Hypothermia In Elderly Patients Research Articles

Perioperative Hypothermia in Elderly Patients During Pelvic Floor Reconstruction Surgery: An Observational Study.

The potential predictors of pelvic floor reconstruction surgery hypothermia remain unclear. This prospective cohort study was aimed at identifying these predictors and evaluating the outcomes associated with perioperative hypothermia. Elderly patients undergoing pelvic floor reconstruction surgery were consecutively enrolled from April 2023 to September 2023. Perioperative temperature was measured at preoperative (T1), every 15min after the start of anesthesia (T2), and 15min postoperative (T3) using a temperature probe. Perioperative hypothermia was defined as a core temperature below 36°C at any point during the procedure. Multivariate logistic regression analysis was conducted to determine factors associated with perioperative hypothermia. A total of 229 patients were included in the study, with 50.7% experiencing hypothermia. Multivariate analysis revealed that the surgical method involving pelvic floor combined with laparoscopy, preoperative temperature < 36.5°C, anesthesia duration ≥ 120min, and the high levels of anxiety were significantly associated with perioperative hypothermia. The predictive value of the multivariate model was 0.767 (95% CI, 0.706 to 0.828). This observational prospective study identified several predictive factors for perioperative hypothermia in elderly patients during pelvic floor reconstruction surgery. Strategies aimed at preventing perioperative hypothermia should target these factors. Further studies are required to assess the effectiveness of these strategies, specifically in elderly patients undergoing pelvic floor reconstruction surgery.

Development and Validation of a Predictive Model for Intraoperative Hypothermia in Elderly Patients Undergoing Craniocerebral Tumor Resection: A Retrospective Cohort Study

ObjectiveTimely identification of elderly patients who are at risk of developing intraoperative hypothermia (IH) is imperative to enable appropriate interventions. This study aimed to develop a nomogram for predicting the risk of IH in elderly patients undergoing resection of craniocerebral tumor, and to validate its effectiveness. MethodsElderly patients who underwent craniocerebral tumor resection at a large tertiary hospital in eastern China between January 2019 and December 2022 were included (n=988). The study population was divided into a training set and a validation set by time period. Risk factors identified through the Least Absolute Shrinkage and Selection Operator Method and logistic regression analysis were used to establish the nomogram. The model was validated internally by Bootstrap method and externally by validation set through receiver operating characteristic (ROC) curve analysis, Hosmer-Lemeshow test, and decision curve analysis (DCA). ResultsA total of 273 (27.6%) patients developed IH. Duration of anesthesia (P<0.001), blood loss (P<0.001), preoperative temperature (P<0.001), tumor location (P<0.001), age (P<0.05), and mean arterial pressure (P<0.05) were identified as independent risk factors for IH. A nomogram integrating these six factors was constructed. The area under the ROC curve was 0.773 (95% CI: 0.735–0.811) (70.5% specificity and 75.0% sensitivity), indicating good predictive performance. The DCA demonstrated the clinical benefit of using the nomogram. ConclusionsOur model showed good performance in identifying elderly patients who are at high risk of developing IH during craniocerebral tumor resection. The nomogram can help inform timely preventive interventions.

Construction and validation of a risk prediction model for intraoperative hypothermia in elderly patients undergoing total hip arthroplasty.

To construct and validate an intraoperative hypothermia risk prediction model for elderly patients undergoing total hip arthroplasty (THA). We collected data from 718 patients undergoing THA in a tertiary hospital from January 2021 to December 2022. Of these patients, 512 were assigned to the modeling group from January 2021 to April 2022, and 206 participants were assigned to the validation group from May 2022 to December 2022. A logistic regression analysis was performed to construct the model. The area under the curve (AUC) was used to test the model's predictive ability. The incidence rate of intraoperative hypothermia was 51.67%. The risk factors entered into the risk prediction model were age, preoperative hemoglobin level, intraoperative blood loss, postoperative hemoglobin level, and postoperative systolic blood pressure. The model was constructed as follows: logit (P) = -10.118 + 0.174 × age + 1.366 × 1 (preoperative hemoglobin level) + 0.555 × 1 (postoperative hemoglobin level) + 0.009 × 1 (intraoperative blood loss) + 0.066 × 1 (postoperative systolic blood pressure). Using the Hosmer-Lemeshow test, the P value was 0.676 (AUC, 0.867). The Youden index, sensitivity, and specificity were 0.602, 0.790, and 0.812, respectively. The incidence rates of intraoperative hypothermia in the modeling and validation groups were 53.15% and 48.06%, respectively. The correct practical application rate was 89.81%. This model had good application potential. This risk prediction model has good predictive value and can accurately predict the occurrence of intraoperative hypothermia in patients who undergo THA, which provides reliable guidance for clinical work and has good clinical application value.

Effect of active forced air warming during the first hour after anesthesia induction and intraoperation avoids hypothermia in elderly patients

BackgroundThe study aimed at exploring an optimal temperature model of forced air warming during the first hour after induction and intraoperation to prevent hyperthermia for elderly patients undergoing laparoscopic abdominal surgery.MethodsThere were 218 patients that were randomly divided into 3 groups warmed with a forced-air warmer during surgery: Group L (intraoperative warming set to 38 °C, n = 63), Group H (intraoperative warming set to 42 °C, n = 65) and Group LH (intraoperative warming set to 42 °C for the first hour then set to 38 °C, n = 65). Core temperature in the preoperative room and PACU was measured by a tympanic membrane thermometer and in the operation room, a nasopharyngeal temperature probe was recorded. The rate of perioperative hypothermia, defined as a reduction in body temperature to < 36 °C was recorded as the primary outcome. Intraoperative anesthetic dosage, recovery time, adverse events, thermal comfort and satisfaction score were measured as secondary outcome.ResultsThe incidence of intraoperative and postoperative hypothermia was significantly lower in Group LH and Group H than Group L (18.75 and 15.62% vs 44.44%, P<0.001; 4.69 and 4.69% vs 20.63%, P<.05). Anesthetic dosage of rocuronium was lower in Group L than other two groups, with the opposite result of recovery time. The number of patients with shivering was higher in Group L but sweating was higher in Group H. Both of the thermal comfort and satisfaction score was highest in Group LH.ConclusionA temperature pattern of forced air warming set at 42 °C during the first hour after anesthesia induction and maintained with 38 °C was a suitable choice for elderly patients undergoing laparoscopic abdominal surgery lasting for more than 120 min.Trial registrationChictr.org.cn ChiCTR-2,100,053,211.

Effect of Forced-Air Warming Blanket on Perioperative Hypothermia in Elderly Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer.

The study aimed to evaluate the effect of forced-air warming blanket combined with conventional thermal insulation measures on inadvertent perioperative hypothermia (IPH) in elderly patients undergoing laparoscopic radical resection of colorectal cancer. A total of 70 elderly patients undergoing laparoscopic radical resection of colorectal cancer with general anesthesia were included, and divided into conventional warming treatment (CT) group or forced-air warming treatment (FT) group. In the FT group, based on the conventional warming strategy, patients received prewarming with the forced-air warming blanket (38°C) for ≥20 minutes before induction of anesthesia, and received this treatment continuously during operation. The core body temperature, recovery time from anesthesia, extubating time, and length of stay in the postanesthesia care unit were recorded. The incidence of IPH and postoperative shivering was observed. The incidence of IPH was significantly lower, and average minimum body temperature during the operation was significantly higher in the FT group than that in the CT group (5.7% vs. 22.8% and 36.23°C vs. 35.89°C, respectively). The intraoperative body temperature decreased less (0.32°C vs. 0.69°C), the recovery time from anesthesia was faster (12.8 minutes vs. 17.1 minutes), and the incidence of postoperative shivering was less (2.8% vs. 28.6%) in the FT group than the CT group. In elderly patients undergoing laparoscopic radical resection of colorectal cancer, use of forced-air warming blankets combined with conventional warming measures is more effective to maintain normal body temperature during the perioperative period and reduce the incidence of IPH.

The effect of interscalene brachial plexus block with propofol sedation on preventing perioperative hypothermia during arthroscopic shoulder surgery.

BackgroundInterscalene brachial plexus block (ISBPB) is commonly used with general anesthesia for postoperative pain management in shoulder surgery. This study investigated the incidence of hypothermia and changes in the body temperature in patients undergoing arthroscopic shoulder surgery under ISBPB with propofol sedation.MethodsThis retrospective study enrolled 220 patients who underwent arthroscopic shoulder surgery. Patients were divided into general anesthesia (n = 34) and ISBPB with propofol sedation (n = 186) groups, and medical records were retrospectively compared. In addition, patients from the ISBPB group were further divided according to age (elderly [≥ 65 years], n = 98 vs. young [< 65 years], n = 88), and the incidence of hypothermia and changes in the body temperature were compared.ResultsTwenty-seven patients (12.3%) experienced perioperative hypothermia (range: 35.3–35.9℃). The incidence of perioperative hypothermia was 29.4% and 9.1% in the general anesthesia and ISBPB groups, respectively, and there was a significant difference between the two groups (P = 0.002). The incidence of perioperative hypothermia according to age in the ISBPB group was 9.2% and 9.1% in the elderly and young groups, respectively, and there was no significant difference between the two groups (P = 0.983).ConclusionsThe incidence of perioperative hypothermia during arthroscopic shoulder surgery under ISBPB with propofol sedation is lower than that under general anesthesia. Furthermore, when using ISBPB with propofol sedation, the incidence of perioperative hypothermia in elderly patients is similar to that in younger patients.

Comparison of efficacy of active forced-air warming for preventing perioperative hypothermia between the elderly and young patients

Objective To observe whether the active forced-air warming has the same efficacy on the prevention of perioperative hypothermia in the elderly as compared with young patients. Methods This was a prospective, randomized, controlled clinical trial.Forty patients scheduled for abdominal surgery under general anesthesia were allocated to two groups: the elderly group and the young group(n=20, each). All patients received active forced-air warming at 20-30 min before induction of anaesthesia till leaving the operation room.Blood products and peritoneal lavage fluids were warmed to 37℃, and other intravenous fluids were at room-temperature.The core temperatures were recorded after entering the operation room(baseline), before induction of anaesthesia, at 15 min intervals after induction of anaesthesia, at the end of surgery and before leaving the operation room.The postoperative shivering and adverse reactions were also recorded. Results The core temperature was lower in elderly patients than in young patients at baseline and at each time points after 30 min of induction of anaesthesia(P<0.05). In elderly patients, the core temperature was significantly lower before leaving operation room than at the baseline(t=2.353, P=0.03), but in young patients, no significant difference was found in the core temperature between at the baseline and before leaving operation room(t=0.233, P=0.818). The incidence of intra-operative hypothermia was higher in elderly patients than in young patients(40.0% or 8/20 vs.5.0% or 1/20, c2=7.025, P=0.008). Conclusions During abdominal surgery under general anesthesia, active forced-air warming cannot effectively prevent perioperative hypothermia in elderly patients as compared with young patients. Key words: Anesthesia, general; Body temperature regulation

Factors associated with intraoperative hypothermia in elderly patients and management strategies

Objective To investigate the incidence of intraoperative hypothermia in elderly patients, and to analyze and discuss related influencing factors and targeted management strategies. Methods From February 2017 to February 2019, 220 elderly patients admitted into our hospital for surgery were selected.According to whether or not they had intraoperative hypothermia, patients were divided into the hypothermia group and the non-hypothermia group.General information and surgical data were compared between the two groups.Measures for the prevention of intraoperative hypothermia were discussed. Results Of the 220 patients, 103 had intraoperative hypothermia, and the incidence rate was 46.8%.The proportion of patients aged ≥70 years or with BMI <24 kg/m2 was higher in the hypothermia group than in the non-hypothermia group(all P<0.05). The proportion of patients with the anesthesia time ≥60 min or total intraoperative fluid intake ≥2000 ml was higher in the hypothermia group than in the non-hypothermia group(all P<0.05). BMI <24 kg/m2 and total intraoperative fluid intake ≥2000 ml were the key risk factors for intraoperative hypothermia in elderly patients(all P<0.05). Conclusions Intraoperative hypothermia is a common complication for elderly patients undergoing surgery.Intraoperative fluid intake and body mass are the key risk factors for intraoperative hypothermia.Targeted treatment measures based on the above related factors should be considered for elderly patients receiving surgery. Key words: Body temperature changes; Related factors

Effect of forced-air warming system in prevention of postoperative hypothermia in elderly patients: A Prospective controlled trial.

Background:Postoperative hypothermia in elderly patients is a well-known serious complication as it impairs wound healing, induces coagulopathy, increases the risk of blood loss, enhances oxygen consumption, and precipitates cardiac arrhythmias. We conducted this randomized controlled trial to evaluate the effect of a forced-air warming system on rewarming elderly patients undergoing total knee or hip arthroplasty.Methods:We recruited 243 elderly patients undergoing total knee or hip arthroplasty between May and December 2016. They were divided into three groups according to a computer-generated randomization table: group C (n = 78, rewarmed with only a regular blanket), group F1 (n = 82, rewarmed with a forced-air warming system set at 38°C), and group F2 (n = 83, rewarmed with a forced-air warming system set at 42°C). The nasopharyngeal temperature was recorded every 5 min for the first half hour, then every 10 min up to the end of the PACU (postanesthesia care unit) stay. The primary outcome was the rewarming time. The rewarming rate, increase in nasopharyngeal temperature (compared to the start of rewarming), hemodynamics, recovery time, and incidences of adverse effects were recorded.Results:No significant differences were found among the three groups in terms of the baseline clinical characteristics, use of narcotic drugs, intraoperative temperature, and hemodynamics (P > .05). Compared with the elderly patients in groups C and F1, both the heart rate and mean arterial pressure of those in group F2 were significantly increased 20 min after arrival at the PACU (P < .05). Patients in group F2 had the shortest rewarming time (35.89 ± 6.45 min, P < .001), highest rewarming efficiency (0.028 ± 0.001°C/min, P < .001), and fastest increased nasopharyngeal temperature among the three groups. Moreover, the elderly patients in group F2 had lower incidences of arrhythmia and shivering (P < .05).Conclusions:The use of a forced-air warming system set at 42°C was shown to be the most effective way of rewarming elderly patients with postoperative hypothermia.

Perioperative hypothermia during hip fracture surgery: An observational study.

Elderly patients are at high risk of accidental perioperative hypothermia. The primary objective of this study was to measure the changes in body temperature and the incidence of hypothermia in elderly patients undergoing hip fracture surgery. We conducted a prospective observational study on all adult patients undergoing surgery for fractured neck of femur between December 2013 and July 2014. We monitored their temperatures in different perioperative areas at multiple time points and also noted the warming methods used. Eighty-seven patients were included in this study. A significant drop in body temperature (0.7°C, 95% CI: 0.6-0.9, P<0.001) occurred from their arrival at the operating theatre until their arrival at the recovery room. A significant drop of 0.2°C (95% CI: 0.1-0.4, P<0.001) was observed at the holding bay area. One third of the patients were noted to be hypothermic when they arrived at the recovery room. These results indicate that despite the use of active warming methods for most patients, significant hypothermia is still an issue amongst elderly patients undergoing hip fracture surgery. Further improvement is necessary to prevent hypothermia in this high-risk group of patients.

Extended Use of Hypothermia in Elderly Patients with Malignant Cerebral Edema as an Alternative to Hemicraniectomy.

Background and PurposeThe use of decompressive hemicraniectomy (DHC) for the treatment of malignant cerebral edema can decrease mortality rates. However, this benefit is not sufficient to justify its use in elderly patients. We investigated the effects of therapeutic hypothermia (TH) on safety, feasibility, and functional outcomes in elderly patients with malignant middle cerebral artery (MCA) infarcts.MethodsElderly patients 60 years of age and older with infarcts affecting more than two-thirds of the MCA territory were included. Patients who could not receive DHC were treated with TH. Hypothermia was started within 72 hours of symptom onset and was maintained for a minimum of 72 hours with a target temperature of 33°C. Modified Rankin Scale (mRS) scores at 3 months following treatment and complications of TH were used as functional outcomes.ResultsEleven patients with a median age of 76 years and a median National Institutes of Health Stroke Scale score of 18 were treated with TH. The median time from symptom onset to initiation of TH was 30.3±23.0 hours and TH was maintained for a median of 76.7±57.1 hours. Shivering (100%) and electrolyte imbalance (82%) were frequent complications. Two patients died (18%). The mean mRS score 3 months following treatment was 4.9±0.8.ConclusionsOur results suggest that extended use of hypothermia is safe and feasible for elderly patients with large hemispheric infarctions. Hypothermia may be considered as a therapeutic alternative to DHC in elderly individuals. Further studies are required to validate our findings.

The clinical analysis of mild hypothermia therapy for severe traumatic brain injury in elderly patients

Objective To investigate the clinical therapeutic effect of mild hypothermia in elderly patients with severe traumatic brain injury. Methods 72 cases of elderly patients with severe traumatic brain injury(GCS≤8) were divided into mild hypothermia therapy group(36 patients)and control group(36 patients) according to the random number table method. Mild hypothermia therapy group received mild hypothermia treatment while control group received normal treatment.The clinical prognosis was analyzed between the two groups. Results After 24h treatment, both mild hypothermia therapy group and control group intracranial pressure began to rise.But the intracranial pressure of the mild hypothermia therapy group(24 h: (13.0±4.5)mmHg, 3 d: (16.6±4.0) mmHg, 5 d: (19.9±3.9)mmHg, 1 mmHg=0.133 kPa) were significantly lower than those of the control group(24 h: (16.6±3.8) mmHg, 3 d: (20.4±4.8) mmHg; 5 d: (24.1±6.2) mmHg), and the difference was statistically significant (t=2.225, 2.260, 2.192, P=0.035, 0.033, 0.039). The rate of good recovery to the control group and the mild hypothermia therapy group were 22.22% and 47.22% respectively while the mortality were 30.56% and 13.89% respectively, and the differences were statistically significant (χ2=4.936, 5.675, P=0.047, 0.035). Conclusion Mild hypothermia treatment can inhibit the increase of intracranial pressure and reduce disability rate and mortality in elderly patients with severe traumatic brain injury, which can increase the survival rate and improve the long-term prognosis. Key words: Severe traumatic brain injury; Mild hypothermia therapy; Intracranial pressure; Elderly

Effect of Preoperative Forced-Air Warming on Hypothermia in Elderly Patients Undergoing Transurethral Resection of the Prostate.

Elderly patients under spinal anesthesia are vulnerable to hypothermia, leading to increased morbidity. The aim of this study was to investigate the effects of preoperative forced-air warming on perioperative hypothermia and shivering in elderly patients undergoing transurethral resection of the prostate (TURP) under spinal anesthesia. Patients (> 65-year-old) scheduled for TURP under spinal anesthesia were randomly assigned to receive preoperative forced-air skin warming for 20 min (the pre-warmed group, n = 25) or not (control group, n = 25). Core temperatures were measured at 15-min intervals after spinal anesthesia, and intra- and post-operative shivering were also assessed. Incidences of intraoperative hypothermia (< 36 ºC) in the pre-warmed and control groups were not significantly different (10/25 [40%] vs. 15/24 [62.5%], P = .259). However, severities of hypothermia were significantly different (P = .019). No patient in the pre-warmed group showed moderate or profound hypothermia, whereas of patients in control group 21% and 13% did so, respectively. This study demonstrated that a brief period of preoperative forced-air warming did not completely prevent intraoperative hypothermia or shivering, but it could significantly reduce its severity in elderly male patients under spinal anesthesia.

Intra-Operative Warming with a Forced-Air Warmer in Preventing Hypothermia after Tourniquet Deflation in Elderly Patients

This randomized, single-blind study aimed to explore the effects of intra-operative warming with a forced-air warmer in the prevention of hypothermia after tourniquet deflation in elderly patients undergoing unilateral total knee replacement arthroplasty under general anaesthesia. Patients were randomized to receive either intra-operative warming using a forced-air warmer with an upper body blanket (warming group; n = 12) or no intra-operative warming (nonwarming group; n = 12). Oesophageal temperature was measured as core body temperature. At 30 min following tourniquet inflation, the core body temperature started to increase in the warming group whereas it continued to drop in the non-warming group. This difference was statistically significant. The final core body temperature after tourniquet deflation was significantly higher in the warming group (mean +/- SD 36.1 +/- 0.2 degrees C) than in the non-warming group (35.4 +/- 0.3 degrees C). Intra-operative forced-air warming increased the core body temperature before tourniquet deflation and prevented subsequent hypothermia in elderly patients under general anaesthesia.

Atropine prevents midazolam-induced core hypothermia in elderly patients

Study Objective: To test the hypothesis that core temperature is well preserved when atropine and midazolam are combined. Design: Randomized, blinded study. Setting: Department of Anesthesia, Yamanashi Medical University. Patients: 40 elderly, ASA physical status I and II patients (aged more than 60 years). Interventions: Patients were randomly assigned (n = 10 per group) to premedication with: 1) saline control; 2) midazolam 0.05 mg/kg; 3) atropine 0.01 mg/kg; and 4) midazolam 0.05 mg/kg combined with atropine 0.01 mg/kg. All premedication was given on the ward at approximately 8:30 am, ≈30 minutes before induction of anesthesia. Measurements and Main Results: Core temperatures were measured at the right tympanic membrane. Mean skin temperature was calculated as 0.3 × (T chest + T arm) + 0.2 × (T thigh + T calf). Fingertip perfusion was evaluated using forearm minus fingertip and calf minus toe, skin-surface temperature gradients. Temperatures were evaluated at the time of premedication and 30 minutes later, just before induction of anesthesia. Core temperature remained nearly constant in the control patients (0.1 ± 0.2°C; mean ± SD), whereas it decreased significantly in the patients given midazolam alone (–0.3 ± 0.1°C). Atropine alone increased core temperature (0.3 ± 0.2°C), although the increase was not statistically significant. The combination of midazolam and atropine attenuated the hypothermia induced by midazolam alone (0.0 ± 0.2°C). Initial skin-temperature gradients exceeded 0°C in all groups, indicating that the patients were vasoconstricted. The gradients were unchanged by premedication with saline or atropine. Midazolam significantly decreased the gradient (–1.8 ± 1.1°C), as did the combination of midazolam and atropine (–1.4 ± 0.9°C). Conclusions: The thermoregulatory effects of benzodiazepine receptor agonist and cholinergic inhibitors oppose each other, and the combination leaves core temperature unchanged.

Atropine Prevents Midazolam-induced Core Hypothermia in Elderly Patients

Atropine Prevents Midazolam-induced Core Hypothermia in Elderly Patients

Mortality in Elderly Patients With Thermoregulatory Failure

Fifty-four elderly patients with thermoregulatory failure were evaluated retrospectively. The most commonly associated cause was underlying sepsis, which occurred in 78% of cases. Underlying conditions that increased the incidence of hypothermia were hypoproteinemia (50%), cachexia (30%), and neuroleptic medications (21%), most commonly thioridazine. Digoxin toxicity was a common finding (20% of all cases). One third of the patients developed hypothermia in warm months and half of them developed it while in the hospital. Patients who presented with hypothermia from out of the hospital had lower temperatures, were more bradycardic and hemoconcentrated, and died more rapidly than the in-hospital group. This could be explained by lower outside temperature or delay in diagnosis and treatment of the underlying disease. The overall mortality rate was extremely high (74%) in both groups. The mortality rate was not affected by age, sex, or degree of hypothermia. We conclude that thermo-regulatory failure in the elderly can occur in warm as well as cold environments or climates. The development of hypothermia in elderly patients should be promptly treated as sepsis unless proven otherwise, in light of the poor prognosis of this condition.

Risk of hypothermia in elderly patients with diabetes.

The incidence of admissions of patients with hypothermia was determined to examine whether hypothermia was more common in elderly patients with diabetes than in the general population after diabetic metabolic emergency cases had been excluded. A prospective survey of three accident and emergency departments identified 134 cases of hypothermia admitted from a catchment population of almost 157,000 aged 65 or over during the winters of 1981-2 to 1983-4. The predicted number of patients with diabetes in the population was nearly 5600 (3.5%). Twenty three admissions for hypothermia (17%) occurred in 20 patients with previously diagnosed diabetes. Women made up 87% of the diabetic admissions; the ratio of diabetic to non-diabetic admission rates in women was 7.9 (95% confidence interval 5.3 to 12.0). After excluding diabetic metabolic emergency admissions the ratio was 6.4. The ratio in men was 2.4, but the small number of admissions produced wide confidence intervals. Ten of the admissions with diabetes (43%) had pathological disorders that are associated with an increased risk of hypothermia. The frequency of these conditions is higher in patients with diabetes than in the general population and partly explains the increased risk of hypothermia in these patients.