Hypothermia in elective surgery: The hidden enemy
Keywords:
Hypothermia, General anesthesia, Anesthesia, Conduction, Body temperature, Ambulatory surgical
Abstract
Introduction: Hypothermia is perhaps the most frequent undesirable event in elective surgery. It is estimated that 1 h after surgery has initiated 70-90% of patients will experience hypothermia. In elective surgery, there are several factors leading to temperatures under 34 °C. Hypothermia may increases infections, bleeding and need for transfusion as well as the occurrence of an undesirable effect of discomfort and feared such as cold and postoperative shivering that can lead to cardiac complications due to increased of sympathetic influence.
Objectives: Review the causes of these low temperatures within intraoperative elective surgery and check if the current alternatives to prevent hypothermia are effective.
Methods: Review of non-systematic literature in PubMed and Medline was performed.
Results: Hypothermia is the most common and least diagnosed undesirable event of patients undergoing surgery although it is easy to detect and preventive measures do not present major difficulties in their implementation.
Conclusions: There are effective measures easy to set up, economical and effective to prevent hypothermia; the most important is the patient warm with hot air under pressure for 1 h and maintenance of air conditioning in the room above 22 °C. We just need to understand these measures and start to implement them.
References
1. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109:318-38.
2. Sessler DI, Lee KA, McGuire J. Isoflurane anesthesia and circadian temperature cycles. Anestesiology. 1991;75:985-9.
3. Sessler DI. Perianesthetic thermoregulation and heat balance in humans. FASEB J. 1993;7:638-44.
4. Kräuchi K. The human sleep-wake cycle reconsidered from a thermoregulatory point of view. Physio Behav. 2007;90:236-45.
5. Werner J. System properties, feedback control and effector coordination of human temperature regulation. Eur J Appl Physiol. 2009;109:13-25.
6. Nakamura K, Morriso SF. A thermosensory pathway that controls body temperature. Nat Neurosci. 2008;11:62-71.
7. Morrison SF, Nakamura K, Madden CJ. Central control of thermogenesis in mammals. Ex Physiol. 2008;93:773-97.
8. Sessler DI. Thermoregulatory defense mechanisms. Crit Care Med. 2009;37:203-10.
9. Sessler DI. Mild perioperative hypothermia. New Engl J Med. 1997;336:1730-7.
10. Sessler DI. Perioperative heat balance. Anesthesiology. 2000;92:578-96.
11. Kurz A, Xiong J, Sessler DI, Dechert M, Noyes K, Belani K. Desflurane reduces the gain of thermoregulatory arteriovenous shunt vasoconstriction in humans. Anesthesiology. 1995;83:1212-9.
12. Sheffield CW, Sessler DI, Hunt TK, Scheunenstuhl H. Mild hypothermia during halothane induced anaesthesia decreases resistance to Staphylococcus aureus dermal infection in guinea pigs. Wound Repair Regen. 1994;2:48-56.
13. Ozaki M, Sessler DI, Ozaqui H, Atarashi K, Negishi C, Suzuki H. The threshold for thermoregulatory vasoconstriction during nitrous oxide/sevoflurane anesthesia is reduced in elderly patients. Anesth Analg. 1997;84:1029-33.
14. Gendron F. "Burns" occurring during lengthy surgical procedures. J Clin Eng. 1980;5:20-6.
15. Cattaneo CG, Frank SM, Hesel TW, El-Rahmany HK, Kim LJ, Tran KM. The accuracy and precisión of body temperature monitoring methods during regional and general anesthesia. Anesth Analg. 2000;90:938-45.
16. Frank SM, El-Rahmany HK, Cattaneo CG, Barnes RA. Predictors of hypothermia during spinal anesthesia. Anesthesiology. 2000;92:1330-4.
17. Arkilitp CM, Akca O, Taguchi A, Sessler DI, Kurz A. Temperature monitoring and management during neuraxial anesthesia: an observational study. Anesth Analg. 2000;91:662-6.
18. Hendolin H, Lansimies E. Skin and central temperatures during continuous epidural analgesia and general anaesthesia in patients subjected to open prostatectomy. Ann Clin Res. 1982;14:181-6.
19. Szmuk P, Ezri T, Sessler DI, Stein A, Geva D. Spinal anesthesia only minimally increases the efficacy of postoperative forced-air rewarming. Anesthesiology. 1997;87:1050-4.
20. Frank SM, Higgins MS, Fleisher LA, Sitzmann JV, Raff H, Breslow MJ. Adrenergic, respiratory, and cardiovascular effects of core cooling in humans. Am J Physiol. 1997;272:R557-62.
21. Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: a randomized clinical rial. J Am Med Assoc. 1997;277:1127-34.
22. Greif R, Laciny S, Rajek A, Doufas AG, Sessler DI. Blood pressure response to thermoregulatory vasoconstriction during isoflurane and desflurane anesthesia. Acta Anaesthesiol Scand. 2003;47:847-52.
23. Frank SM, Beattie C, Christopherson R, Norris EJ, Perler BA, Williams GM, et al. Unintentional hypothermia is associated with postoperative myocardial ischemia. Anesthesiology. 1993;78:468-76.
24. Rand PW, Lacombe E, Hunt HE, Austin WH. Viscosity of normal human blood under normothermic and hypothermic conditions. J Appl Physiol. 1964;19:117-22.
25. Rohrer MJ, Natale AM. Effect of hypothermia on the coagulation cascade. Crit Care Med. 1992;20:1402-5.
26. Hessel E, Schmer G, Dillard D. Platelet kinetics during deep hypothermia. J Surg Res. 1980;28:23-34.
27. Valeri CR, Cassidy G, Khuri S, Feingold H, Ragno G, Altschule MD. Hypothermia-induced reversible platelet dysfunction. Ann Surg. 1987;205:175-81.
28. Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A. Mild intraoperative hypothermia increases blood loss and allogenic transfusion requirements during total hip arthroplasty. Lancet. 1996;347:289-92.
29. Cavallini M, Preis FWB, Casati A. Effects of mild hypothermia on blood coagulation in patients undergoing elective plastic surgery. Plast Reconstr Surg. 2005;116:316-21.
30. Van Oss CJ, Absolam DR, Moore LL, Park BH, Humbert JR. Effect of temperature on the chemotaxis, phagocytic engulfment, digestion and oxygen consumption of human polymorphonuclear leukocytes. J Reticuloendothelial Soc. 1980;27:561-5.
31. Fairchild KD, Viscardi RM, Hester L, Singh IS, Hasday JD. Effects of hypothermia and hyperthermia on cytokine production by cultured human mononuclear phagocytes from adults and newborns. J Interferon Cytokine Res. 2000;20:1049-55.
32. Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial. Lancet. 2001;358:876-80.
33. Kumar S, Wong PF, Melling AC, Leaper DJ. Effects of perioperative hypothermia and warming in surgical practice. Int Wound J. 2005;2:193-204.
34. Kirkpatrick AW, Chun R, Brown R, Simons RK. Hypothermia and the trauma patient. Can J Surg. 1999;42:333-43.
35. Macario A, Dexter F. What are the most important risk factors for a patient's developing intraoperative hypothermia? Anesth Analg. 2002;94:215-20.
36. Kurz A, Sessler DI, Narzt E, Lenhardt R, Lackner F. Morphometric influences on intraoperative core temperature changes. Anesth Analg. 1995;80:562-657.
37. Krenzischek DA, Frank SM, Kelly S. Forced air warming versus routine thermal care and core temperature measurement sites. J Postgrad Anesth Nurs. 1995;10:69-78.
38. Giesecke A, Sharkey A, Murphy M, Rice L, Lipton J. Control of postanaesthetic shivering with radiant heat. Acta Anesthesiol Scand. 1987;31:28-32.
39. Castillo Monzón CG, Candia Arana CA, Valz HA, Fernando Aguilar Rodríguez FA, Benavides Mejía JJ, Alvarez Gómez JA. Manejo de la temperatura en el perioperatorio y frecuencia de hipotermia inadvertida en un hospital general. Rev Colomb Anestesiol. 2013;41:97-103.
40. Slottman GJ, Jed EH, Burchard KW. Adverse effects of hypothermia in postoperative patients. Am J Surg. 1985;149:495-501.
41. Gauthier RL. Use of forced air warming system for intra-operative warming. Anaesthesiology. 1990;73:462.
42. Just B, Trévien V, Delva E, Lienhart A. Prevention of intraoperative hypothermia by preoperative skin-surface warming. Anesthesiology. 1993;79:214-8.
43. Glosten B, Hynson J, Sessler DI, McGuire J. Preanesthetic skin-surface warming reduces redistribution hypothermia caused by epidural block. Anesth Analg. 1993;77:488-93.
44. Hynson JM, Sessler DI, Moayeri A, McGuire J, Schroeder M. The effects of pre-induction warming on temperature and blood pressure during propofol/nitrous oxide anesthesia. Anesthesiology. 1993;79:219-28.
45. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical wound infection and shorten hospitalisation. N Engl J Med. 1996;334:1209-15.
46. Sessler DI, Schroeder M, Merrifield B, Matsukawa T, Cheng C. Optimal duration and temperature of prewarming. Anesthesiology. 1995;82:674-81.
47. Sessler DI, Moayeri A. Skin-surface warming: heat flux and central temperature. Anesthesiology. 1990;73:218-24.
48. Hynson J, Sessler DI. Intraoperative warming therapies: a comparison of three devices. J Clin Anesth. 1992;4:194-9.
49. Sessler DI. Consequence and treatment of perioperative hypothermia. Anesth Clin N Am. 1994;12:425-56.
51. Robles-Cervantes JA, Martinez-Molina R, Cárdenas-Camarena L. Heating infiltration solutions used in tumescent liposuction: minimizing surgical risk. Plast Reconstr Surg. 2005;116:1077-81.
2. Sessler DI, Lee KA, McGuire J. Isoflurane anesthesia and circadian temperature cycles. Anestesiology. 1991;75:985-9.
3. Sessler DI. Perianesthetic thermoregulation and heat balance in humans. FASEB J. 1993;7:638-44.
4. Kräuchi K. The human sleep-wake cycle reconsidered from a thermoregulatory point of view. Physio Behav. 2007;90:236-45.
5. Werner J. System properties, feedback control and effector coordination of human temperature regulation. Eur J Appl Physiol. 2009;109:13-25.
6. Nakamura K, Morriso SF. A thermosensory pathway that controls body temperature. Nat Neurosci. 2008;11:62-71.
7. Morrison SF, Nakamura K, Madden CJ. Central control of thermogenesis in mammals. Ex Physiol. 2008;93:773-97.
8. Sessler DI. Thermoregulatory defense mechanisms. Crit Care Med. 2009;37:203-10.
9. Sessler DI. Mild perioperative hypothermia. New Engl J Med. 1997;336:1730-7.
10. Sessler DI. Perioperative heat balance. Anesthesiology. 2000;92:578-96.
11. Kurz A, Xiong J, Sessler DI, Dechert M, Noyes K, Belani K. Desflurane reduces the gain of thermoregulatory arteriovenous shunt vasoconstriction in humans. Anesthesiology. 1995;83:1212-9.
12. Sheffield CW, Sessler DI, Hunt TK, Scheunenstuhl H. Mild hypothermia during halothane induced anaesthesia decreases resistance to Staphylococcus aureus dermal infection in guinea pigs. Wound Repair Regen. 1994;2:48-56.
13. Ozaki M, Sessler DI, Ozaqui H, Atarashi K, Negishi C, Suzuki H. The threshold for thermoregulatory vasoconstriction during nitrous oxide/sevoflurane anesthesia is reduced in elderly patients. Anesth Analg. 1997;84:1029-33.
14. Gendron F. "Burns" occurring during lengthy surgical procedures. J Clin Eng. 1980;5:20-6.
15. Cattaneo CG, Frank SM, Hesel TW, El-Rahmany HK, Kim LJ, Tran KM. The accuracy and precisión of body temperature monitoring methods during regional and general anesthesia. Anesth Analg. 2000;90:938-45.
16. Frank SM, El-Rahmany HK, Cattaneo CG, Barnes RA. Predictors of hypothermia during spinal anesthesia. Anesthesiology. 2000;92:1330-4.
17. Arkilitp CM, Akca O, Taguchi A, Sessler DI, Kurz A. Temperature monitoring and management during neuraxial anesthesia: an observational study. Anesth Analg. 2000;91:662-6.
18. Hendolin H, Lansimies E. Skin and central temperatures during continuous epidural analgesia and general anaesthesia in patients subjected to open prostatectomy. Ann Clin Res. 1982;14:181-6.
19. Szmuk P, Ezri T, Sessler DI, Stein A, Geva D. Spinal anesthesia only minimally increases the efficacy of postoperative forced-air rewarming. Anesthesiology. 1997;87:1050-4.
20. Frank SM, Higgins MS, Fleisher LA, Sitzmann JV, Raff H, Breslow MJ. Adrenergic, respiratory, and cardiovascular effects of core cooling in humans. Am J Physiol. 1997;272:R557-62.
21. Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: a randomized clinical rial. J Am Med Assoc. 1997;277:1127-34.
22. Greif R, Laciny S, Rajek A, Doufas AG, Sessler DI. Blood pressure response to thermoregulatory vasoconstriction during isoflurane and desflurane anesthesia. Acta Anaesthesiol Scand. 2003;47:847-52.
23. Frank SM, Beattie C, Christopherson R, Norris EJ, Perler BA, Williams GM, et al. Unintentional hypothermia is associated with postoperative myocardial ischemia. Anesthesiology. 1993;78:468-76.
24. Rand PW, Lacombe E, Hunt HE, Austin WH. Viscosity of normal human blood under normothermic and hypothermic conditions. J Appl Physiol. 1964;19:117-22.
25. Rohrer MJ, Natale AM. Effect of hypothermia on the coagulation cascade. Crit Care Med. 1992;20:1402-5.
26. Hessel E, Schmer G, Dillard D. Platelet kinetics during deep hypothermia. J Surg Res. 1980;28:23-34.
27. Valeri CR, Cassidy G, Khuri S, Feingold H, Ragno G, Altschule MD. Hypothermia-induced reversible platelet dysfunction. Ann Surg. 1987;205:175-81.
28. Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A. Mild intraoperative hypothermia increases blood loss and allogenic transfusion requirements during total hip arthroplasty. Lancet. 1996;347:289-92.
29. Cavallini M, Preis FWB, Casati A. Effects of mild hypothermia on blood coagulation in patients undergoing elective plastic surgery. Plast Reconstr Surg. 2005;116:316-21.
30. Van Oss CJ, Absolam DR, Moore LL, Park BH, Humbert JR. Effect of temperature on the chemotaxis, phagocytic engulfment, digestion and oxygen consumption of human polymorphonuclear leukocytes. J Reticuloendothelial Soc. 1980;27:561-5.
31. Fairchild KD, Viscardi RM, Hester L, Singh IS, Hasday JD. Effects of hypothermia and hyperthermia on cytokine production by cultured human mononuclear phagocytes from adults and newborns. J Interferon Cytokine Res. 2000;20:1049-55.
32. Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial. Lancet. 2001;358:876-80.
33. Kumar S, Wong PF, Melling AC, Leaper DJ. Effects of perioperative hypothermia and warming in surgical practice. Int Wound J. 2005;2:193-204.
34. Kirkpatrick AW, Chun R, Brown R, Simons RK. Hypothermia and the trauma patient. Can J Surg. 1999;42:333-43.
35. Macario A, Dexter F. What are the most important risk factors for a patient's developing intraoperative hypothermia? Anesth Analg. 2002;94:215-20.
36. Kurz A, Sessler DI, Narzt E, Lenhardt R, Lackner F. Morphometric influences on intraoperative core temperature changes. Anesth Analg. 1995;80:562-657.
37. Krenzischek DA, Frank SM, Kelly S. Forced air warming versus routine thermal care and core temperature measurement sites. J Postgrad Anesth Nurs. 1995;10:69-78.
38. Giesecke A, Sharkey A, Murphy M, Rice L, Lipton J. Control of postanaesthetic shivering with radiant heat. Acta Anesthesiol Scand. 1987;31:28-32.
39. Castillo Monzón CG, Candia Arana CA, Valz HA, Fernando Aguilar Rodríguez FA, Benavides Mejía JJ, Alvarez Gómez JA. Manejo de la temperatura en el perioperatorio y frecuencia de hipotermia inadvertida en un hospital general. Rev Colomb Anestesiol. 2013;41:97-103.
40. Slottman GJ, Jed EH, Burchard KW. Adverse effects of hypothermia in postoperative patients. Am J Surg. 1985;149:495-501.
41. Gauthier RL. Use of forced air warming system for intra-operative warming. Anaesthesiology. 1990;73:462.
42. Just B, Trévien V, Delva E, Lienhart A. Prevention of intraoperative hypothermia by preoperative skin-surface warming. Anesthesiology. 1993;79:214-8.
43. Glosten B, Hynson J, Sessler DI, McGuire J. Preanesthetic skin-surface warming reduces redistribution hypothermia caused by epidural block. Anesth Analg. 1993;77:488-93.
44. Hynson JM, Sessler DI, Moayeri A, McGuire J, Schroeder M. The effects of pre-induction warming on temperature and blood pressure during propofol/nitrous oxide anesthesia. Anesthesiology. 1993;79:219-28.
45. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical wound infection and shorten hospitalisation. N Engl J Med. 1996;334:1209-15.
46. Sessler DI, Schroeder M, Merrifield B, Matsukawa T, Cheng C. Optimal duration and temperature of prewarming. Anesthesiology. 1995;82:674-81.
47. Sessler DI, Moayeri A. Skin-surface warming: heat flux and central temperature. Anesthesiology. 1990;73:218-24.
48. Hynson J, Sessler DI. Intraoperative warming therapies: a comparison of three devices. J Clin Anesth. 1992;4:194-9.
49. Sessler DI. Consequence and treatment of perioperative hypothermia. Anesth Clin N Am. 1994;12:425-56.
51. Robles-Cervantes JA, Martinez-Molina R, Cárdenas-Camarena L. Heating infiltration solutions used in tumescent liposuction: minimizing surgical risk. Plast Reconstr Surg. 2005;116:1077-81.
How to Cite
1.
Bayter-Marín JE, Rubio J, Valedón A, Maciás Álvaro A. Hypothermia in elective surgery: The hidden enemy. Colomb. J. Anesthesiol. [Internet]. 2017 Jan. 1 [cited 2024 Apr. 27];45(1):48-53. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/48
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2017-01-01
How to Cite
1.
Bayter-Marín JE, Rubio J, Valedón A, Maciás Álvaro A. Hypothermia in elective surgery: The hidden enemy. Colomb. J. Anesthesiol. [Internet]. 2017 Jan. 1 [cited 2024 Apr. 27];45(1):48-53. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/48
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Narrative review
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