Effects of Cling Film Draping Material on Body Temperature of Mice During Surgery
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Journal of the American Association for Laboratory Animal Science Vol 60, No 2
Copyright 2021 March 2021
by the American Association for Laboratory Animal Science Pages 195–200
Effects of Cling Film Draping Material on Body
Temperature of Mice During Surgery
Natalie A Celeste,1,* Kathryn M Emmer,1 Willie A Bidot,2 Marcel I Perret-Gentil,3 and Raphael A Malbrue1
General anesthesia induces many systemic effects, including thermoregulatory impairment and subsequent perioperative
hypothermia. Due to the animals’ small size, monitoring and maintaining body temperatures in laboratory rodents during
anesthesia is important for successful surgical outcomes and prompt anesthetic recovery. Draping materials have the potential
to aid in thermal support during surgical anesthesia. In this study, rectal and surface (infrared) temperatures were measured
in C57BL/6 mice under isoflurane anesthesia every 5 min for the duration of a 35-min sham surgery. In addition to placement
on a circulating water bath, mice (n = 6/group) were draped with commercial cling film (CF; Press’n Seal, Glad, Oakland,
CA), a conventional paper drape (PD), or no drape (ND) during surgery. Results demonstrated that CF-draped animals had
significantly higher rectal temperatures than nondraped animals. Furthermore, surface temperatures of CF-draped mice were
considerably higher than those of both paper-draped and undraped animals. The data indicate that cling film is an effective
material to help minimize hypothermia in mice and potentially in other laboratory rodents requiring general anesthesia.
Abbreviations: CF, commercial cling film; ND, no drape; PD, paper drape
DOI: 10.30802/AALAS-JAALAS-20-000089
Surgery and anesthesia introduce many challenges, especially selection of an appropriate anesthetic protocol and careful moni-
in veterinary medicine, due to the diversity of species. One toring of the patient throughout anesthesia until full recovery
major challenge during general anesthesia involves changes in occurs. Strict anesthetic monitoring and the use of supplemental
an animal’s thermoregulatory ability.1,14 Body temperatures in heat devices have been shown to reduce the likelihood of com-
mice and rats fall significantly during anesthesia if no thermal plications, improve overall postoperative recovery, and reduce
support is provided.29,30 Hypothermia occurs due to drug- mortality associated with surgical procedures.1,7,15,16 However,
induced alterations to the thermoregulatory center, inadequate due to these species’ small size, monitoring equipment must
circulation, and a loss of body heat to the environment from be specialized and is often costly. Cost-effective and practical
evaporation, radiation, conduction, and convection.7 Mice are alternative equipment and materials would facilitate monitor-
particularly susceptible to hypothermia, due to their large sur- ing and care of rodents.
face area per gram of body weight, which permits significant Various draping options are available for rodent surgery, and
physiologic changes in response to fluctuations in the ambient their use is vital for both sterile technique and heat retention.
temperature.31 Covering the animal’s body with towels, drapes, Traditionally, paper draping material has been a popular op-
or blankets to reduce the area exposed to the environment can tion, because it is relatively inexpensive and can be autoclaved
minimize heat loss.6,7,13 Placing the animal on an insulated sur- together with surgical instruments.15,16 Some institutions have
face can limit conductive heat loss. In larger animals, warmed adopted varying methods and types of draping, including no
fluids can be given perioperatively, heated anesthetic gasses drape and paper draping. Commercial cling film (CF) has been
can be administered, and heated blankets and heat packs can used as draping due to its low cost, ease of use, and sterility
be applied to body surfaces to provide exogenous heat.1,7 Safer straight out of the box.9 Our study team sought to evaluate the
and more practical methods for rodents are circulating water effects of draping material on intraoperative thermoregulation
heating blankets, thermal gel packs, and warming lamps, which in mice by measuring rectal temperature (modified rectal probe)
are commonly used for thermal support during anesthesia.5,14 and surface temperature (infrared device) during a 35-min
Addressing all of these factors can contribute to maintaining laparotomy procedure, with both temperature devices chosen
normothermia during anesthesia. for affordability and availability. We hypothesized that mice
Risk of mortality is elevated during anesthesia and in the draped with CF would maintain a higher intraoperative body
postoperative period, including in rodents.1,13 Hypothermia temperature under general anesthesia than would mice with
induced by anesthesia can negatively affect rodents by alter- traditional paper drapes or no drape.
ing vital parameters such as heart rate and blood pressure and
delaying anesthetic recovery.3,5,12,19 These risks require careful Materials and Methods
Animals and facility Male C57BL/6 mice (n = 18; weight, 25
Received: 25 Jun 2020. Revision requested: 19 Jul 2020. Accepted: 15 Sep 2020. to 30 g; age, 3 to 5 mo; The Jackson Laboratory, Bar Harbor, ME)
1University Laboratory Animal Resources, The Ohio State University, Columbus, Ohio;
were used in this study. All procedures were approved by Ohio
2Office of Animal Resources, Western University of Health Sciences, Pomona, California;
State University’s IACUC and were completed at the univer-
and 3Laboratory Animal Resources Center, The University of Texas at San Antonio, San
Antonio, Texas sity. The facility is AAALAC-accredited, USDA-registered, and
*Corresponding author. Email: celeste.11@osu.edu OLAW-assured. Animals were housed at 70 to 72 °F (21.1 to 22.2
195
Vol 60, No 2 Journal of the American Association for Laboratory Animal Science March 2021 °C), 30% to 70% humidity, 10 to 12 room air changes hourly, and No additional thermal support was provided. The abdomen was a 12:12-h light:dark cycle with 4 or 5 mice in each polysulfone clipped to expose a 3 × 3 cm square of skin. A surgical scrub IVC (NexGen Mouse 500, Allentown Caging, Allentown, NJ) consisting of 6 alternating passes of chlorohexidine and isopro- on disposable bedding (0.12-in., Bed-O-Cobs, The Andersons, pyl alcohol was applied to the surgical area. Lidocaine (1 mg/kg Maumee, OH). Mice were fed pelleted laboratory rodent chow (LidoJect [lidocaine 2%], Henry Schein Animal Health, Melville, (Teklad LM-485 Mouse/Rat Sterilizable Diet [7912-irradi- NY) diluted in sterile saline was administered by intradermal ated], Envigo, Indianapolis, IN) and received water through injection at the midline to provide local anesthesia. Excess sur- an automatic watering system. The facility sentinel program gical scrub was removed by using sterile gauze, leaving a dry tests for and excludes mouse parvoviruses, murine norovirus, surgical site for consistent surface temperature measurements. mouse hepatitis virus, Theiler murine encephalomyelitis vi- The skin preparation time averaged 4.3 min across all 3 groups. rus, murine rotavirus, Sendai virus, pneumonia virus of mice, After preparation, the mouse was moved to the surgery area reovirus types 1 through 4, Mycoplasma pulmonis, lymphocytic and placed on a circulating water heating blanket (38 °C; model choriomeningitis virus, Spironucleus muris, Entamoeba, fur mites TP650, Gaymar Industries, Orchard Park, NY). The rectal probe (Myobia, Myocoptes, and Radfordia spp.), pinworms (Aspiculuris was inserted (Figure 1 B), and the specified draping material and Syphacia spp.), Pneumocystis spp., Corynebacterium bovis, and was placed over the mouse. At this time, the first tempera- mouse chapparvovirus. ture measurements were taken by using the rectal probe and Drape material Mice were divided into 3 groups according infrared thermometer and recorded as the 0-min time point. to the draping method. Six mice were assigned randomly to After 5 min, a 1-cm longitudinal surgical incision was made each group: paper drape (PD; catalog number 89534, Sterile into the abdominal cavity to permit additional heat loss from Half Drape, Halyard Health, Alpharetta, GA), CF (Press’n Seal, an exposed body cavity, as occurs during a surgery. Another 100 ft2 roll, The Glad Products Company, Oakland, CA), or no temperature measurement was taken at this time. Rectal and surgical drape (ND). Any draping used was sized to cover the infrared temperatures were taken every 5 min after the time of entire animal, and fenestration was cut to match the 3 × 3 cm surgical incision, for a total of 35 min. After the 35-min timepoint area of surgical preparation. The PD rested on the table around reading, mice were euthanized via exsanguination under deep the mouse, whereas the CF drape was lightly pressed to stick it anesthesia, followed by cervical dislocation. to the table on either side of the mouse. Statistical analysis All data were analyzed by using GraphPad Temperature-monitoring devices The rectal probe was cre- Prism statistical software (Prism 7, GraphPad Software, La ated from a skin temperature sensor device (Level 1 Skin Jolla, CA). Two-way repeated-measures ANOVA was used for Temperature Sensor–Adult; Smiths Medical, Minneapolis, MN) statistical comparison of temperature measurements between as shown in Figure 1 A. The device was connected to a vital groups. When appropriate, posthoc analysis was performed by parameter–monitoring device (Surgivet Advisor 3 Parameter using the Tukey multiple-comparisons test. For all analyses, an Vital Signs Monitor, Smiths Medical). The fabric pad around α level of P ≤ 0.05 was considered statistically significant. Sum- the thermometer was removed, exposing the sensor. A small mary data are presented as mean and SEM. amount of sterile lubricant was applied before inserting the full length of the probe (15 mm). Prior to study initiation, a Results randomly selected subset of mice (n = 6) was used to verify Surgical procedure The preparation time for all draping that the modified rectal probe was giving physiologically ap- groups (anesthesia induction, drug administration, and surgical propriate readings by manually restraining the conscious mice preparation) averaged 4.3 min and did not differ significantly and inserting the rectal probe as described. between groups. The mean total anesthesia time was 45.8 min Surface temperatures of mice were monitored by using an for the PD group, 49.3 min for the CF animals, and 45.5 min for infrared thermometer (model RAYMT4U, Raytek MiniTemp ND mice and did not significantly differ between groups. The Infrared Thermometer, Fluke, Everett, WA). At each data col- temperature in the procedural room in which the study took lection point, infrared thermometers were held 6 in. (15.2 cm) place was 71.9 ± 0.2 °F (22.2 ± 0.1 ºC). away from the mouse. To ensure a consistent distance for infra- Rectal temperatures The baseline rectal temperatures taken for red temperature measurements, a sterile cotton-tip applicator rectal probe verification prior to the study had a mean of 99.2 ± 6 in. (15.24 cm) in length was held in between the mouse and 2.7°F (37.3 ± 1.7 ºC) in awake mice. The mean rectal temperatures the infrared device, with one end of the applicator touching for all groups at each time point can be seen in Figure 2. The CF the skin and the opposite end touching the infrared device. group showed an increase in mean rectal temperature at each The infrared device was pointed at a skin site 3 to 4 mm left time point over the course of the procedure. In contrast, the PD and lateral to the abdominal incision not covered by draping and ND groups showed a decrease in mean rectal temperature material (Figure 1 B). during the first 10 min and began to increase thereafter. Surgical procedure and temperature measurements The Examining the change in rectal temperature from 0 to 35 min mice in this study were tested over 2 d, according to draping revealed that the CF group had a mean increase of 2.1 ± 1.0 °F group. Mice were premedicated with buprenorphine (0.1 mg/ (1.2 ± 0.6 ºC), the mean change of the PD group was 0.0 ± 2.9 kg SC; buprenorphine hydrochloride, injection [0.3 mg/mL], °F (0.0 ± 1.6 ºC), and the ND group had mean decrease of 0.1 Par Pharmaceutical, Chestnut Ridge, NY) 15 to 20 min prior to ± 3.7 °F (0.0 ± 2.1 ºC). Overall, drape material had a significant anesthesia. All procedures were conducted in the same room effect (F2,15 = 5.128, P = 0.0201) on rectal temperature. Posthoc under thermostatic control set to 72 °F (22.2 °C) and during analysis showed that CF-draped mice had significantly higher the light phase of the photoperiod. Each mouse was placed in rectal temperatures than did ND mice at time points 5 min (P an induction chamber with 100% oxygen and 5% isoflurane = 0.0336), 10 min (P = 0.0027), 15 min (P = 0.0021), 20 min (P = at a flow rate of 1 L/min. After losing the righting reflex, the 0.0027), 25 min (P = 0.0035), 30 min (P = 0.0026), and 35 min (P mouse was removed from the induction chamber and moved = 0.0064). However, the mean rectal temperatures of CF-draped to the preparation table. A nose cone was applied to continue animals were not significantly different than those of PD animals anesthesia at 2% isoflurane for the remainder of the procedure. at time points 5 min through 35 min. Rectal temperatures were 196
Using cling film for thermal support during mouse surgery
Figure 1. (A) Rectal temperature-monitoring device used in this study. Fabric was removed to expose the sensor (*) for rectal temperature
measurement. (B) Image displays application and position of rectal sensor (arrow) in a mouse draped in CF during the procedure. The white
circle indicates where the infrared device was pointed on the skin (left-lateral to incision site) for temperature readings. The white line indicates
abdominal incision.
Figure 2. Rectal temperatures (mean ± SEM [error bars]) during anesthesia for ND (black, n = 6), PD (blue, n = 6), and CF (red, n = 6) animal
groups over time (in minutes). Abdominal incision was made at timepoint 5 min (+). Rectal temperature differed significantly (P < 0.05) between
CF and ND groups (red asterisk,*) and between PD and ND groups (blue asterisk, *) but not between CF and PD groups.
significantly higher in PD mice than in ND at time points 15 (P = 0.0214), 30 min (P = 0.0214), and 35 min (P = 0.0073). In
min (P = 0.0404), 20 min (P = 0.0343), 25 min (P = 0.0293), and addition, CF-draped animals had significantly higher average
30 min (P = 0.0204). Temperatures at all other time points were infrared temperatures than PD animals at 5 min (P = 0.0003),
not statistically different between draping groups (P > 0.05). 10 min (P = 0.0012), 15 min (P = 0.0018), 20 min (P = 0.0171), 25
Surface temperatures The mean infrared temperatures for min (P = 0.0138), 30 min (P = 0.0211), and 35 min (P = 0.0064).
each group can be seen in Figure 3. As compared with the rectal In contrast to rectal temperatures, infrared temperatures were
temperatures, the infrared temperatures were more variable significantly higher in the ND group than in the PD group at
between mice within each group. Examination of the changes in time points 5 min (P = 0.0121), 10 min (P = 0.0154), 15 min (P
surface body temperature from 0 to 35 min revealed that the CF = 0.0097), and 20 min (P = 0.0493). Temperatures at all other
and PD groups had mean increases of 0.8 ± 3.8 °F (0.4 ± 2.1 ºC) time points were not statistically different between draping
and 0.8 °F ± 3.8 °F (0.4 ± 2.1 ºC), respectively. The ND group had groups (P > 0.05).
an average decrease of 0.8 ± 3.6 °F (0.5 ± 2.0 ºC) in the infrared
body temperature. Drape material had a significant effect (F2,15 Discussion
= 16.77, P < 0.001) on infrared temperature. Posthoc analysis Most surgical patients become hypothermic due to cold ex-
showed that CF-draped animals had significantly higher aver- posure (room temperature, surgical site preparation and open
age infrared temperatures than did ND animals at 25 min body cavities) and anesthetic-induced inhibition of thermoregu-
197Vol 60, No 2 Journal of the American Association for Laboratory Animal Science March 2021 Figure 3. Infrared temperatures (mean ± SEM [error bars]) during anesthesia for ND (black, n = 6), PD (blue, n = 6), and CF (red, n = 6) animal groups. Abdominal incision was made at the 5-min time point (+). Surface body temperature differed significantly (P < 0.05) between CF and ND groups (red asterisk, *), PD and ND animals (blue asterisk, *), and CF and PD mice (black asterisk, *). latory control.1,14,20 Hypothermia is especially critical in small body temperature. When draping material was not used, the rodents, where even mild hypothermia may adversely affect lowest mean rectal body temperature measured was 88.2 °F (31.2 surgical outcomes.26 Therefore, providing heat support and en- ºC) and occurred 10 min into the monitoring period. Signifi- suring appropriate anesthetic monitoring is vital for successful cantly, the ND group had the lowest average rectal temperatures surgical outcomes and prompt anesthetic recovery. In addition at almost every time point, as compared with both CF and PD to delivering exogenous heat support, the choice of draping animals. Typical anesthetic doses increase the threshold range material can influence heat retention intraoperatively. In the for body temperatures to thermoregulatory defenses.18,20,32 The field of laboratory animal medicine, CF has many advantages temperature at which the hypothalamus responds to hypother- as a rodent draping material, including availability, low cost, mia is lowered due to an anesthetic-induced dose-dependent and transparency, which aids in intraoperative monitoring. We suppression of hypothalamic activity. 8,17,21 Compensatory had previously validated CF’s sterility by using ATP testing mechanisms to generate or preserve heat are also impaired. and RODAC plates,9 showing CF’s compatibility with sterile Anesthesia inhibits sympathetic response through cerebral technique. However, to our knowledge, no studies have been suppression, resulting in decreased heart and respiratory rates published to test this hypothesis that CF has a positive effect in addition to the inhibition of increases in metabolic rate and on temperature. The current study aimed to evaluate the effect heat production.14 In rodents, these physiologic changes have of draping material on intraoperative rectal and surface body multiple consequences due to hypothermia during anesthesia, temperatures. including delayed recovery to consciousness and decreases in The normal body temperature of laboratory mice is 98.8 to heart rate and blood pressure.3,5,12,19 Although not investigated 99.3 °F (37.1 to 37.4 ºC).31 Using the modified rectal probe, we in mice, hypothermia during anesthesia in other species, in- established a baseline rectal temperature of 99.2 ± 2.7 °F (37.3 ± cluding humans, confers an increased risk of cardiac events, 1.7 ºC) in healthy, awake mice. According to both temperature- coagulopathies, and infection.11,18,23,24 Therefore, maintaining measurement devices, CF maintained the highest mean body normothermia through thermal support is a critical practice temperatures (time point, 35 min; rectal temperature, 92.6 °F; in mitigating hypothermia’s negative effects during and after infrared temperature, 91.8 °F) throughout the procedure. How- anesthetic events. Reference ranges for detrimental hypothermia ever, CF and PD mean rectal temperatures were not statistically have not been established in rodents. Based on institutional different, perhaps warranting further investigation, possibly with experience and ranges published for other species, body tem- a larger sample size than in the current study. Throughout the peratures below 27 °C (80.6 °F) can be considered detrimental procedure, CF-draped animals did not experience a decrease in for mice,2,5,26 however, validation of a defined temperature is average rectal temperature early in anesthesia, as occurred with needed to verify this assumption. the other groups (Figure 2). Other studies have shown similar In comparison to findings in rectal temperatures, infrared results, with drops in body temperatures in mice and rats 10 to 20 temperature findings revealed an unexpected result. The mean min into anesthesia.25,30 We suspect that, compared with PD, CF infrared temperature for the ND group was higher than that provides better insulation around the animal by trapping warm for the PD group at all time points. A plausible explanation for air and, due to its impervious qualities, is uniquely able to reduce this is that because the paper drapes were not secured to the cutaneous heat loss.21 This would explain the overall higher patient or table, any movement caused the paper drape to shift intraoperative body temperatures with CF as compared with or lift. This shift, even if mild, could have caused air move- traditional PD. Thus, use of CF was able to ameliorate an initial ment over the patient and decreased temperature measured dip in rectal body temperature at the beginning of anesthesia. at the skin surface. Another explanation may be the method This study shows that using any draping material is better in which groups were tested. Not all mice were tested on the than using no drape at all for maintaining intraoperative rectal same day, thus introducing the possibility of the infrared device 198
Using cling film for thermal support during mouse surgery
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We thank the Ohio State University ULAR surgery and training Alfentanil slightly increases the sweating threshold and mark-
staff, especially Daniel Mackessy, Natalie Burkey, Curtis Rheingold, edly reduces the vasoconstriction and shivering thresholds.
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