Inadvertent Perioperative Hypothermia Research Articles

Perioperative Health Care Professionals’ Knowledge of Evidence-Based Inadvertent Perioperative Hypothermia Management

PurposeTo evaluate the perioperative healthcare professionals’ knowledge of evidence-based inadvertent perioperative hypothermia management DesignA descriptive, cross-sectional study. MethodsThe research sample consisted of 219 perioperative nurses and anesthesia technicians working in the university hospital and participating in perioperative care. Data were collected by the researchers using a questionnaire that included descriptive characteristics of healthcare professionals and inadvertent perioperative hypothermia management between March and April 2021. Descriptive statistics, Shapiro-Wilk normality, Kruskal Wallis, Mann Whitney U, and Spearman correlation test were used to analyze the data. FindingsIn this study, only 29.2% of the healthcare professionals knew that the threshold value for inadvertent perioperative hypothermia was <36°C. The mean knowledge score of healthcare professionals on the management of inadvertent perioperative hypothermia was 13.78±3.47. The knowledge score of 79.5% of healthcare professionals was moderate level. A significant correlation was determined between inadvertent perioperative hypothermia management knowledge score and education status (p=0.032), task (p<0.001), and mean years in the profession (p=0.02). ConclusionThe knowledge of the healthcare professionals working in the perioperative process about evidence-based practices related to inadvertent perioperative hypothermia management was determined to be moderate. It is recommended to increase the level of knowledge of healthcare professionals by providing training on guidelines regarding inadvertent perioperative hypothermia management.

The Relationship of Perioperative Inadvertent Hypothermia with Anxiety and Comfort.

The study aimed to investigate the relationship of perioperative inadvertent hypothermia with anxiety and thermal and general comfort in surgical patients. Inadvertent perioperative hypothermia occurs after surgery and affects many patient outcomes. However, the relationship between hypothermia and anxiety has been given little attention. The research is of descriptive type. A total of 117 surgical patients who met the inclusion criteria were sampled and divided into two groups: hypothermic (n = 54) and normothermic (n = 63). Patients undergoing surgery were monitored for body temperature, systolic and diastolic blood pressure, heart rate, pain intensity, anxiety (Numeric Rating Scale [NRS] and State Anxiety Scale [SAI]), and comfort (Perianesthesia Comfort Questionnaire) levels. The groups were similar in terms of descriptive characteristics (p > 0.05). Among the patients undergoing surgical intervention, 46.1% were hypothermic. Compared with the normothermic group, the hypothermic group had significantly lower body temperature until the second postoperative hour, lower thermal comfort score until the third postoperative hour, and higher heart rate and anxiety (NRS) score until the first postoperative day. Furthermore, there was a significant difference between the groups in terms of pain intensity up to the first 30 minutes after surgery (p < 0.05). Moreover, there was no significant difference between the groups in terms of pre and postoperative day one anxiety (SAI) and Periantesthesia Comfort Scale mean scores (p > 0.05). The study findings showed that hypothermia affected thermal comfort up to the first 3 hours after surgery, pain intensity up to the first 30 minutes, and heart rate and anxiety (NRS) levels up to the first day.

Inadvertent perioperative hypothermia prevention strategies for urology surgical patients who received a blood transfusion: A retrospective analysis.

This study aimed to establish whether hypothermia was present in patients who required a blood transfusion and underwent a urology procedure, as well as identify staff knowledge and understanding. A staff survey was conducted with respondents from a range of clinical settings, with some staff working across more than one area. A retrospective review of 46 medical records was conducted between January 2021 and July 2022. All data were exported into an Excel spreadsheet and analysed. Staff (70%) were unaware of guidelines informing thermoregulation practices; however, 90% understood the importance of normothermia in the perioperative environment. Medical record review demonstrated temperature monitoring and intervention implementation varied across the perioperative journey, with 20% of patients hypothermic on admission and 89% of the cohort having two or more risk factors. There is no formal process for the management of inadvertent perioperative hypothermia throughout the patient journey at the hospital. A variety of intrinsic factors (age, patient comorbidities, American Society of Anaesthesiologists score) and external factors (patient waiting times, anaesthetic modality, type of procedure, environmental influences), impact each patient's risk of inadvertent perioperative hypothermia.

Inadvertent perioperative hypothermia and surgical site infections after liver resection

BackgroundIn the overall surgical population, inadvertent perioperative hypothermia has been associated with an increased incidence of surgical site infection (SSI). However, recent clinical trials did not validate this notion. This study aimed to investigate the potential correlation between inadvertent perioperative hypothermia and SSIs following liver resection. MethodsThis retrospective cohort study included all consecutive patients who underwent liver resection between January 2019 and December 2021 at the First Affiliated Hospital, Zhejiang University School of Medicine. Perioperative temperature managements were implemented for all patients included in the analysis. Estimated propensity score matching (PSM) was performed to reduce the baseline imbalances between the normothermia and hypothermia groups. Before and after PSM, univariate analyses were performed to evaluate the correlation between hypothermia and SSI. Multivariate regression analysis was performed to determine whether hypothermia was an independent risk factor for postoperative transfusion and major complications. Subgroup analyses were performed for diabetes mellitus, age > 65 years, and major liver resection. ResultsAmong 4000 patients, 2206 had hypothermia (55.2%), of which 150 developed SSI (6.8%). PSM yielded 1434 individuals in each group. After PSM, the hypothermia and normothermia groups demonstrated similar incidence rates of SSI (6.3% vs. 7.0%, P = 0.453), postoperative transfusion (13.3% vs. 13.7%, P = 0.743), and major complications (9.0% vs. 10.1%, P = 0.309). Univariate regression analysis revealed no significant effects of hypothermia on the incidence of SSI in the group with the highest hypothermia exposure [odds ratio (OR) = 1.25, 95% confidence interval (CI): 0.84-1.87, P = 0.266], the group with moderate exposure (OR = 1.00, 95% CI: 0.65-1.53, P = 0.999), or the group with the lowest exposure (OR = 1.11, 95% CI: 0.73-1.65, P = 0.628). The subgroup analysis revealed similar results. Regarding liver function, patients in the hypothermia group demonstrated lower γ-glutamyl transpeptidase (37 vs. 43 U/L, P = 0.001) and alkaline phosphatase (69 vs. 72 U/L, P = 0.016). However, patients in the hypothermia group exhibited prolonged activated partial thromboplastin time (29.2 vs. 28.6 s, P < 0.01). ConclusionsIn our study of patients undergoing liver resection, we found no significant association between mild perioperative hypothermia and SSI. It might be due to the perioperative temperature managements, especially active warming measures, which limited the impact of perioperative hypothermia on the occurrence of SSI.

Applying Adult Learning Theory in Improving Knowledge, Attitude, and Practice of Inadvertent Perioperative Hypothermia in Operating Room Nurses: Single-Group "Before and After Study".

The study aimed to explore the effect of the training scheme guided by Knowles' adult learning theory model on perioperative hypothermia prevention-related knowledge, practice, and behavior in operating room nurses. Operating room nurses of a teaching hospital were included from February to May 2023. Under the guideline of the adult learning theory, we accessed the score of the knowledge, attitude, and practice in operating room nurses about the prevention of the inadvertent perioperative hypothermia (IPH) before and after trainings through qualitative interviews and questionnaire surveys. There were statistically significant differences in scores of knowledge, attitude, and practice of IPH prevention in operating room nurses before and after training. The training program guided by adult learning theory could significantly increase the scores of IPH prevention-related knowledge of operating room nurses, improve the attitude of perioperative hypothermia prevention, and advance the compliance with IPH prevention interventions. Clinical Trial Registration number: 2023IIT109.

The Development of the Inadvertent Perioperative Hypothermia Knowledge Test (IPH-KT)

PurposeThis study aimed to develop the inadvertent perioperative hypothermia knowledge test (IPH-KT) for health care professionals and examine its validity and reliability. DesignThe methodological and cross-sectional study design was used. MethodsThe research was carried out with 326 nursing students in Turkey. Data for the study were collected using a demographic information form and the IPH-KT. FindingsThe item difficulty index and item distinctiveness index of the questions included in the draft form of the 25-item test ranged from 0.03 to 0.81 and from 0.25 to 0.99, respectively. After the analyses, 8 items were excluded from the draft test, and the final version of the test consisted of 17 questions. The item difficulty index of the final test ranged from 0.30 to 0.96, and the item distinctiveness index ranged from 0.33 to 0.81. The reliability of the test was determined using the Kuder-Richardson formula 20 and found to be 0.72, indicating high internal consistency. Therefore, the IPH-KT was accepted as a reliable test. ConclusionsThe study revealed that the questions in the IPH-KT had varying difficulty levels and a high ability to discriminate between individuals with knowledge of IPH and those without. The results demonstrated that the test had good content and face validity and showed high reliability for measuring the IPH knowledge of nursing students.

Perioperative hypothermia in robotic-assisted thoracic surgery: Incidence, risk factors, and associations with postoperative outcomes

ObjectiveInadvertent perioperative hypothermia has been associated with poor surgical outcomes. The purpose of this study was to evaluate the incidence and associated postoperative complications of inadvertent perioperative hypothermia in patients undergoing robotic-assisted thoracic surgery lung resections. MethodsThis was a single-center, retrospective cohort study evaluating all consecutive patients who underwent robotic-assisted thoracic surgery lung resection between January 1, 2021, and November 30, 2022. Temperatures were measured at 5 time points: preprocedure unit, anesthesia induction, 30 minutes postinduction, extubation, and recovery room arrival. Temperature changes were calculated at each interval. Adjusted and unadjusted comparison was performed between those who experienced varying levels of inadvertent perioperative hypothermia (Hypothermia I: <36 °C, Hypothermia II: <35.5 °C, and Hypothermia III: <35 °C) and those who did not. ResultsA total of 313 patients were included, and 201 (64.2%) lobectomies, 50 (16.0%) segmentectomies, and 62 (19.8%) wedge resections were performed. Across all patients, 291 (93.0%) had a temperature less than 36 °C, 195 (62.3%) had a temperature less than 35.5 °C, and 100 (31.9%) had a temperature less than 35.0 °C. Patients experienced significant temperature change at all intervals (P < .001), with the greatest loss occurring during the preprocedure interval (between leaving preprocedure unit and anesthesia induction). On adjusted analysis, patients who experienced inadvertent perioperative hypothermia less than 35.5 °C were older (odds ratio, 1.03; 95% CI, 1.01-1.05), had lower body mass index (odds ratio, 0.95; 95% CI, 0.87-0.98), and had increasing operative time (odds ratio, 1.00; 95% CI, 1.00-1.01). Patients who experienced inadvertent perioperative hypothermia had higher risk-adjusted rates of overall morbidity and infectious postoperative complications. ConclusionsThe majority of patients undergoing robotic-assisted thoracic surgery lung resections experience some degree of inadvertent perioperative hypothermia and have associated increased rates of 30-day morbidity. Structured and interval-specific interventions should be implemented to decrease rates of inadvertent perioperative hypothermia and subsequent complications.

The Effect of Temperature Chain Management Scheme During da Vinci Robot-Assisted Radical Resection of Urological Tumor.

To explore the effect of the temperature chain management scheme on inadvertent perioperative hypothermia (IPH) during robot-assisted radical resection of urological tumors. Fifty male patients who underwent elective robot-assisted radical prostatectomy (RARP) or robot-assisted radical cystectomy (RARC) surgery from February 2022 to March 2023 in a teaching hospital were enrolled and randomized to receive either intraoperative warming, including forced-air warming blanket and prewarming fluid (group C) or the temperature chain management involving an active warming bunch covering the whole perioperative period (group T). Comparing the core temperature, IPH rates, the incidence of shivering, recovery from anesthesia, and thermal between the two groups. Perioperative core temperature of group T was higher compared with group C (p < 0.05); IPH rates and the incidence of shivering in postanesthesia care unit (PACU) of group T were lower compared with group C (p < 0.05); group T scored higher in thermal comfort compared with group C after PACU 15 minutes, after PACU 30 minutes, and when leaving the PACU (p < 0.05); group T took shorter time on recovering from anesthesia (p < 0.05). Temperature chain management could reduce IPH and postoperative complications during RARP and RARC.

Perioperative active warming strategies in children: a protocol for a multicentre, prospective, randomized controlled trial.

Inadvertent perioperative hypothermia (IPH) refers to a core body temperature lower than 36.0 °C, which can contribute to many adverse events. The special physiological characteristics in children further increase the incidence of IPH. Therefore, it is very important to perform effective perioperative warming measures for children. Traditional passive warming measures with additional layers have limited thermal insulation effects. Active warming measures might be the better choice, and most measures have achieved good effects in adults. This study combines a variety of active warming measures to propose perioperative active warming strategies and aims to verify the feasibility and thermal insulation effects of perioperative active warming strategies in children. This study is a multicentre, prospective, randomized controlled trial. From August 2022 to July 2024, 400 paediatric patients undergoing elective surgery will be recruited in four centres and randomly divided into the active warming strategies group and control group at a ratio of 1:1. The primary outcome is the perioperative cumulative hypothermia effect value (Σ ΔTi × Δti, i = 1…, n). Multiple complications covering the anaesthesia recovery period and postoperative hospitalization will be considered as secondary outcomes to comprehensively analyse the prognosis. ClinicalTrials.gov identifier: ChiCTR2200062168. Registered on July 26th, 2022. Registered with the name of "Perioperative Active Warming Strategies in Children: A multicenter, prospective, randomized controlled trial". URL:http://www.chictr.org.cn/showproj.aspx?proj=172778.

Inadvertent Perioperative Hypothermia in Ambulatory Surgery Patients: Incidence, Risk Factors, and Prevention Initiatives

PurposeAlthough the number and complexity of ambulatory surgical interventions has grown considerably over the years, it has not been fully established whether hypothermia still poses a risk for these interventions. In this study, we aimed to determine the incidence, risk factors, and methods applied to prevent perioperative hypothermia in ambulatory surgery patients. DesignA descriptive research design was used. MethodsThe study was conducted with 175 patients between May 2021 and March 2022 in the outpatient units of a training and research hospital in Mersin, Turkey. Data were collected using the Patient Information and Follow-up Form. FindingsThe incidence of perioperative hypothermia was 20% in ambulatory surgery patients. Hypothermia developed in 13.7% of the patients at the 0th minute at the PACU, and 96.6% of the patients were not warmed intraoperatively. We noted a statistically significant relationship between perioperative hypothermia and advanced age (≥60 years), high American Society of Anesthesiologists' (ASA) class, and low hematocrit values. In addition, we determined that the female gender, presence of chronic diseases, general anesthesia, and a long operation time were other risk factors for hypothermia in the perioperative period. ConclusionsThe incidence of hypothermia during ambulatory surgeries is lower than that in inpatient surgeries. The warming rate of ambulatory surgery patients, which is quite low, can be improved by increasing the awareness of the perioperative team and following the guidelines.

Improving the recognition and management of inadvertent perioperative hypothermia

Improving the recognition and management of inadvertent perioperative hypothermia

A study on the effect of preoperative warming on post-induction core temperature and incidence of postoperative shivering in patients under general anesthesia

BackgroundInadvertent perioperative hypothermia (IPH) defined as core temperature below 36.0 °C is a common complication of general anesthesia with prevalence up to 70%. Warming of peripheral tissues prior to induction of anesthesia reduces the central to peripheral temperature gradient, thereby minimizing central heat loss due to heat redistribution, after induction of anesthesia. This study aimed to evaluate the effect of prewarming on post-induction core temperature and incidence of perioperative inadvertent hypothermia leading to postanesthetic shivering (PAS) in patients undergoing general anesthesia.This is a single-arm study performed after authorization from the scientific review committee (IRB no.:10/2015/05) in a cohort of patients between the ages of 18 and 65 years in ASA I and II physical status, undergoing GA for elective surgeries lasting less than 3 h. Rates of IPH and PAS in 60 patients who were warmed before anesthesia over a 30-min period with a forced-air warmer set at 38.0 °C were compared with existing data from an equal number of cohorts who received only intraoperative warming, during similar surgical procedures according to routine GA.Comparisons between the two groups were made using the Student’s t-test and chi-square test. A paired t-test or Wilcoxon’s signed rank test was applied for pairwise comparisons. The results were considered statistically significant when the P-value was < 0.05.ResultsThe mean decrease in core temperature in the unwarmed group was 0.7 °C (+ /- 0.23) compared with a 0.2 °C decrease (+ /- 0.06) in the prewarmed group of patients. A total of 31.70% of patients in the unwarmed group developed IPH compared with one patient (1.7%) in the prewarmed group shortly after onset. Twenty-six patients (43.30%) in the unwarmed group had hypothermia at the end of surgery, compared with one patient (1.7%) in the prewarmed group. Shivering was observed in 46% of patients in the unwarmed group, while no shivering was observed in the prewarmed group.ConclusionsPreoperative warming is an effective intervention to reduce the frequency of core temperature drops after induction of anesthesia, thereby preventing inadvertent perioperative hypothermia and the incidence of postoperative shivering.

Effect of Short Duration Used of Active Prewarming for Preventing Hypothermia in Non-Anesthetized Volunteer: A Randomized-Controlled Trial

Background: Prewarming with a forced-air warmer device at least 30 minutes before entering the operating room (OR) helps to prevent inadvertent perioperative hypothermia (IPH), although doing so on a regular schedule may be difficult. Prewarming for a short time may reduce IPH and is more practical. Objective: To investigate the incidence of hypothermia in non-anesthetized volunteers who used a forced-air warmer device for 10 minutes before entering the OR. Materials and Methods: The present study was a prospective, randomized-controlled trial that included 32 non-anesthetized volunteers. Sixteen volunteers were randomly assigned to receive prewarming using a forced-air warmer set at 38℃ for 10 minutes as the PW group and 16 other volunteers did not receive prewarming as the NW group, before entering a 20℃ OR for an hour. The primary outcome was the incidence of hypothermia in the OR. The secondary outcomes were a change in body temperature in the OR, thermal comfort, the requirement for an additional forced-air warmer device, and complications such as skin rash and burn. Results: The incidence of hypothermia in the OR was 25% in the PW group and 18.75% in the NW group, with no statistically significant differences (p&gt;0.999). There were no significant differences in body temperature between groups. In the waiting room, about 50% of the PW group and none of the NW group reported feeling hot discomfort (p=0.002). However, there were no significant differences in thermal comfort when entering the OR and PACU. No participant asked for an additional forced-air warmer device, and there were no observable device-related complications. Conclusion: A short-term use of active prewarming cannot reduce the incidence of hypothermia in non-anesthetized volunteers. Keywords: Short duration; Active prewarming; Hypothermia

THE EFFECTS OF MINIMAL, LOW AND HIGH FLOW ANESTHESIA ON BODY TEMPERATURE AND TISSUE OXYGENATION IN NASAL SURGERIES

OBJECTIVE: Intraoperative high fresh gas flow may cause Inadvertent perioperative hypothermia (IPH). For this reason, low and minimal flow anesthesia methods that improve the anesthesia climate are applied. We aimed to investigate the effects of minimal, low and high flow anesthesia on body temperature and tissue oxygenation in patients undergoing elective nasal surgery.MATERIAL AND METHODS: Prospective randomized controlled study included 92 patients aged 18-60 years, ASA1-2 operation time 1-4 hours, scheduled for elective nasal surgery under hypotensive anesthesia. The patients were divided into Group 1 (0.5Lmin-1), Group 2 (1Lmin-1) and Group 3 (2 Lmin-1). Demographic and operative data of the patients, preoperative waiting room temperature, intraoperative operating room temperature, intraoperative body temperature, anesthesia breathing circuit humidity and temperature, tissue oxygen saturation, 0th, 15th, 30th, 60th, 90th, 120th, 150thmin and postoperative shivering, Aldrete score, room temperature and body temperatures in the recovery unit were recorded.RESULTS: Perioperative hypothermia developed in all patients (p=0.001). Tympanic temperatures were similar in all three groups (p&amp;gt;0.05). In the subgroup comparison, it was found that the tissue oxygen saturation (StO2) 60 th min value of Group1 was higher than Group 2 (p=0.046). It was found statistically significant that the StO2 90 th min value of Group1 was higher than that of Group 2 and 3 (p=0.013, p=0.013). It was statistically significant that the StO2 120th min value of Group1 was higher than Group 3 (p=0.008).In Group1, postoperativeAldrete score was found to be significantly higher than the other two groups(p=0.002, p=0.002). A correlation was found between operating room temperature, postoperative recovery room temperature, and body temperature(r=.446, p&amp;lt;0.05;r=.531, p&amp;lt;0.01).CONCLUSIONS: Inadvertent perioperative hypothermia developed in all patients who underwent elective nasal surgery with hypotensive anesthesia in minimal, low and high flow anesthesia applications. It was observed that body temperatures, humidity and the temperature of the anesthesia period were similar in all groups. Tissue oxygen saturation was higher in the minimal flow anesthesia group and Aldrete score was higher in the postoperative recovery unit. Minimal flow anesthesia applications can be a good alternative to prevent IPH. However, we think that more studies are needed for the effects of low-flow anesthesia techniques at the tissue level.

Health Technology Assessment for the Prevention of Peri-Operative Hypothermia: Evaluation of the Correct Use of Forced-Air Warming Systems in an Italian Hospital.

This study investigates the implications of using a system for the maintenance of normothermia in the treatment of patients undergoing surgery, determining whether the FAW (Forced-Air Warming) systems are more effective and efficient than the non-application of appropriate protocols (No Technology). We conducted Health Technology Assessment (HTA) analysis, using both real-world data and the data derived from literature, assuming the point of view of a medium-large hospital. The literature demonstrated that Inadvertent Perioperative Hypothermia (IPH) determines adverse events, such as surgical site infection (FAW: 3% vs. No Technology: 12%), cardiac events (FAW: 3.5% vs. No Technology: 7.6%) or the need for blood transfusions (FAW: 6.2% vs. No Technology: 7.4%). The correct use of FAW allows a medium saving of 16% per patient to be achieved, compared to the non-use of devices. The Cost Effectiveness Value (CEV) is lower in the hypothesis of FAW: it enables a higher efficacy level with a contextual optimization of patients' path costs. The social cost is reduced by around 30% and the overall hospital days are reduced by between 15% and 26%. The qualitative analyses confirmed the results. In conclusion, the evidence-based information underlines the advantages of the proper use of FAW systems in the prevention of accidental peri-operative hypothermia for patients undergoing surgery.

Knowledge and Practices of Surgical Nurses on Inadvertent Perioperative Hypothermia.

This study aimed to determine surgical nurses' knowledge of the risk factors and complications of inadvertent perioperative hypothermia and the practices preferred to prevent inadvertent perioperative hypothermia and to provide normothermia. This descriptive study was conducted on 122 volunteer nurses working in the surgical clinics of a state and a private hospital between August 1 and September 15, 2019. The data collection form included questions to determine the characteristics of nurses and the risk factors, complications, and preventive practices of inadvertent perioperative hypothermia. The data forms were distributed by visiting the nurses one by one and were retrieved after an appropriate time. For statistical analyses, Statistical Package for the Social Sciences 22.0 software was used. The most known risk factors for IPH were "excessive blood loss" (75.4%), "anemia" (73.0%), and "inadequate covering of the patient/ not enough clothing" (72.9%). The most known complications of inadvertent perioperative hypothermia were "increased oxygen consumption and need" (65.6%), "hypoxemia" (61.5%), and "hypoxia" (49.4%). The most preferred method to provide normothermia in the perioperative period was "covering the patient with a blanket" (80.3%). In this study, nurses did not have enough information about the risk factors and complications of Inadvertent perioperative hypothermia. In addition, it was determined that most of the nurses did not use the methods in the guidelines to prevent inadvertend perioperative hypothermia.

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.