Abstract
BackgroundDespite the availability of effective warming systems, the prevalence of hypothermia remains high in patients undergoing surgery. Occurrence of perioperative hypothermia may influence the rate of postoperative complications. Recommendations for the prevention of inadvertent perioperative hypothermia have been developed and are effective to reduce the frequency of perioperative hypothermia when professionals comply with. French Society of Anesthesiology (SFAR) decided to promote guidelines for the prevention of inadvertent hypothermia, and to conduct beforehand a pragmatic assessment of the prevalence of hypothermia in France. The hypothesis was that the rate of hypothermic patients (Tc<36°C) admitted to the RR remains high (around 50%), and that was the consequence of a warming device underutilization and/or was related to the type of health facilities.MethodsAn observational, prospective and multi-centric study was conducted in France between October 2014 and May 2016 among patients over 45 years undergoing non-cardiac, non-outpatient surgery with anesthesia lasting >30 minutes in 52 centers. Patients undergoing pulmonary or proctologic surgery and those having non-invasive procedures performed under general anesthesia (for example, digestive endoscopy) were excluded from our study. Patients being operated under plexus anesthesia alone, surgeries involving hemorrhaging or infection, and patients presenting at least one organ failure were also excluded. The primary endpoint was the percentage of patients with a core temperature (Tc) <36°C on admission to the recovery room (RR).ResultsAmong 893 subjects (median age 66.9 years), prevalence of hypothermia on admission to the RR was 53.5%. At least one warming system was used for 90.4% of the patients. Identified risk factors for Tc<36°C included age≥70 years (OR = 1.41 [CI95%: 1.02–1.94]), duration of anesthesia from 1 to 2 hours (OR = 1.94 [CI95%: 1.04–3.64]) and a decrease in Tc of >0.5°C between anesthesia induction and surgical incision (OR = 1.82 [CI95%: 1.15–2.89]). Only a combination of pre-warming and intraoperative warming prevented a Tc<36°C (OR = 0.48 [CI95%: 0.24–0.96]).ConclusionsThe prevalence of hypothermia among patients admitted to the RR remains high. Our results suggest that only the combination of pre-warming and intraoperative warming significantly decreases it.
Highlights
Our results suggest that only the combination of pre-warming and intraoperative warming significantly decreases it
General or neuraxial anesthesia causes a change in thermoregulation leading to the appearance of inadvertent hypothermia, which is defined as a core body temperature (Tc) below 36 ̊C when corrective measures are not taken [1]
A survey on perioperative hypothermia conducted in 17 European countries has shown that active warming is used in only 38.5% of cases and that the perioperative temperature was monitored in only 19.4% of patients [7]
Summary
General or neuraxial anesthesia causes a change in thermoregulation leading to the appearance of inadvertent hypothermia, which is defined as a core body temperature (Tc) below 36 ̊C when corrective measures are not taken (active warming) [1]. Such perioperative hypothermia may be responsible for a range of adverse events on awakening from anesthesia and/or during the postoperative period [1,2]. In spite of data supporting active warming during surgery and the availability of effective warming systems, the prevalence of perioperative hypothermia remains extremely variable from one health facility to another, ranging from 4% to more than 70% [5,6]. The hypothesis was that the rate of hypothermic patients (Tc
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