In reply to Dr Booth and colleagues, we certainly agree that there are many clinical benefits when maintaining perioperative normothermia. Some of them are the basis of our present perioperative practice, and several reports demonstrate important clinical findings outlined in our paper . It was our ambition to add knowledge about the pharmacological aspects of mild hypothermia and opioid use in the immediate postoperative period. The patients in our study population were otherwise healthy middle-aged females undergoing a standardized surgical procedure of short duration. Our patients did not demonstrate any postoperative morbidity that could be related to the group assignment.
At the time the study was undertaken - 3-4 yr before publication of the final paper - it was not an established routine at Kristianstad Central Hospital to provide forced air warming to all patients undergoing surgical procedures. In that perspective, it was indeed not unethical to conduct a clinical study that, in addition, introduced a method known to improve outcome in other patient populations. In addition, we are convinced that despite the demonstrated benefits of forced air warming, it is not used on a regular basis in hospitals even today, besides conventional heat-preserving methods, i.e. patients may still unfortunately experience far lower perioperative body temperatures than observed among our closely monitored study patients. As with all aspects of anaesthetic practice, it is important to use perioperative heat-preserving techniques to suit the individual patient's needs and the planned surgical procedure.
Thus, we believe it is still not unethical to decide whether forced air warming should be used or not in a specific setting instead of applied as a mandatory rule.
Department of Anesthesiology and Intensive Care; Kristianstad Central Hospital, Kristianstad and Lund University Hospital, Lund; Sweden
1. Persson K, Lundberg J. Hypothermia and opioid requirements. Eur J Anaesthesiol