Abstract
BackgroundBased on the previous investigation in our institution, the incidence of intraoperative hypothermia in neonates was high. Since September 1st, 2019, the recommendation had been launched to utilize ≤1 L/min fresh gas flow during the neonates’ surgical procedure. We therefore intended to evaluate the association between low fresh gas flow anesthesia and the occurrence of hypothermia in neonates undergoing digestive surgeries.MethodsA retrospective chart review, before-after study was conducted for neonates who underwent digestive surgeries. The primary outcomes were the incidence of hypothermia. The secondary outcomes included hospital mortality, the value of lowest temperature, blood loss, mean body temperature during the surgery, the length of hypothermia during the surgery and postoperative hospital length-of- stay (PLOS).Results249 neonates fulfilled the eligibility criteria. The overall incidence of intraoperative hypothermia was 81.9%. The low fresh gas flow anesthesia significantly reduced the odds of hypothermia [routine group: 149 (87.6%) versus low flow group: 55 (69.6%); p < 0.01]. Moreover, the low fresh gas flow anesthesia could reduce the length of hypothermia [routine group: 104 mins (50, 156) versus low flow group: 30 mins (0,100); p < 0.01], as well as elevate the value of lowest temperature for neonates [routine group: 35.1 °C (34.5, 35.7) versus low flow group: 35.7 °C (35.3, 36); p < 0.01]. After adjustment for confounding, low fresh gas flow anesthesia and the length of surgical time were independently associated with intraoperative hypothermia.ConclusionsLow fresh gas flow anesthesia is an effective way to alleviate hypothermia in neonates undergoing open digestive surgery.
Highlights
Based on the previous investigation in our institution, the incidence of intraoperative hypothermia in neonates was high
After screening for inclusion and exclusion criteria, 249 patients enrolled in this retrospective study, including 170 who underwent routine fresh gas flow anesthesia group and 79 in the low fresh gas flow anesthesia group
The neonates in the two groups were demographically similar with the routine group composed of 98 boys (57.6%) and low flow group 50 boys (63.3%)
Summary
Based on the previous investigation in our institution, the incidence of intraoperative hypothermia in neonates was high. We intended to evaluate the association between low fresh gas flow anesthesia and the occurrence of hypothermia in neonates undergoing digestive surgeries. Some congenital intestinal disorders in neonates need urgent surgical intervention, i.e., necrotizing enterocolitis, meconium ileus, and congenital intestinal atresia. This is a challenge for anesthesia providers and scrub nurses because normothermia is hard to be maintained on neonates undergoing digestive surgeries. The neonates are more susceptible to develop hypothermia since the mechanism of thermoregulation has not yet been well established. This problem is amplified by inadequately warmed operating room and fluid infusion. With increasing awareness of intraoperative hypothermia, emerging evidence has proposed various methods to maintain normothermia [5], while the effectiveness strategies on neonates are limited
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