Temperature management during the perioperative period and frequency of inadvertent hypothermia in a general hospital
Keywords:
Hypothermia, Body temperature regulation, Perioperative period, Anesthesia
Abstract
Introduction: Perioperative hypothermia is associated with increased morbidity and mortality. Consequently, surgical patient temperature should be the fundamental concern but, nonetheless, it is still the least valued physiological parameter
Objectives: To assess temperature management during the perioperative period and determine the frequency of inadvertent hypothermia and related factors.
Materials and methods: Prospective observational study in adult patients scheduled for surgical procedure with anesthesia time >30 min. Hypothermia is defined as a forehead skin temperature <35.9 °C. The null hypothesis of no difference between patients with normoth-ermia and hypothermia was proposed. Comparison of quantitative variables was analyzed with the Student "t" test, and the Chi square was used for the qualitative variables. The analysis was followed by a logistic regression analysis.
Results: We included 167 consecutive patients; intraoperative monitoring of temperature was used in 10% of patients, and the use of warm intravenous fluids and forced air heating in 78% and 63%, respectively. The frequency of inadvertent hypothermia was 56.29%, associated with age >65 years, female gender and BMI > 30 kg/m2. This last variable might have been influenced by the method of temperature measurement.
Conclusion: Warming measures without temperature monitoring do not result in the desired effect. The high frequency of inadvertent hypothermia requires action guidelines for prevention and management, especially in high-risk patients who, in this study, were patients > 65 years of age and females.
References
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2. Rajagopalan S, Mascha E, Na J, Sessler DI. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology. 2008;108:71-7.
3. Tse EY, Cheung WY, Ng KF, Luk KD. Reducing perioperative blood loss and allogeneic blood transfusion in patients undergoing major spine surgery. J Bone Joint Surg Am. 2011;93:1268-77.
4. 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 trial. JAMA. 1997;277:1127-34.
5. 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.
6. Mauermann WJ, Nemergut EC. The Anesthesiologist's role in the prevention of surgical site infections. Anesthesiology. 2006;105:413-21.
7. Heier T, Caldwell JE. Impact of hypothermia on the response to neuromuscular blocking drugs. Anesthesiology. 2006;104:1070-80.
8. Heier T, Caldwell JE, Sessler DI, Miller RD. Mild intraoperative hypothermia increases duration of action and spontaneous recovery of vecuronium blockade during nitrous oxide-isofluorane anesthesia in humans. Anesthesiology. 1991;74:815-9.
9. Leslie K, Sessler DI, Bjorksten AR, Moayeri A. Mild hypothermia alters propofol pharmacokinetics and increases the duration of action of atracurium. Anesth Analg. 1995;80:1007-14.
10. Vitez TS, White PF, Eger E. Effects of hypothermia on halothane MAC and isoflurane MAC in the rat. Anesthesiology. 1974;41:80-1.
11. Sessler DI. Complications and treatment of mild hypothermia. Anesthesiology. 2001;95:531-43.
12. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109:318-38 [review]
13. Harper CM, Andrzejowski JC, Alexander R. Nice and warm. Br J Anaesth. 2008;101:293-5.
14. Knaepel A. Inadvertent perioperative hypothermia: a literatura review. J Perioper Pract. 2012;22:86-90.
15. Moola S, Lockwood C. Effectiveness of strategies for the management and/or prevention of hypothermia within the adult perioperative environment. Int J Evid Based Healthc. 2011;9:337-45.
16. Ross-Anderson DJ. A NICE idea or a high price to pay? Local assessment of national guidelines. Anaesthesia. 2009;64:330-1.
17. De Mattia AL, Barbosa MH, De Mattia Rocha A, Farias HL, Santos CA, Santos DM. Hipotermia en pacientes en el período perioperatorio. Rev Esc Enferm USP. 2012;46:60-6.
18. Karalapillai D, Story DA, Calzavacca P, Licari E, Liu YL, Hart GK. Inadvertent hypothermia and mortality in postoperative intensive care patients: retrospective audit of 5050 patients. Anaesthesia. 2009;64:968-72.
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21. Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, et al., ACC/AHA. Guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. J Am Coll Cardiol. 2007;50:1707-32.
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29. Modell JG, Katholi CR, Kumaramangalam SM, Hudson EC, Graham D. Unreliability of the infrared tympanic thermometer in clinical practice: a comparative study with oral mercury and oral electronic thermometers. South Med J. 1988;91:649-54.
30. Hooper VD, Chard R, Clifford T, Fetzer S, Fossum S, Godden B, et al. ASPAN's evidence-based clinical practice guideline for the promotion of perioperative normothermia: second edition. J Perianesth Nurs. 2010;25:346-65.
31. Kongsayreepong S, Chaibundit C, Chadpaibool J, Komoltri C, Suraseranivongse S, Suwannanonda P, et al. Predictor of core hypothermia and the surgical intensive care unit. Anesth Analg. 2003;96:826-33.
32. Fernandes LA, Braz LG, Koga FA, Kakuda CM, Módolo NS, de Carvalho LR, et al. Comparison of peri-operative core temperature in obese and non-obese patients. Anaesthesia. 2012;67:1364-9.
33. Kasai T, Hirose M, Matsukawa T, Takamata A, Tanaka Y. The vasoconstriction threshold is increased in obese patients during general anaesthesia. Acta Anaesthesiol Scand. 2003;47:588-92.
34. Hart SR, Bordes B, Hart J, Corsino D, Harmon D. Unintended perioperative hypothermia. Ochsner J. 2011;11:259-70.
35. Andrzejowski J, Hoyle J, Eapen G, Turnbull D. Effect of prewarming on post-induction core temperature and the incidence of inadvertent perioperative hypothermia in patients undergoing general anaesthesia. Br J Anaesth. 2008;101:627-31.
36. Díaz M, Becker DE. Thermoregulation: physiological and clinical considerations during sedation and general anesthesia. Anesth Prog. 2010;57:25-32.
37. Matsukawa T, Sessler DI, Sessler AM, Schroeder M, Ozaki M, Kurz A, et al. Heat flow and distribution during induction of general anesthesia. Anesthesiology. 1995;82:662-73.
38. Torrie JJ, Yip P, Robinson E. Comparison of forced-air warming and radiant heating during transurethral prostatic resection under spinal anaesthesia. Anaesth Intensive Care. 2005;33:733-8.
39. Leung KK, Lai A, Wu A. A randomised controlled trial of the electric heating pad vs forced-air warming for preventing hypothermia during laparotomy. Anaesthesia. 2007;62:605-8.
40. Fanelli A, Danelli G, Ghisi D, Ortu A, Moschini E, Fanelli G. The efficacy of a resistive heating under-patient blanket versus a forced-air warming system: a randomized controlled trial. Anesth Analg. 2009;108:199-201.
41. Truell KD, Bakerman PR, Teodori MF, Maze A. Third-degree burns due to intraoperative use of a Bair Hugger warming device. Ann Thorac Surg. 2000;69:1933-4.
42. Ayala JL, Coe A. Thermal softening of tracheal tubes: an unrecognized hazard of the Bair Hugger active patient warming system. Br J Anaesth. 1997;79:543-5.
43. Andrzejowski JC, Turnbull D, Nandakumar A, Gowthaman S, Eapen G. A randomised single blinded study of the administration of pre-warmed fluid vs. active fluid warming on the incidence of peri-operative hypothermia in short surgical procedures. Anesthesia. 2010;65:942-5.
44. Insler SR, Sessler DI. Perioperative thermoregulation and temperature monitoring. Anesthesiol Clin. 2006;24: 823-37.
45. Lindhoff GA, Mac G, Palmer JH. An assessment of the thermal safety of microwave warming of crystalloid fluids. Anaesthesia. 2000;55:251-4.
46. Nierman DM. Tools that we use: if you can't measure it, you can't manage it. Crit Care Med. 2007;35:312-3.
2. Rajagopalan S, Mascha E, Na J, Sessler DI. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology. 2008;108:71-7.
3. Tse EY, Cheung WY, Ng KF, Luk KD. Reducing perioperative blood loss and allogeneic blood transfusion in patients undergoing major spine surgery. J Bone Joint Surg Am. 2011;93:1268-77.
4. 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 trial. JAMA. 1997;277:1127-34.
5. 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.
6. Mauermann WJ, Nemergut EC. The Anesthesiologist's role in the prevention of surgical site infections. Anesthesiology. 2006;105:413-21.
7. Heier T, Caldwell JE. Impact of hypothermia on the response to neuromuscular blocking drugs. Anesthesiology. 2006;104:1070-80.
8. Heier T, Caldwell JE, Sessler DI, Miller RD. Mild intraoperative hypothermia increases duration of action and spontaneous recovery of vecuronium blockade during nitrous oxide-isofluorane anesthesia in humans. Anesthesiology. 1991;74:815-9.
9. Leslie K, Sessler DI, Bjorksten AR, Moayeri A. Mild hypothermia alters propofol pharmacokinetics and increases the duration of action of atracurium. Anesth Analg. 1995;80:1007-14.
10. Vitez TS, White PF, Eger E. Effects of hypothermia on halothane MAC and isoflurane MAC in the rat. Anesthesiology. 1974;41:80-1.
11. Sessler DI. Complications and treatment of mild hypothermia. Anesthesiology. 2001;95:531-43.
12. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109:318-38 [review]
13. Harper CM, Andrzejowski JC, Alexander R. Nice and warm. Br J Anaesth. 2008;101:293-5.
14. Knaepel A. Inadvertent perioperative hypothermia: a literatura review. J Perioper Pract. 2012;22:86-90.
15. Moola S, Lockwood C. Effectiveness of strategies for the management and/or prevention of hypothermia within the adult perioperative environment. Int J Evid Based Healthc. 2011;9:337-45.
16. Ross-Anderson DJ. A NICE idea or a high price to pay? Local assessment of national guidelines. Anaesthesia. 2009;64:330-1.
17. De Mattia AL, Barbosa MH, De Mattia Rocha A, Farias HL, Santos CA, Santos DM. Hipotermia en pacientes en el período perioperatorio. Rev Esc Enferm USP. 2012;46:60-6.
18. Karalapillai D, Story DA, Calzavacca P, Licari E, Liu YL, Hart GK. Inadvertent hypothermia and mortality in postoperative intensive care patients: retrospective audit of 5050 patients. Anaesthesia. 2009;64:968-72.
19. Torossian A. Thermal management during anaesthesia and thermoregulation standards for the prevention of inadvertent perioperative hypothermia. Best Pract Res Clin Anaesthesiol. 2008;22:659-68.
20. Hannenberg AA, Sessler DI. Improving perioperative temperature management. Anesth Analg. 2008;107:1454-7.
21. Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, et al., ACC/AHA. Guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. J Am Coll Cardiol. 2007;50:1707-32.
22. American Society of Anesthesiologist Task Force on Postanesthetic Care. Practice guidelines for postanesthetic care: a report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology. 2002;96:742-52.
23. National Institute for Health and Clinical Evidence. Clinical practice guidelines: The management of inadvertent perioperative hypothermia in adults. Available from: www.nice.org.uk/CG65
24. Langham GE, Maheshwari A, Contrera K, You J, Mascha E, Sessler DI. Noninvasive temperature monitoring in postanesthesia care units. Anesthesiology. 2009;111:90-6.
25. Höcker J, Bein B, Böhm R, Steinfath M, Scholz J, Horn EP. Correlation, accuracy, precision and practicability of perioperative measurement of sublingual temperature in comparison with tympanic membrane temperature in awake and anaesthetised patients. Eur J Anaesthesiol. 2012;29:70-4.
26. de Silva A. Anesthetic monitoring. In: Basic of anesthesia. 6th ed. Philadelphia: Elsevier Saunders Inc.; 2011. p. 817.
27. American Society of Anesthesiologists. Standards for basic anesthetic monitoring; 2010. http://asahq.org/For-Healthcare-Professionals/~/media/For%20Members/documents/Standards %20Guidelines%20Stmts/Basic%20Anesthetic%20Monitoring %202011.ashx [accessed 13.01.11]
28. Manuel Blanco-Pajón. ¿Es recomendable el monitoreo de la temperatura en los pacientes bajo anestesia? Implicaciones clínicas y anestésicas. Rev Mex Anestesiología. 2010;33:S70-5.
29. Modell JG, Katholi CR, Kumaramangalam SM, Hudson EC, Graham D. Unreliability of the infrared tympanic thermometer in clinical practice: a comparative study with oral mercury and oral electronic thermometers. South Med J. 1988;91:649-54.
30. Hooper VD, Chard R, Clifford T, Fetzer S, Fossum S, Godden B, et al. ASPAN's evidence-based clinical practice guideline for the promotion of perioperative normothermia: second edition. J Perianesth Nurs. 2010;25:346-65.
31. Kongsayreepong S, Chaibundit C, Chadpaibool J, Komoltri C, Suraseranivongse S, Suwannanonda P, et al. Predictor of core hypothermia and the surgical intensive care unit. Anesth Analg. 2003;96:826-33.
32. Fernandes LA, Braz LG, Koga FA, Kakuda CM, Módolo NS, de Carvalho LR, et al. Comparison of peri-operative core temperature in obese and non-obese patients. Anaesthesia. 2012;67:1364-9.
33. Kasai T, Hirose M, Matsukawa T, Takamata A, Tanaka Y. The vasoconstriction threshold is increased in obese patients during general anaesthesia. Acta Anaesthesiol Scand. 2003;47:588-92.
34. Hart SR, Bordes B, Hart J, Corsino D, Harmon D. Unintended perioperative hypothermia. Ochsner J. 2011;11:259-70.
35. Andrzejowski J, Hoyle J, Eapen G, Turnbull D. Effect of prewarming on post-induction core temperature and the incidence of inadvertent perioperative hypothermia in patients undergoing general anaesthesia. Br J Anaesth. 2008;101:627-31.
36. Díaz M, Becker DE. Thermoregulation: physiological and clinical considerations during sedation and general anesthesia. Anesth Prog. 2010;57:25-32.
37. Matsukawa T, Sessler DI, Sessler AM, Schroeder M, Ozaki M, Kurz A, et al. Heat flow and distribution during induction of general anesthesia. Anesthesiology. 1995;82:662-73.
38. Torrie JJ, Yip P, Robinson E. Comparison of forced-air warming and radiant heating during transurethral prostatic resection under spinal anaesthesia. Anaesth Intensive Care. 2005;33:733-8.
39. Leung KK, Lai A, Wu A. A randomised controlled trial of the electric heating pad vs forced-air warming for preventing hypothermia during laparotomy. Anaesthesia. 2007;62:605-8.
40. Fanelli A, Danelli G, Ghisi D, Ortu A, Moschini E, Fanelli G. The efficacy of a resistive heating under-patient blanket versus a forced-air warming system: a randomized controlled trial. Anesth Analg. 2009;108:199-201.
41. Truell KD, Bakerman PR, Teodori MF, Maze A. Third-degree burns due to intraoperative use of a Bair Hugger warming device. Ann Thorac Surg. 2000;69:1933-4.
42. Ayala JL, Coe A. Thermal softening of tracheal tubes: an unrecognized hazard of the Bair Hugger active patient warming system. Br J Anaesth. 1997;79:543-5.
43. Andrzejowski JC, Turnbull D, Nandakumar A, Gowthaman S, Eapen G. A randomised single blinded study of the administration of pre-warmed fluid vs. active fluid warming on the incidence of peri-operative hypothermia in short surgical procedures. Anesthesia. 2010;65:942-5.
44. Insler SR, Sessler DI. Perioperative thermoregulation and temperature monitoring. Anesthesiol Clin. 2006;24: 823-37.
45. Lindhoff GA, Mac G, Palmer JH. An assessment of the thermal safety of microwave warming of crystalloid fluids. Anaesthesia. 2000;55:251-4.
46. Nierman DM. Tools that we use: if you can't measure it, you can't manage it. Crit Care Med. 2007;35:312-3.
How to Cite
1.
Castillo Monzón CG, Candia Arana CA, Marroquín Valz HA, Aguilar Rodríguez F, Benavides Mejía JJ, Alvarez Gómez JA. Temperature management during the perioperative period and frequency of inadvertent hypothermia in a general hospital. Colomb. J. Anesthesiol. [Internet]. 2013 Apr. 1 [cited 2024 Apr. 28];41(2):97-103. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/795
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2013-04-01
How to Cite
1.
Castillo Monzón CG, Candia Arana CA, Marroquín Valz HA, Aguilar Rodríguez F, Benavides Mejía JJ, Alvarez Gómez JA. Temperature management during the perioperative period and frequency of inadvertent hypothermia in a general hospital. Colomb. J. Anesthesiol. [Internet]. 2013 Apr. 1 [cited 2024 Apr. 28];41(2):97-103. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/795
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