypothemia with recovery after laparoscopic gastrectomy surgery.\u003c/p\u003e\n\u003cp\u003eThe results of this study showed that the overall incidence of hypothermia was 16.13% in 62 patients. Reduction of body temperature were divided into three stages according to the characteristics of the change in the perioperative core temperature: ① Redistribution period, it occurs within 1 hour after the induction of anesthesia. The peripheral blood vessels expansion under the taking effect of anesthetic drugs leads to the heat transfers from the center to the periphery, and the core body temperature can be reduced by 1.0 to 1.5℃; ② Linear reduction period, it occurs within 2 to 3 hours after general anesthesia. Due to anesthetic drugs, surgical factors and ambient temperature et al., the heat production and heat dissipation unbalanced under anesthesia; ③ Plateau period, it occurs 3 to 4 hours after anesthesia, the core temperature no longer decreases continuously, but gradually stabilizes\u003csup\u003e[18]\u003c/sup\u003e. The forced-air warming blanket can form a thermal environment arround the patient\u0026apos;s body, prevent the transfer of heat from the core to the peripheral and effectively elevate core body temperature after anesthesia induction\u003csup\u003e[19]\u003c/sup\u003e. Therefore, although the forced-air warming blanket was applied to the patients in the BAW group, it is difficult to elevate the core body temperature above 36℃ because the core body temperature has decreased within the first hour after the induction of anesthesia. Dan et al.\u003csup\u003e[20]\u003c/sup\u003e showed that the incidence of intraoperative hypothemia in patient undergoing elective open abdominal surgery was at least 34.1%. However, their study included patients undergoing all abdominal surgery and did not focus on patients with gastric cancer. Thus, the incidence of hypothermia was higher than that in our study. Ninht et al.\u003csup\u003e[21]\u003c/sup\u003e Showed that the prevalence of perioperative hypothermia was up to 41%, the possible explaination was the different temperature measurements, esophageal temperature probe was placed to monitor core temperature after induction of anesthesia and abdominal temperature was placed intraabdominally next to one of the trocars in their study, and bladder temperature cather was used in our research. In addition, the subjects of their study underwent open abdominal surgery which with prolonged exposure of large surfaces of skin. \u003c/p\u003e\n\u003cp\u003eIn present study, intraoperative hypothermia was associated with more presence of postoperative shivering and agitation, more time from end of surgery to tracheal extubation and time to first postoperative flatus, as well as higher immediate postoperative pain score. The results of this study were consistent with those of previous studies, Madrid et al.\u003csup\u003e[22]\u003c/sup\u003e indicated that the risk of postoperative shivering in surgical patients undergoing active warming was about one-third of patients who did not be supplied of the forced air warming. Most narcotic drugs impair thermoregulation mechanisms in a dose-dependent manner, the patient\u0026apos;s sensitivity to hypothermia was reduced by lowering the shivering threshold and impairing the body\u0026apos;s ability to regulate temperature. The results showed that the incidence of postoperative shivering in patients under general anesthesia was up to 65%, and shivering can increase the risk of complications by increasing the body\u0026rsquo;s demand for oxygen\u003csup\u003e[23, 24]\u003c/sup\u003e. Agitation after anesthesia and prolonged postoperative extubation time were common complications in the previous study\u003csup\u003e[23, 25]\u003c/sup\u003e, the result of the present study suggested that the difference in the incidence of agitation and time to extubation between the two groups, which is consistent with the findings of Huniler H C et al.\u003csup\u003e[26]\u003c/sup\u003e. Most cellular functions and enzyme activity are temperature-dependent. Therefore, it is unsurprising that even mild hypothermia prolongs the actions of various drugs. By affecting drug metabolism, perioperative hypothermia is associated with delayed emergence from anesthesia\u003csup\u003e[27]\u003c/sup\u003e. The results of Luke Reynolds et al. suggested that only 1.9℃ core hypothermia triples the incidence of surgical wound infection following colon resection and increases the duration of hospitalization by 20%\u003csup\u003e[28]\u003c/sup\u003e, which was contrast with the present study. This may be due to various subjects and different statistical methods. Rongjuan\u0026ensp;et al.\u003csup\u003e[29]\u003c/sup\u003e showed that introperative normothermia coule enhance the return of intestinal motility and forced-air warmer set to 38\u0026deg;C during insufflations in laporascopic colorectal patients could significantly reduce the day to first flatus, which was consist with our study. Yeh et al.\u003csup\u003e[30]\u003c/sup\u003e showed that the passage of flatus was more delayed on the use of heated and humidified CO\u003csub\u003e2\u003c/sub\u003e in patients undergoing laparoscopic colorectal surgery. However, the day to first flatus was relatedy to much more risk factors, such as enema, perioperative care in accordance with the enhanced recovery after surgery (ERAS) guidelines, et al. Furthermore, the study was limited to the colorectal surgery. In our study, intraoperative hypothermia resulted in higher immediate postoperative pain score that was clinically significant. Persson et al\u003csup\u003e[31]\u003c/sup\u003e studied the relationship between hypothermia and the disposition of opioids in patients undergoing subtotal hysterectomy. However, the conclusion of the study was that the requirements of opioid did not seem to be influenced by intraoperative hypothermia in a clinical setting which was contrast with us. This may be due to the timing of postoperative pain assessment is inconsistent. David et al\u003csup\u003e[32]\u003c/sup\u003e showed that humidified and heated laparoscopy significantly decreased immediate postoperative pain scores compared to standard laparoscopy. Whereas, whether intraoperative hypothermia lower the immediate postoperative pain score still need to be confirmed.\u003c/p\u003e\n\u003cp\u003eWe observed that hypothermia prolonged the proinflammatory response whereas normothermia enhanced the anti-inflammatory response were consistent with those of previous studies\u003csup\u003e[33, 34]\u003c/sup\u003e. It has been shown that the expression of proinflammatory cytokines such as TNF-ɑ and IL-6 is significantly increased when the body is stimulated by hypothermia\u003csup\u003e[35]\u003c/sup\u003e. Intraoperative hypothermia, as an acute stressor, could cause obvious neuroendocrine changes in the body, and the immune system cells release a large number of immune factors into the body, which could participate in the regulation of immune and inflammatory responses of the body. Intraoperative hypothermia suppresses the initial phase of thrombin production, thereby reducing the coagulant activity and inhibiting the coagulation reaction. Studies have confirmed that there is a slight delay in thrombin production at mild hypothermia, and a significant delay at 32~34℃. This was consistent with the results of our study. We found that patients with intraoperative hypothermia lost more blood during surgery, although there was no significant difference.\u003c/p\u003e\n\u003cp\u003eWe acknowledge that the study has several limitations. First of all, this study was only conducted for patients undergoing laparoscopic gastric cancer surgery, and its applicability to other populations needs to be further verified. In addition, bladder temperature seems to have a good reliability and not to be inferior to the other assessment site currently used\u003csup\u003e[36]\u003c/sup\u003e. However, the gold standard for measuring core temperature remains the pulmonary artery catheter\u003csup\u003e[37]\u003c/sup\u003e, therefore, the quality need to be verified by more temperature measurement methods in the future. However, it is notable that the patients with same surgical procedure, the same surgeon, and the same treatment plan were included in the study. \u003c/p\u003e\n\u003cp\u003eIn conclusion, continuous active warming can effectively prevent intraoperative hypothermia in patients with gastric cancer, and improve the quality of postoperative rehabilitation. Operating room nurses and anesthesiologists should pay more attention to perioperative core body temperature changes and take targeted preventive measures.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could influence the work reported in this article.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eAdditional information\u003c/h2\u003e \u003cp\u003eCorrespondence and requests for materials should be addressed to Mengjia Luo.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis trial did not receive any external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConception of the study: Mengjia Luo, Hongjuan Lang, Yanran Dai; Literature review and design of trial: Mengjia Luo, Hongjuan Lang, Xiangying Feng; Data analysis and Statistics: Yujie Wang, Xin Guo; Manuscript editing and review: Mengjia Luo, Hongjuan Lang, Juan Du, Gang Ji; The final version of the manuscript has been approved by all authors.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank nurses at Department of Gastrointestinal Surgery of Xijing Hospital for being in-charge of recording data and measures of active warming. We also would like to thank operating room nursing supervisor for supporting of implement of the trial.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data generated or analysed during this study are included in the supplementary information files.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOsilla E V, Marsidi J L, Shumway K R, et al. Physiology, Temperature Regulation[M]. 2023.Jul,30.\u003c/li\u003e\n\u003cli\u003eSessler D I. Perioperative thermoregulation and heat balance[J]. Lancet, 2016,387(10038):2655-2664.\u003c/li\u003e\n\u003cli\u003eTorossian A, Brauer A, Hocker J, et al. Preventing inadvertent perioperative hypothermia[J]. Dtsch Arztebl Int, 2015,112(10):166-172.\u003c/li\u003e\n\u003cli\u003eLi T, Xu G, Yi J, et al. Intraoperative Hypothermia Induces Vascular Dysfunction in the CA1 Region of Rat Hippocampus[J]. Brain Sci, 2022,12(6):692.\u003c/li\u003e\n\u003cli\u003eTsuchida T, Takesue Y, Ichiki K, et al. 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Comparative effects of warming systems applied to different parts of the body on hypothermia in adults undergoing abdominal surgery: A systematic review and network meta-analysis of randomized controlled trials[J]. J Clin Anesth, 2023,89:111190.\u003c/li\u003e\n\u003cli\u003eJiang D, Li Q, Wang H, et al. Effect of a Forced-Air Warming Blanket on Different Parts of the Body on Core Temperature of Patients Undergoing Elective Open Abdominal Surgery: A Randomized Controlled Single-Blind Trial[J]. J Perianesth Nurs, 2024,5:S1089-9472(24) 00040-6 .\u003c/li\u003e\n\u003cli\u003eNguyen N T, Fleming N W, Singh A, et al. Evaluation of core temperature during laparoscopic and open gastric bypass[J]. Obesity surgery, 2001,11(5):570-575.\u003c/li\u003e\n\u003cli\u003eMadrid E, Urrutia G, Roque I F M, et al. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults[J]. 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J Orthop Surg Res, 2022,17(1):336.\u003c/li\u003e\n\u003cli\u003eBuccione E, Chiavaroli V, Scarponcini F D, et al. Bladder Temperature During Neonatal Targeted Temperature Management: A Case Report[J]. Adv Neonatal Care, 2023,23(5):418-424.\u003c/li\u003e\n\u003cli\u003eVerheyden C, Neyrinck A, Laenen A, et al. Clinical evaluation of a cutaneous zero-heat-flux thermometer during cardiac surgery[J]. J Clin Monit Comput, 2022,36(5):1279-1287.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4785274/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4785274/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDespite evidence has shown that the core temperature below 36℃ under surgery would lead to a sequence of adverse complications, and active warming measures are taken in order to reduce the incidence of the intraoperative hypothermia, core temperature disturbance during laparoscopic gastrectomy is common. The purpose of this research was to determine if a significant difference between continuous active warming (CAW) and active warming when body temperature is below 36℃ (BAW) in terms of incidence of intraoperative hypothermia and clinical rehabilitation in patients undergoing laparoscopic gastrectomy surgery. Patients assigned to CAW group were warmed immediately since the surgical incision procedure, the others were warmed while the body bladder temperature dropped to 36℃. The bladder temperature of the patient was recorded every 30 minutes during the operation. The primary outcome was the incidence of intraoperative hypothermia. Secondary outcomes included presence of shivering and agitation after operation, the time from end of surgery to tracheal extubation, postoperative pain score, the time to first postoperative flatus, postoperative complications, and the inflammatory markers. The overall incidence of hypothermia was 16.13% in 62 patients who underwent elective total laparoscopic radical gastrectomy. The incidence of shivering and agitation after operation was both 3.23% in CAW group, and it was 32.26% and 29.03% in BAW group. Time from end of surgery to tracheal extubation in CAW group was significantly lower than BAW group. In addition, continuous active warming could shorten time to first postoperative flatus of patients and relieve postoperative pain. In general, continuous active warming in patients undergoing laparoscopic gastrectomy decreased the incidence of intraoperative hypothermia and contributed to postoperative rehabilitation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration:\u003c/strong\u003e Registered at Chinese Clinical Trial Registry (ChiCTR) on 20/07/2024.\u003c/p\u003e","manuscriptTitle":"A prospective randomized study of the efficacy of continuous active warming in patients undergoing laparoscopic gastrectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-08 19:28:55","doi":"10.21203/rs.3.rs-4785274/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"54fb1052-fa82-4d05-af94-37682f7b142e","owner":[],"postedDate":"September 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":36615519,"name":"Biological sciences/Cancer/Gastrointestinal cancer/Gastric cancer"},{"id":36615520,"name":"Health sciences/Health care"},{"id":36615521,"name":"Health sciences/Medical research/Study design/Randomized controlled trials"}],"tags":[],"updatedAt":"2024-11-25T10:23:39+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-08 19:28:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4785274","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4785274","identity":"rs-4785274","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}