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Randomizing patients to permit the development of perioperative hypothermia is inappropriate

Booth, M. G.; Gallagher, G.; Kinsella, J.

European Journal of Anaesthesiology: September 2002 - Volume 19 - Issue 9 - p 688

Department of Anaesthesia; Royal Infirmary; Glasgow, UK

Correspondence to: Malcolm Booth, Department of Anaesthesia, Walton Building, Royal Infirmary, Castle Street, Glasgow, G4 0SF, UK. E-mail:; Tel: +44 (0)141 211 4620; Fax: +44(0)141 211 4622

Accepted for publication October 2001 EJA 793


We are surprised that Persson and Lundberg obtained ethical approval for a study in which a group of patients was allowed to develop perioperative hypothermia [1]. Hypothermia prolongs recovery [2], increases perioperative bleeding [3], compromises wound healing, and increases the risk of wound infection [4] and cardiac complications [5]. Persson and Lundberg themselves referred to most of these problems.

The Declaration of Helsinki states that the importance of the objective of the research should outweigh the inherent risks and burdens to the subject [6]. It is difficult to see how exposing patients to the risks of hypothermia is in proportion to asking whether patients require more or less opioid analgesia. The evidence that hypothermia is harmful is compelling, and hypothermia can be avoided by simple routine measures. It is now time to accept that allowing patients to become hypothermic is, at best, inappropriate and, at worst, bad practice, and we believe that Persson and Lundberg's study was unethical.

M. G. Booth

G. Gallagher

J. Kinsella

Department of Anaesthesia; Royal Infirmary; Glasgow, UK

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1. Persson K, Lundberg J. Hypothermia and postoperative opioid requirements. Eur J Anaesthesiol 2001; 18: 679-686.
2. Lenhardt R, Marker E, Goll V, et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology 1997; 87: 1318-1323.
3. Schied H, Kurz A, Sessler DI, Kozek S, Reiter A. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet 1996; 347: 289-292.
4. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Eng J Med 1996; 334: 1209-1215.
5. Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 1997; 277: 1127-1134.
6. Declaration of Helsinki [].
© 2002 European Academy of Anaesthesiology