Inadvertent Perioperative Hypothermia Research Articles

Importance of Preventing Inadvertent Perioperative Hypothermia During Liver Transplant

Inadvertent perioperative hypothermia (IPH) leads to a series of deleterious effects that can be especially in complex procedures such as liver transplant. The implementation of a protocol is key to ensure the patient's normothermia. A cohort of 209 patients who underwent liver transplant in a tertiary hospital in a period between January 2016 and December 2018 was retrospectively analyzed. The patients were divided into 2 groups: group 1, patients with normothermia (core body temperature ≥ 36°C) and group 2, patients with hypothermia (core body temperature < 36°C). Mortality between both groups at 1 month, 1 year, and 3 years is compared. Postoperative morbidity is also compared. The incidence of IPH is 21.5%. Patients with normothermia present with statistical significance: a lower mortality at 1 year; a lower need for transfusion of platelets, plasma, fibrinogen consumption, or massive polytransfusion; and lower primary graft dysfunction, graft and surgical complications, rejection, hemodynamic complications, and metabolic and surgical reintervention. No significant differences were found in mortality at 1 month or 3 years in the need for prolonged mechanical ventilation; hospital readmission; length of stay in the intensive care unit or in hospital stay; rate of red blood cell transfusion; vascular, biliary, respiratory, or digestive complications; refractory ascites; or neurologic, kidney, hematological, endocrine, thrombotic, nutritional, or infectious issues. The incidence of IPH is relatively low in our patients, based on what is described in the literature, and in most cases it is mild. There is a reduction in complications fundamentally related to the consumption of blood products and the graft.

The Effect of Inadvertent Perioperative Hypothermia on Surgical-Site Infection in Bariatric Surgery Patients

The Effect of Inadvertent Perioperative Hypothermia on Surgical-Site Infection in Bariatric Surgery Patients

Preoperative Forced-Air Warming Strategy: Is It Effective in Averting Intraoperative Hypothermia in Elderly Trauma Surgical Patients?

Background and objectivesInadvertent perioperative hypothermia is expected in the elderly during central neuraxial anesthesia. We aimed to compare the incidence of intraoperative hypothermia (< 36-degree celsius) between preoperative forced-air warming for 30 minutes and non-warming groups. Also, we compared the time to develop hypothermia, perioperative shivering, duration of intraoperative active warming, metabolic acidosis, surgical site infections, coagulation derangements, and post-anesthesia care unit (PACU) stay.Material and methodologyA total of 100 American Society of Anesthesiologists (ASA) I-III (Age > 60 years) patients scheduled to undergo femur fracture surgeries under central neuraxial anesthesia were enrolled in this single-blinded prospective randomized study. They were randomly allocated into Group A (active forced-air warming for 30 minutes in the preoperative period) and Group B (without forced-air warming). Then, patients were transferred to the operation theatre, where central neuraxial anesthesia was administered for surgery. An infrared tympanic membrane thermometer measured the core body temperature during the different study points.ResultsThe intraoperative hypothermia incidences were 26.0% and 68.0% in groups A and B, respectively. The mean time for developing hypothermia was found to be 143.08 ± 26.26 min and 25.88 ± 9.25 min in groups A and B, respectively. The mean duration of intraoperative active warming was observed to be 15.6 minutes and 103.6 minutes in groups A and B, respectively. The shivering and surgical site infection (SSI) grades were lower in group A.ConclusionA preoperative forced-air warming strategy for 30 minutes helps in reducing the incidence of intraoperative hypothermia and shivering in elderly patients undergoing femur fracture surgeries under central neuraxial anesthesia.

Prewarming for Prevention of Hypothermia in Older Patients Undergoing Hand Surgery Under Brachial Plexus Block.

BackgroundOlder patients are more vulnerable to inadvertent perioperative hypothermia. Prewarming contributes to the prevention of inadvertent perioperative hypothermia in patients under general or neuraxial anesthesia. However, the effects of brachial plexus block (BPB) on thermoregulation and the efficacy of prewarming in the prevention of hypothermia in older patients undergoing surgery with BPB remain unclear. This study evaluated the effects of BPB on thermoregulation and the efficacy of prewarming during BPB in older patients.MethodsPatients aged ≥65 years were randomly allocated to receive either standard preoperative insulation (control group, n=20) or preanesthetic forced-air warming for 20 minutes before BPB (prewarming group, n=20). During the perioperative period, tympanic temperatures were measured. Thermal comfort scores and shivering grades were also obtained.ResultsThe tympanic temperatures at the end of surgery did not differ between the groups (36.9°C±0.5°C and 37.0°C±0.4°C in the control and prewarming groups, respectively; p=0.252). The maximum temperature change was significantly lower in the prewarming group compared to the control group (0.36°C±0.4°C and 0.65°C±0.3°C, respectively; p=0.013). The hypothermia incidence and severity, thermal comfort scores, and shivering grades did not differ between the groups.ConclusionRegardless of the application of prewarming, BPB did not cause a clinically significant impairment of thermoregulation. Moreover, the efficacy of prewarming appeared to be low; thus, it may not be routinely required in patients undergoing orthopedic hand surgery under BPB.

Understanding the use of tympanic thermometry in the Post Anaesthesia Care Unit: A discussion paper

Inadvertent perioperative hypothermia (IPH) is an uncomfortable, dangerous and costly but preventable complication of surgery. For perioperative nurses to treat this condition, they must first have an accurate means of detecting it. In making clinical decisions based on patients’ temperature, an important vital sign, nurses must understand how different thermometers work and be competent in their use. It is vital that patients have accurate core body temperature recorded when admitted to the Post Anaesthesia Care Unit (PACU). Infrared tympanic thermometers are a non-invasive tool regularly used by PACU nurses and provide a quick and easily obtained measurement that is a reflection of core body temperature. Despite this, uncertainty remains about the accuracy of tympanic thermometer readings and their ability to accurately estimate core temperature, leading to questions being raised about their acceptability in clinical use. This discussion paper will evaluate the use of tympanic thermometers within the PACU and identify their benefits, limitations and alternatives, as well as the competency requirements of the nurse. Clinical trials give varying results and more research is needed into both the use of tympanic thermometers in the PACU and the competence of the user.

Incidence of inadvertent perioperative hypothermia in pediatric laparoscopic surgery: a prospective observational single-center study.

Abstract&#x0D; Objective&#x0D; The pediatric age group is in the risk group for Inadvertent perioperative hypothermia (IPH) due to insufficient subcutaneous adipose tissue and underdeveloped thermoregulatory responses.&#x0D; We aimed to determine the frequency of IPH in the pediatric age group undergoing laparoscopic surgery.&#x0D; Methods&#x0D; The study is prospective observational.&#x0D; Pediatric patients (1-18 years old) who underwent laparoscopic surgery under general anaesthesia were evelueted. The tympanic membrane temperature measurements of the patients (°C) were recorded before anaesthesia induction (T0) and then every 15 minutes during the surgery.&#x0D; Results&#x0D; A total of 100 patients were evaluated. The frequency of inadvertent perioperative hypothermia was detected 13 (13%). Frequency of IPH on elective surgery patients was higher than emergency surgery (

The Effect of Body Temperature Changes on Inflammation Response and Patients’ Comfort in Patients Undergoing Laparotomy with General Anesthesia

Abstract Background: Surgery and general anesthesia are responsible for disrupting the normal balance between heat production and loss. Inadvertent perioperative hypothermia is a common complication in patients undergoing surgery with general anesthesia. General anesthestic agents are known to cause suppression of thermoregulatory defense mechanisms during general anesthesia, which results in perioperative hypothermia. Hypothermia carries significant various adverse effects; patients’ discomfort and inflammatory stress response are the two variable which will be studied. Materials and Methods: This is a prospective observational analytic cohort study, conducted in the central operating theater of Sanglah Hospital, Bali over a period of 4 months. We included all eligible patients who underwent elective laparotomy and gave consent to the study. Body temperature was measured in three different locations: axilla, tympanic membrane, and nasopharynx, before, during, and after surgery. We measured C-reactive protein (CRP), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (PLR) before and after the surgery. Patients’ comfort level was obtained using the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) scoring system. Results: A total of 60 patients were included. There was a significant increase of inflammatory markers, CRP, PLR, and NLR, before and after the surgery (P &lt; 0.001), as well as reduced body temperature during surgery (P &lt; 0.01); however, there was no significant relationship between the two (P &gt; 0.05). The changes of body temperature significantly affect patients’ comfort level (P &lt; 0.001), whereas room temperature did not show significant impact on patients’ comfort level. On linear regression, there is no significant correlation between body temperature changes and inflammatory response escalation. The increase of CRP was significantly correlated with gender, women, and blood loss, whereas the increase of PLR was related significantly with blood loss and age. Conclusion: Surgery and general anesthesia are causing hypothermia and escalation of inflammatory response. This study result supports prior publication in which both surgery and general anesthesia are the cause of inadvertent perioperative hypothermia; yet, hypothermia does not induce significant rise in all of inflammatory responses measured in this study. It is believed that the major surgery stress response is the cause of significant increase in inflammatory responses.

Comparison of two different uses of underbody forced-air warming blankets for the prevention of hypothermia in patients undergoing arthroscopic shoulder surgery: a prospective randomized study

BackgroundForced-air warming (FAW) is an effective method of preventing inadvertent perioperative hypothermia (IPH). However, its warming effects can be influenced by the style and position of the FAW blanket. This study aimed to compare the effects of underbody FAW blankets being placed under or over patients in preventing IPH.MethodsPatients (n=100) undergoing elective arthroscopic shoulder surgery in the lateral decubitus position were randomized into either under body (UB) group or the over body (OB) group (50 per group). The body temperature of the patients was recorded from baseline to the end of anesthesia. The incidences of postoperative hypothermia and shivering were also collected.ResultsA steady decline in the body temperature was observed in both groups up to 60 minutes after the start of FAW. After 60 minutes of warming, the OB group showed a gradual increase in the body temperature. However, the body temperature still decreased in UB group until 75 minutes, with a low of 35.7℃ ± 0.4℃. Then the body temperature increased mildly and reached 35.8℃ ± 0.4℃ at 90 minutes. After 45 minutes of warming, the body temperature between the groups was significantly different (P < 0.05). The incidence of postoperative hypothermia in the UB group was significantly higher than that in the OB group (P = 0.023).ConclusionsThe body temperature was significantly better with the use of underbody FAW blankets placed over patients than with them placed under patients. However, there was not a clinically significant difference in body temperature. The incidence of postoperative hypothermia was much lower in the OB group. Therefore, placing underbody FAW blankets over patients is recommended for the prevention of IPH in patients undergoing arthroscopic shoulder surgery.Trial registrationThis single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 13/1/2021 with the registration number ChiCTR2100042071. It was conducted from 14/1/2021 to 30/10/2021 as a single, blinded trial in Sichuan Provincial Orthopedic Hospital.

Perioperative hypothermia in open and laparoscopic colorectal surgery.

The consequences of even mild inadvertent perioperative hypothermia (IPH) are significant. There is a perception laparoscopic abdominal surgery is less prone to cause hypothermia than open surgery. However, during laparoscopic surgery, the peritoneal cavity is insufflated with carbon dioxide, which has a greater evaporative capacity than ambient air. This study compared the intra-operative temperature profile of patients undergoing open and laparoscopic colorectal surgery to define the incidence and severity of hypothermia. All adult patients undergoing colorectal surgery between May 2005 and August 2013 were identified from an electronic database. Cases were categorized into laparoscopic and open cases. Hypothermic episodes were defined as a temperature less than 36°C lasting for more than two consecutive minutes. The incidence of hypothermic episodes, the total time under 36°C and the area under the curve (degree-minutes) were calculated. A total of 1547 cases were analysed. The overall incidence of hypothermia was 67.0%. The incidence of cases with a hypothermic episode was greater in the laparoscopic group compared to the open group (71.23% versus 63.16%; chi-squared P-value 0.001). However, when other factors were considered, there was no significant difference in the relative risk of a hypothermic episode between types of surgery. There were significant differences in the severity of hypothermia. Despite current measures to reduce the incidence, IPH remains a significant problem in colorectal surgery irrespective of the surgical approach. Further research is required to better characterize techniques that can reduce its incidence.

Are Operating Rooms With Laminar Airflow a Risk for Inadvertent Perioperative Hypothermia During Ureterorenoscopic Lithotripsy Under Spinal Anesthesia? A Prospective Randomized Clinical Trial.

Inadvertent perioperative hypothermia (IPH), defined as a core temperature &lt;36°C, is common during a surgical procedure and is associated with high morbidity and mortality. Laminar (LAS) and conventional airflow systems (CAS) are used frequently for clean microenvironmental surgical areas in operating rooms. In LAS, the cold airflow is directed toward the patient, unlike CAS. Does this airflow in LAS cause heat loss from the patient by convection more than CAS? We aimed to compare the IPH frequencies of these airflow systems on patients who underwent ureterorenoscopic lithotripsy (ureterorenoscopic surgery) under spinal anesthesia. The study was a prospective, parallel-group, randomized trial. A total of 246 volunteers were included in the study and divided into group LAS (n = 123) and group CAS (n = 123). Randomization of patients was performed using the closed-envelope method (as 1:1).The tympanic membrane temperature of patients was measured before spinal anesthesia ( T0 ) and then every 15 minutes ( T n ) during the procedure. The IPH ratio and the change of the tympanic temperatures (Δ T ) were recorded (clinical trial number: IRCT20180324039145N5). In total, there were no statistical differences between the IPH ratios of group LAS and group CAS (61.2% [71 of 116] versus 49.6% [57 of 115], respectively; P = 0.075). The IPH ratio was 55.4% (128 of 231). The tympanic temperatures of patients decreased about 0.64°C (0.45°C) at the 30th minute. In both groups, Δ 30 was similar (0.62; 95% confidence interval, 0.52-0.72 [ P = 0.65]; 95% confidence interval, 0.55-0.74 [ P = 0.236], respectively). The risk for IPH of both LAS and CAS in the operating room is similar during ureterorenoscopic surgery.

Using a Normothermia Bundle With Perioperative Prewarming to Reduce Patient Hypothermia

PurposeTo determine if implementing a normothermia bundle, which includes preoperative forced-air warming blankets, reduces incidence of inadvertent perioperative hypothermia (IPH). DesignIntervention study using retrospective chart review. MethodsPatients received a preoperative forced-air warming blanket and temperature management with the normothermia bundle. Temperature status data was collected from patient charts to evaluate the incidences of IPH and findings from this data analysis was used to measure improvement in perioperative temperature management. FindingsOf 200 patients, 63 (31.5%) remained normothermic, 37 (18.5%) had at least one documented hypothermic temperature, and 100 (50%) had no documented temperature during the intraoperative phase of care. Although compliance with intraoperative temperature monitoring decreased by 13% postintervention, the incidence of documented IPH in reviewed records was decreased by 3.6-fold. ConclusionImplementing a normothermia bundle that includes a preoperative forced-air warming blanket may lower the incidences of IPH, especially in surgical cases lasting over 120 minutes.

Resistant fabric warming is a viable alternative to forced-air warming to prevent inadvertent perioperative hypothermia during hemiarthroplasty in the elderly

Surgical site infection (SSI) is associated with inadvertent perioperative hypothermia (IPH). This can be prevented by active patient warming. However, results from comparisons of warming techniques are conflicting. They are based mostly on elective surgery, are from small numbers of patients, and are dominated by the market leader, forced-air warming (FAW). Furthermore, the definition of hypothermia is debatable and systematic reviews of warming systems conclude that a stricter control of temperature is required to study the benefits of warming. To analyse core temperatures in detail in a large subset of elderly patients who took part in a randomized trial of patient warming following hemiarthroplasty who had received constant zero-flux thermometry to record their temperature. Regression models with a fixed effect for warming group and covariates related to temperature were compared for 257 participants randomized to FAW or resistant fabric warming (RFW) from a prior clinical trial. Those in the RFW group were-0.08°C cooler and had a cumulative hypothermia score-1.87 lower than those in the FAW group. There was no difference in the proportion of hypothermic patients at either <36.5°C or <36.0°C. This is the first study to provide accurate temperature measurements in patients undergoing a procedure predominantly under regional rather than general anaesthetic. It shows that RFW is a viable alternative to FAW for preventing IPH during hemiarthroplasty. Further studies are needed to measure the benefits of patient warming in terms of clinically important outcomes.

Is Normothermia Maintained in the Operating Room?

Background: Inadvertent hypothermia is one of the most common problems in the perioperative period. Providing and maintaining normothermia is very important in preventing inadvertent perioperative hypothermia as well as complications. Purpose: The aim of the study was to determine the knowledge and practices of operating room nurses to prevent hypothermia. Methods: A cross-sectional descriptive study was carried out in the operating rooms of 4 hospitals in Istanbul between July 2016 and September 2017. The sample consisted of a total of 95 participants who met the inclusion criteria. Data were collected by using a data collection form. Data collection forms were filled with face-to-face interview techniques. Results: According to this study, 84.2% of the participants did not receive any training to prevent hypothermia, 85.3% stated that it was very important to protect the patients from hypothermia, and 88.4% stated that there was no protocol on hypothermia in the hospital. Conlusions: The majority of the operating room nurses who participated in this study about determining the practices in maintaining normothermia in the operating room environment stated that they did not receive any training to prevent hypothermia, and the prevention of hypothermia was important. There was no common protocol used.

Comment on "Effect of competence health cultivation on the prevention and control of inadvertent perioperative hypothermia".

Comment on "Effect of competence health cultivation on the prevention and control of inadvertent perioperative hypothermia".

Perioperative temperature management: a survey of 6 Asia\u2013Pacific countries

BackgroundAnesthesia leads to impairments in central and peripheral thermoregulatory responses. Inadvertent perioperative hypothermia is hence a common perioperative complication, and is associated with coagulopathy, increased surgical site infection, delayed drug metabolism, prolonged recovery, and shivering. However, surveys across the world have shown poor compliance to perioperative temperature management guidelines. Therefore, we evaluated the prevalent practices and attitudes to perioperative temperature management in the Asia–Pacific region, and determined the individual and institutional factors that lead to noncompliance.MethodsA 40-question anonymous online questionnaire was distributed to anesthesiologists and anesthesia trainees in six countries in the Asia–Pacific (Singapore, Malaysia, Philippines, Thailand, India and South Korea). Participants were polled about their current practices in patient warming and temperature measurement across the preoperative, intraoperative and postoperative periods. Questions were also asked regarding various individual and environmental barriers to compliance.ResultsIn total, 1154 valid survey responses were obtained and analyzed. 279 (24.2%) of respondents prewarm, 508 (44.0%) perform intraoperative active warming, and 486 (42.1%) perform postoperative active warming in the majority of patients. Additionally, 531 (46.0%) measure temperature preoperatively, 767 (67.5%) measure temperature intraoperatively during general anesthesia, and 953 (82.6%) measure temperature postoperatively in the majority of patients. The availability of active warming devices in the operating room (p < 0.001, OR 10.040), absence of financial restriction (p < 0.001, OR 2.817), presence of hospital training courses (p = 0.011, OR 1.428), and presence of a hospital SOP (p < 0.001, OR 1.926) were significantly associated with compliance to intraoperative active warming.ConclusionsCompliance to international perioperative temperature management guidelines in Asia–Pacific remains poor, especially in small hospitals. Barriers to compliance were limited temperature management equipment, lack of locally-relevant standard operating procedures and training. This may inform international guideline committees on the needs of developing countries, or spur local anesthesiology societies to publish their own national guidelines.

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.

Effectiveness of prewarming in prevention of inadvertent intraoperative hypothermia

Background: Inadvertent perioperative hypothermia (IPH), defined as a perioperative core temperature < 36 °C is attributable to redistribution of body heat from the core to peripheries during the initial phase of anaesthesia and is difficult to treat. We conducted this study to find the effectiveness of pre-warming in preventing the occurrence of hypothermia intraoperatively in adult patients undergoing elective laparotomy under general anaesthesia. Material and Methods: Forty-four adult patients undergoing elective laparotomy were randomized into two groups of 22 each. Patients in Group P were prewarmed for 60 minutes prior to induction and those in Group C did not receive prewarming. Results: Patients in Group P had a significantly higher peripheral temperature at induction compared to those in Group C (p = 0.025), whereas the core temperature at induction was found to be comparable between the 2 groups. The core to peripheral temperature gradient was found to be lower in group P when compared to group C and the difference was statistically significant (p = 0.042). The core temperature dropped to less than 35 °C in the first two hours following induction in 2 patients in Group P and in 14 patients in group C (p < 0.001). The rate of drop in the core temperature was higher in group C compared to group P (p=0.002).The mean peripheral temperature as well as the core temperature in group P was significantly higher than in group C from induction to 60th minute, and it was statistically significant. Conclusion: In the first 2 hours post induction, prewarming is effective in preventing the drop in core temperature and reduces the rate of drop in core temperature. Prewarming is effective in reducing the core to peripheral temperature gradient at induction.

Efficacy of active forced air warming during induction of anesthesia to prevent inadvertent perioperative hypothermia in intraoperative warming patients: Comparison with passive warming, a randomized controlled trial.

Background:This study aimed to evaluate the efficacy of peri-induction forced air warming to prevent inadvertent perioperative hypothermia, defined as a reduction in body temperature to <36.0°C during the perioperative period, in intraoperatively warmed patients receiving major surgery lasting >120 minutes.Methods:In total, 130 patients scheduled for elective surgery under general anesthesia lasting >120 minutes were divided into 2 groups: peri-induction warming (n = 65) and control (n = 65). Patients in the peri-induction warming group were warmed during the anesthetic induction period using a forced-air warmer set at 47°C, whereas patients in the control group were covered passively with a cotton blanket. All patients were warmed with a forced-air warmer during surgery. Body temperature was measured using a tympanic membrane thermometer in the pre- and postoperative periods and using a nasopharyngeal temperature probe during surgery. Patients were evaluated for shivering scale score, thermal comfort scale score, and satisfaction score in the post-anesthesia care unit.Results:The incidence rates of intraoperative and postoperative hypothermia were lower in the peri-induction warming group than in the control group (19.0% vs 57.1%, P < .001; 3.3% vs 16.9%, P = .013, respectively). Body temperature was higher in the peri-induction warming group (P < .001). However, intraoperative blood loss, as well as postoperative thermal comfort scale score, shivering scale score, and patient satisfaction score, were similar between groups. Post-anesthesia care unit duration was also similar between groups.Conclusions:Peri-induction active forced air warming is an effective, simple, and convenient method to prevent inadvertent perioperative hypothermia in intraoperatively warmed patients undergoing major surgery lasting >120 minutes.

The use of forced air warmer for the prevention of inadvertent perioperative hypothermia under general anaesthesia - A prospective observational study

Temperature is an important parameter which determines patient outcomes perioperatively. Iatrogenic hypothermia during surgery under general anaesthesia leads to significant side effects which can be corrected with the use of active body surface warming devices like the forced air warmer. A prospective observational study was conducted with a sample size of 362 which included patients of either sex aged 18-65years posted for any elective surgery under general anaesthesia lasting &amp;#62;60 and ≤180minutes. Baseline oral temperature was recorded preoperatively. Patients were warmed with forced air warmer intraoperatively at 44°C with half hourly monitoring of nasopharyngeal temperature until extubation. Intravenous fluids were given at room temperature. Further, oral temperature was monitored at 15 and 60 minutes in post anaesthesia care unit and patients were warmed if hypothermic or shivering. The final mean intraoperative temperature (nasopharyngeal) was 36.01⁰C (n=362) with a range from 34.7⁰C to 37.1⁰C. 139 of 362(n) (38.4%) patients were hypothermic (&amp;#60;36⁰C) at the end of surgery. 61.6% of patients were normothermic. In 9 patients (2.5%, n=362) the forced air warmer was turned off due to over heating (temperature &amp;#62;37⁰C). 33 patients (n=362, 9.1%) had shivering postoperatively. Comparing the nasopharyngeal temperature (mean) at half hourly intervals post induction revealed statistically significant results (p&amp;#60;0.001). The establishment of near constant temperature (36±0.03°C) following the initial fall in core body temperature can be attributed to the forced air warmer. However, it is imperative to continuously monitor core body temperature to detect temperature changes(hypo/hyperthermia) in order to use the device safely as chances of overheating is always present.

The Role of Perioperative Hypothermia in the Development of Surgical Site Infection: A Systematic Review

Surgical patients may experience inadvertent perioperative hypothermia, a condition that can cause a variety of complications, including surgical site infection (SSI). The authors of this systematic review used the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines to examine the role of perioperative hypothermia in the development of SSI. The authors searched the PubMed, Cumulative Index Nursing and Allied Health Literature, Cochrane, and ScienceDirect databases for eligible articles published between January 2008 and November 2018 and identified seven studies that met the inclusion criteria. The results of this review indicate that the relationship between hypothermia and SSI is closely related to the type of the surgical intervention performed (eg, emergent, colorectal), and that severe hypothermia (eg, <35.0° C [95.0° F]) can increase the risk of developing an SSI. Perioperative nurses should monitor patients for inadvertent hypothermia and prevent its occurrence when possible.