Background
Robot assisted laparoscopic surgery is a widespread technique used more frequently in colorectal surgery. ERAS perioperative management have demonstrated better outcome of patients. Hypothermia during general anesthesia has been correlated to many complication and this could compromise the outcome. Although many type of warming devices have been applied during surgery, the contest of Robotic surgery, we hypothesize, may be different due to ineffective warming methods linked to different operative setting.
Materials and Methods
We enrolled 20 adults patients scheduled to undergo to elective robot assisted laparoscopic major colorectal surgery. Perioperative management was conducted following ERAS protocol. General characteristics of patients (age, gender, comorbidity) were registered. ASA physical status were recorded before surgery.
Patients were warmed with forced air system and fluid were warmed with set point fixed at 41°C. Temperature was monitored with Spoton System and data were collected every 30 minutes also in post surgery period. Temperature of operating room was fixed on 23° C. Post-operative Bedside Shivering Assessment and patient temperature comfort were collected at 5, 15, and 30 minutes after surgery.
Results and Discussion
Demographical and ASA physical status of our group were homogeneous. Our patients showed a characteristic pattern of development of hypothermia during anesthesia and continuous to be hypothermic (35,2 °C0,5) in post-anesthesia period with prolonged shivering. Particularly we noted high incidence (90% [n=18/20];) of postoperative discomfort (“severe” 40% [n=8/20]; “moderate” 50% [n=10/20]) 5 minutes after surgery and the same incidence remain at 15 minutes although fluid warming and the use of warmed forced air showing a not adequate control of body temperature. Moreover 60% (n=12/20;) of patients showed “mild” shivering and 30% (n=6/20;) presented “moderate” shivering.
Conclusions
Few data exist on ERAS perioperative management of temperature in Robotic Surgery.
Our patients were hypothermic although multiple strategies were applied for preventing and control heat loss. This may be related to position and little surface body area exposed for active warming in robotic setting. These preliminary findings suggest the need of improving strategies for warming in robotic surgery.

06 / “Perioperative Managementof temperature of Robot Assisted Laparoscopic Surgery patients in the ERAS setting“