Mild hypothermia does not increase blood loss during total hip arthroplasty

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Abstract
Background: The effects of mild hypothermia on blood loss are little known. Methods: Patients, undergoing primary prosthetic hip surgery under spinal anaesthesia, were randomised to the operative procedure, with (n=25) or without (n=25) forced air warming. Core temperature was repeatedly measured from the tympanic membrane. The blood loss was calculated by three different methods; the intraoperative loss was estimated visually. The loss during and after the operation was obtained by determination of lost haemoglobin (the Hb-method). The blood loss during hospital stay was also calculated from the haemoglobin balance. Results: Among controls, core temperature decreased by 1.3±0.6°C (mean±SD) and in the warmed patients 0.5±0.4°C (P<0.0001). Preoperative variables and the number of allogeneic units transfused did not differ between the groups. In controls, the blood loss during operation was, with the visual method, 698±314 ml, compared with 665±292 ml in warmed patients. With the Hb-method, the loss was 662±319 and 657±348 ml, respectively. With this method, the external loss during the entire hospital stay was, in controls, 1066±441 ml and in the warmed group, 1047±413 ml. The balance method yielded 1674±646 ml and 1507±652 ml, respectively. Indices of blood loss did not differ significantly between groups and there was no covariation between those variables and the decrease in core temperature. Conclusions: Forced air warming did not decrease the blood loss. Methods for determination of blood loss yielded widely differing results.

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