Incidence Of Intraoperative Hypothermia Research Articles

Effects of intraoperative hypothermia on patients undergoing laparoscopic surgery: A retrospective cohort study.

This study aims to explore the association between intraoperative hypothermia and outcomes in adult patients undergoing laparoscopic surgery. A retrospective analysis of 2048 adult laparoscopic surgery patients treated between 2020 and 2021 was conducted at Songklanagarind Hospital, Thailand. Intraoperative hypothermia, defined as a core temperature below 36°C, was recorded as either one or more than one episode. Patient demographics, clinical information and postoperative outcomes were extracted from the hospital information system. The outcomes were intraoperative and postoperative cardiac arrhythmias, postoperative oxygen requirement, length of post-anesthetic care unit (PACU) stay, and length of hospital stay. Univariate and multivariate logistic/linear regression models were fit to assess the association between hypothermia and outcomes, presented as odds ratio (OR) or beta-coefficient (β) with 95% confidence interval (CI). The incidence of intraoperative hypothermia was 34.9%, with 688 experiencing one episode and 27 experiencing multiple episodes. On multivariate analysis, patients with one and more than one episode of hypothermia had an increased risk of intraoperative cardiac arrhythmia compared to normothermic patients (OR [95%CI]: 1.67[1.24,2.25] and 3.65[1.53,8.74], respectively, P<0.001). Normothermic patients and hypothermic patients with more than one-episode had a higher odds of postoperative oxygen requirement compared to hypothermic patients with only one episode (OR [95%CI]:1.32[1.02,1.7] and 2.64[1.1,6.32], respectively, P = 0.019). Hypothermic patients with one and more than one-episode also had longer PACU stays compared to normothermic patients (β[95%CI]:3.82[1.34,6.29] and 12.43[2.29,22.57] minutes, respectively, P = 0.001). No significant differences were observed in the other outcomes. Intraoperative hypothermia in laparoscopic surgery is associated with a higher likelihood of intraoperative cardiac arrhythmias, prolonged PACU stay and higher postoperative oxygen requirement. Further research and prospective studies are warranted to validate these results and develop strategies to manage intraoperative hypothermia effectively.

The Warming Management Measures May Need to Be Further Enhanced During Scoliosis Correction and Internal Fixation Surgery: A Retrospective Cohort Study.

The incidence of intraoperative hypothermia (IPH) exceeds 70% during spinal surgery, which can lead to many adverse outcomes, including increased intraoperative blood loss/transfusion and delayed recovery. We aimed to evaluate the comprehensive efficiency of a kind of enhanced warming measure on patients undergoing spinal surgery. A retrospective analysis was conducted on the clinical data, surgical procedures, and outcomes of consecutive patients admitted to the department of orthopedics of a hospital from December 2019 to May 2023 and undergoing spinal surgery (scoliosis correction and internal fixation surgery). The impact of the perioperative warming measures on surgical temperature variation and postoperative recovery was analyzed. The surgical patients who received normal active warming measures (quilt, blood transfusion and infusion warming, flushing fluid warming) were the control group (Normal Warming Group [NWG], n = 199), and the enhanced active warming measures (NWG and forced air warming) were the experimental group (Enhanced Warming Group [EWG], n = 201). Incidence of IPH was the primary endpoint of this study. EWG exhibited a significantly reduced incidence of IPH and average frequency of hypothermia per patient compared with NWG (respectively, p < 0.01) and demonstrated notable reductions in intraoperative blood loss, urine output, anesthesia recovery time, and duration of arousal (respectively, p < 0.05, p < 0.01, and p < 0.001). Postoperatively, EWG showed a significantly reduced incidence of shivering (p < 0.001) and had lower costs for postoperative antibiotic use and albumin administration (respectively, p < 0.05 and p < 0.01). So we infer that the occurrence of hypothermia during spinal surgery may seem unavoidable, but EWG can effectively lower the occurrence of IPH and its adverse outcomes, and then somewhat alleviate the postoperative treatment burden. However, given that this study is a retrospective cohort study, it is not yet possible to definitively prove the above conclusions, so we will design relevant prospective clinical studies to prove that the optimization of temperature management may be crucial to ensure optimal overall recovery outcomes.

Intraoperative temperature management during emergency cesarean section: a retrospective observational study.

Intraoperative hypothermia is a common complication during cesarean section (C-section) and associated with the high maternal mortality and morbidity. This study aimed to explore the risk factors associated with the incidence of intraoperative hypothermia in women who underwent emergency C-section deliveries. We retrospectively enrolled women who underwent emergency cesarean deliveries from August 2022 to Dec 2023 at Suzhou Municipal Hospital of Anhui Province. Baseline characteristics, thermal status, and perioperative information were extracted. Hypothermia was defined as the onset of a core temperature below 36°C. Data were compared between patients with and without a hypothermia during surgery. Logistic regression analyses were performed to determine the risk factors for low-temperature-status. Overall, 87 patients were included, and 30 underwent hypothermia during surgery. For women with a normal temperature status, women in the hypothermia group had a lower incidence of receiving active warming methods (52.6% vs. 30%, P = 0.044). In the logistic regression model involving core temperature, a pre-surgery core temperature < 36.5°C (OR 4.22, 95% CI 1.13-15.63, p = 0.032) and a long surgery duration (per 10min, OR 1.97, 95% CI 1.24-3.11, p = 0.004) were associated with a high probability of hypothermia. Administering active warming methods to women can reduce the risk of experiencing a hypothermia during emergency C-sections (OR 0.19, 95% CI 0.05-0.63; p = 0.007). Hypothermia is common in emergency C-section deliveries. It is recommended that active warming methods should be applied to parturient undergoing emergency C-sections more proactively, especially for women who have a low baseline core temperature (< 36.5°C) and are expected to have a long surgery duration.

Cross-Combination Analyses of Random Forest Feature Selection and Decision Tree Model for Predicting Intraoperative Hypothermia in Total Joint Arthroplasty

BackgroundIn total joint arthroplasty patients, intraoperative hypothermia (IOH) is associated with perioperative complications and an increased economic burden. Previous models have some limitations and mainly focus on regression modeling. Random forest (RF) algorithms and decision tree modeling are effective for eliminating irrelevant features and making predictions that aid in accelerating modeling and reducing application difficulty. MethodsWe conducted this prospective observational study using convenience sampling and collected data from 327 total joint arthroplasty patients in a tertiary hospital from March 4, 2023, to September 11, 2023. Of those, 229 patients were assigned to the training and 98 to the testing sets. The Chi-square, Mann–Whitney U, and t-tests were used for baseline analyses. The feature variables selection used the RF algorithms, and the decision tree model was trained on 299 examples and validated on 98. The sensitivity, specificity, recall, F1 score, and area under the curve were used to test the model’s performance. ResultsThe RF algorithms identified the preheating time, the volume of flushing fluids, the intraoperative infusion volume, the anesthesia time, the surgical time, and the core temperature after intubation as risk factors for IOH. The decision tree was grown to 5 levels with 9 terminal nodes. The overall incidence of IOH was 42.13%. The sensitivity, specificity, recall, F1 score, and area under the curve were 0.651, 0.907, 0.916, 0.761, and 0.810, respectively. The model indicated strong internal consistency and predictive ability. ConclusionsThe preheating time, the volume of flushing fluids, the intraoperative infusion volume, the anesthesia time, the surgical time, and the core temperature after intubation could accurately predict IOH in total joint arthroplasty patients. By monitoring these factors, the clinical staff could achieve early detection and intervention of IOH in total joint arthroplasty patients.

Association between intraoperative hypothermia and outcomes in neonatal patients undergoing non-cardiac surgery

Objective: To investigate the impact of intraoperative hypothermia on postoperative outcome in neonatal patients undergoing non-cardiac surgery. Methods: The data of 1 008 neonates undergoing non-cardiac surgery in Children's Hospital, Zhejiang University School of Medicine from January 2020 to October 2022 were retrospectively collected,which included 558 males and 450 females, with a midian age [M (Q1, Q3)] of 6 (2, 14) days. Neonates were divided into 4 groups according to whether hypothermia (below 36 ℃) occurred and the lowest body temperature during the surgery: normal temperature group (n=246), mild hypothermia group (the lowest temperature ranged 35.0-35.9 ℃, n=434), moderate hypothermia group (the lowest temperature ranged 34.0-34.9 ℃, n=232) and severe hypothermia group (the lowest temperature<34 ℃, n=96). The primary outcome was the incidence of intraoperative hypothermia. The four groups' difference of postoperative hospital stay, postoperative mortality within 30 days, postoperative pulmonary complications, postoperative hemorrhage/blood transfusion and acidosis were compared. Multivariate logistic regression was used to analyze the relationship between intraoperative hypothermia and prolonged postoperative hospital stay (>14 d), 30 d-mortality and other complications. Results: In the 1 008 neonatal patients, 762 (75.6%) cases suffered intraoperative hypothermia, among which the incidence of mild, moderate and severe hypothermia was 43.1% (434/1008), 23.0% (232/1008) and 9.5% (96/1008), respectively. The postoperative hospital stay in normal, mild, moderate and severe hypothermia groups was 9.0 (5.8, 18.0), 12.0 (7.0, 21.0), 17.0 (10.0, 34.5) and 31.5 (12.5, 55.8) days. The mortality rate with 30 days after surgery was 2.9% (7/246), 4.4% (19/434), 6.9% (16/232) and 14.7% (14/96), the incidence of postoperative pulmonary complications was 31.7%(78/246), 39.9%(173/434), 44.8%(104/232) and 67.4%(64/96), the rate of postoperative hemorrhage/blood transfusion was 19.9%(49/246), 32.3%(140/434), 49.1%(114/232) and 79.0%(75/96), and the incidence of acidosis was 26.8%(66/246), 35.7%(155/434), 44.4%(103/232) and 46.3%(44/96), respectively. All differences were statistically significant (all P<0.05). According to the adjusted logistic regression analysis, compared with the normal body temperature group, severe hypothermia was associated with prolonged postoperative hospital stay (OR=1.962, 95%CI: 1.063-3.619) and postoperative pulmonary complications (OR=2.020, 95%CI: 1.149-3.553). The mild, moderate and severe hypothermia group could increase the risk of postoperative blood/transfusion rate (mild: OR=1.690, 95%CI: 1.080-2.644; Moderate: OR=2.382, 95%CI: 1.444-3.927; Severe: OR=8.334, 95%CI: 3.123-8.929). The mild and moderate hypothermia could raise the risk of acidosis (mild: OR=1.458, 95%CI: 1.009-2.107; Moderate: OR=1.949, 95%CI: 1.279-2.972). Conclusion: Intraoperative hypothermia can prolong the postoperative hospital stay, and increase the risk of postoperative mortality, postoperative pulmonary complications, postoperative hemorrhage/transfusion, and acidosis.

Effect of a Forced-Air Warming Blanket on Different Parts of the Body on Core Temperature of Patients Undergoing Elective Open Abdominal Surgery: A Randomized Controlled Single-Blind Trial

PurposeThis study aimed to determine the effect of a forced-air warming blanket placed on different body parts on the core temperature of patients undergoing elective open abdominal surgery. DesignProspective, single-center, randomized, controlled, single-blind trial. MethodsA total of 537 patients who underwent open abdominal surgery were randomized into groups A, B, and C and provided with different forced-air warming blankets. Group A was given an upper body blanket, group B a lower body blanket, and group C an underbody blanket. The incidence of intraoperative hypothermia, the time maintaining the core temperature over 36 ℃ before hypothermia, the duration of hypothermia, the rewarming rate, and relevant complications were compared among three groups. FindingsIntraoperative hypothermia occurred in 51.4% of patients in group B, 37.6% of patients in group A, and 34.1% of patients in group C (P = .002). Maintaining the core temperature above 36 ℃ was longer before hypothermia in groups A and C (log-rank P = .006). In groups A and C, the duration of hypothermia was shorter, the rewarming rate was higher, and the incidence of shivering and postoperative nausea and vomiting were lower, compared to group B. ConclusionsIn patients undergoing elective open abdominal surgery, a forced-air warming blanket on the upper body part or underbody area decreased intraoperative hypothermia, prolonged the time to maintain the core temperature above 36 ℃ before hypothermia, and could better prevent further hypothermia when the core temperature had decreased below 36 ℃. In addition, it was significantly superior in reducing shivering and postoperative nausea and vomiting in the postanesthesia care unit.

Effect of different covering methods of inflatable heating blanket on the incidence of intraoperative hypothermia in patients undergoing photoselective vaporization of the prostate

Effect of different covering methods of inflatable heating blanket on the incidence of intraoperative hypothermia in patients undergoing photoselective vaporization of the prostate

The Effect of Brief Warming during Induction of General Anesthesia and Warmed Intravenous Fluid on Intraoperative Hypothermia in Patients Undergoing Urologic Surgery.

Background and Objectives: Transurethral urologic surgeries frequently lead to hypothermia due to bladder irrigation. Prewarming in the preoperative holding area can reduce the risk of hypothermia but disrupts surgical workflow, preventing it from being of practical use. This study explored whether early intraoperative warming during induction of anesthesia, known as peri-induction warming, using a forced-air warming device combined with warmed intravenous fluid could prevent intraoperative hypothermia. Materials and Methods: Fifty patients scheduled for transurethral resection of the bladder (TURB) or prostate (TURP) were enrolled and were randomly allocated to either the peri-induction warming or control group. The peri-induction warming group underwent whole-body warming during anesthesia induction using a forced-air warming device and was administered warmed intravenous fluid during surgery. In contrast, the control group was covered with a cotton blanket during anesthesia induction and received room-temperature intravenous fluid during surgery. Core temperature was measured upon entrance to the operating room (T0), immediately after induction of anesthesia (T1), and in 10 min intervals until the end of the operation (Tend). The incidence of intraoperative hypothermia, change in core temperature (T0-Tend), core temperature drop rate (T0-Tend/[duration of anesthesia]), postoperative shivering, and postoperative thermal comfort were assessed. Results: The incidence of intraoperative hypothermia did not differ significantly between the two groups. However, the peri-induction warming group exhibited significantly less change in core temperature (0.61 ± 0.3 °C vs. 0.93 ± 0.4 °C, p = 0.002) and a slower core temperature drop rate (0.009 ± 0.005 °C/min vs. 0.013 ± 0.004 °C/min, p = 0.013) than the control group. The peri-induction warming group also reported higher thermal comfort scores (p = 0.041) and less need for postoperative warming (p = 0.034) compared to the control group. Conclusions: Brief peri-induction warming combined with warmed intravenous fluid was insufficient to prevent intraoperative hypothermia in patients undergoing urologic surgery. However, it improved patient thermal comfort and mitigated the absolute amount and rate of temperature drop.

Effect of Remimazolam on the Incidence of Intraoperative Hypothermia Compared with Inhalation Anesthetics in Patients Undergoing Endoscopic Nasal Surgery: A Prospective Randomized Controlled Trial.

Remimazolam is an ultrashort-acting benzodiazepine that is increasingly used for its efficacy in anesthesia induction and maintenance. However, limited research has explored its impact on intraoperative hypothermia compared to that of traditional inhalation anesthetics. This study aimed to compare the incidence of hypothermia during endoscopic nasal surgery when using remimazolam for maintenance anesthesia versus using inhalation anesthetics. This prospective study included 70 patients who underwent endoscopic nasal surgery under general anesthesia. The patients were randomly assigned to one of two groups: the inhalation anesthetic (IA) group (n=35), in which desflurane and nitrous oxide were administered, and the remimazolam (R) group (n=35), in which remimazolam and remifentanil were administered for anesthesia maintenance. The primary outcome was the incidence of intraoperative hypothermia, defined as an esophageal temperature below 36 °C during anesthesia. The incidence of intraoperative hypothermia was significantly higher in the R group than in the IA group (P = 0.014). Furthermore, the temperature at the end of the surgery was significantly lower in the R group than in the IA group (P = 0.006). Additionally, the use of warming devices after surgery was more frequent in the R group than in the IA group (P = 0.047). These findings suggest that the use of remimazolam for maintenance anesthesia during endoscopic nasal surgery increases the risk of intraoperative hypothermia compared to the use of inhalation anesthetics. This highlights the importance of temperature monitoring in patients receiving remimazolam to minimize the adverse outcomes associated with hypothermia during surgery.

Incidence and associated factors of perioperative hypothermia in adult patients at a university-based, tertiary care hospital in Thailand

BackgroundInadvertent perioperative hypothermia is an unintentional drop in core body temperature to less than 36 °C perioperatively and is associated with many negative outcomes such as infection, a prolonged stay in a recovery room, and decreased patient comfort.ObjectiveTo determine the incidence of postoperative hypothermia and to identify the associated factors with postoperative hypothermia in patients undergoing head, neck, breast, general, urology, and vascular surgery. The incidences of pre- and intraoperative hypothermia were examined as the intermediate outcomes.Materials and methodsA retrospective chart review was conducted in adult patients undergoing surgery at a university hospital in a developing country for two months (October to November 2019). Temperatures below 36 °C were defined as hypothermia. Univariate and multivariate analyses were used to identify factors associated with postoperative hypothermia.ResultsA total of 742 patients were analyzed, the incidence of postoperative hypothermia was 11.9% (95% CI 9.7%-14.3%), and preoperative hypothermia was 0.4% (95% CI 0.08%-1.2%). Of the 117 patients with intraoperative core temperature monitoring, the incidence of intraoperative hypothermia was 73.5% (95% CI 58.8–90.8%), and hypothermia occurred most commonly after anesthesia induction. Associated factors of postoperative hypothermia were ASA physical status III-IV (OR = 1.78, 95%CI 1.08–2.93, p = 0.023) and preoperative hypothermia (OR = 17.99, 95%CI = 1.57-206.89, p = 0.020). Patients with postoperative hypothermia had a significantly longer stay in the PACU (100 min vs. 90 min, p = 0.047) and a lower temperature when discharged from PACU (36.2 °C vs. 36.5 °C, p < 0.001) than those without hypothermia.ConclusionThis study confirms that perioperative hypothermia remains a common problem, especially in the intraoperative and postoperative periods. High ASA physical status and preoperative hypothermia were associated factors of postoperative hypothermia. In order to minimize the incidence of perioperative hypothermia and enhance patient outcomes, appropriate temperature management should be emphasized in patients at high risk.RegistrationClinical Trials.gov (NCT04307095) (13/03/2020).

The Effect of Postinduction Blood Glucose on Intraoperative Hypothermia

Background and Objectives: Hypothermia frequently occurs in patients undergoing surgery and is associated with adverse complications. Therefore, this study aimed to investigate the postinduction blood glucose and occurrence of intraoperative hypothermia in patients undergoing laparoscopic surgery. Materials and Methods: This retrospective observational study included 334 patients aged ≥20 years who had undergone elective laparoscopic surgery. The primary outcome of this study was the incidence of intraoperative hypothermia. Stratified analysis revealed differences between patients with and without diabetes. Results: Hypothermia occurred in 200 (59.9%) patients. In multivariate analysis, out-of-range postinduction glucose was independently associated with hypothermia (>150 mg/dL: odds ratio 2.17, 95% confidence interval (1.02, 4.61), p = 0.045; <110 mg/dL: odds ratio 2.02, 95% confidence interval (1.15, 3.55), p = 0.015), whereas preoperative HbA1c >6% was not significantly associated with hypothermia (odds ratio 1.02, 95% confidence interval (0.56, 1.84), p = 0.961). Considering only patients with diabetes, the incidence of hypothermia was lower (p = 0.002), the duration of hypothermia was shorter (p = 0.007), and the minimum temperature was higher (p = 0.006) in those with a postinduction glucose level of 110-150 mg/dL. Conclusions: The postinduction glucose level is independently associated with intraoperative hypothermia. Out-of-range postinduction glucose appeared to have an impact on the development of hypothermia in patients with diabetes, especially those with a postinduction glucose level <110 mg/dL.

Validation of a Prediction Model for Intraoperative Hypothermia in Patients Receiving General Anesthesia.

Objectives There have been no fully validated tools for the rapid identification of surgical patients at risk of intraoperative hypothermia. The objective of this study was to validate the performance of a previously established prediction model in estimating the risk of intraoperative hypothermia in a prospective cohort. Methods In this observational study, consecutive adults scheduled for elective surgery under general anesthesia were enrolled prospectively at a tertiary hospital between September 4, 2020, and December 28, 2020. An intraoperative hypothermia risk score was calculated by a mobile application of the prediction model. A wireless axillary thermometer was used to continuously measure perioperative core temperature as the reference standard. The discrimination and calibration of the model were assessed, using the area under the receiver operating characteristic curve (AUC), Hosmer–Lemeshow goodness-of-fit test, and Brier score. Results Among 227 participants, 99 (43.6%) developed intraoperative hypothermia, and 10 (4.6%) received intraoperative active warming with forced-air warming. The model had an AUC of 0.700 (95% confidence interval [CI], 0.632–0.768) in the overall cohort with adequate calibration (Hosmer–Lemeshow χ2 = 13.8, P=0.087; Brier score = 0.33 [95% CI, 0.29–0.37]). We categorized the risk scores into low-risk, moderate-risk, and high-risk groups, in which the incidence of intraoperative hypothermia was 23.0% (95% CI, 12.4–33.5), 43.4% (95% CI, 33.7–53.2), and 62.7% (95% CI, 51.5–74.3), respectively (P for trend <0.001). Conclusions The intraoperative hypothermia prediction model demonstrated possibly helpful discrimination and adequate calibration in our prospective validation. These findings suggest that the risk screening model could facilitate future perioperative temperature management.

Comparison of Core Body Temperatures in Patients Administered Remimazolam or Propofol during Robotic-Assisted and Laparoscopic Radical Prostatectomy.

Background and Objectives: Different types of anesthetics affect thermoregulatory mechanisms, such as the redistribution of body temperature, loss of skin heat, or inhibition of thermoregulatory vasoconstriction. Therefore, we compared remimazolam with propofol in terms of core body temperature in patients undergoing robotic-assisted and laparoscopic radical prostatectomy. Materials and methods: Ninety patients were randomly assigned to either the propofol–remifentanil (PR) group or the remimazolam–remifentanil (RR) group. The PR group (n = 45) received effect-site concentrations of 6.0 μg/mL of propofol and 4 ng/mL of remifentanil, followed by 0.9 mg/kg of 1% rocuronium and maintenance with effect-site concentrations of 2–4 μg/mL of propofol and 3 ng/mL of remifentanil. The RR group (n = 45) received remimazolam 6 mg/kg/h by continuous intravenous infusion and the effect-site concentration of 4 ng/mL of remifentanil, followed by 0.9 mg/kg of 1% rocuronium, remimazolam 1–3 mg/kg/h, and remifentanil 3 ng/mL. The primary outcome was core body temperature, and secondary outcomes included vasoconstriction threshold (°C) and time to onset of vasoconstriction (min). Results: The core body temperature in the RR group was significantly higher at 60, 80, 100, 120, 140, 160, and 180 min after induction than in the PR group (p < 0.01). The vasoconstriction threshold was significantly higher in the RR group (35.2 ± 0.4) than in the PR group (34.8 ± 0.3) (p < 0.01). The time to onset of vasoconstriction was significantly less in the RR group (150.5 ± 10.2) than in the PR group (158.5 ± 8.4) (p < 0.01). However, the incidence of intraoperative hypothermia was not significant between two groups. Conclusions: Remimazolam appears to reduce vasoconstriction threshold less than and had a faster onset of vasoconstriction, resulting in superior thermoregulatory control.

Implementation of multi-mode nursing insulation program for patients receiving surgery for spine tumor: a propensity score-matched analysis

BackgroundSpinal tumor surgery usually involved long operation time, large area of soft tissue resection and long wound, and was prone to hypothermia during the operation. Therefore, actively promoting insulation and optimizing the intraoperative insulation program have great potential in reducing the incidence of hypothermia and reducing the incidence of postoperative complications. In this study, we compared patients who did not implement multi-mode nursing insulation program (MNIP) with those who implemented MNIP, observing and comparing clinical outcomes, and complications in both groups, with the aim of developing an optimal management plan for the preoperative, intraoperative, and postoperative periods, respectively.MethodsWe selected 2 periods of 1 year, before (n = 120 patients) and after MINP implementation (n = 120 patients). Data were collected on patient demographics, operative, perioperative details, temperature changes, anesthesia recovery effect, incidence of postoperative wound infection, length of hospital stay and complications. PS analyses were used for dealing with confounding bias in this retrospective observational study.ResultsAfter PS matching, the outcomes of 120 well-balanced pairs of patients were compared (No-MNIP vs MNIP). There was no significant difference concerning the satisfaction survey. The results indicated that the MNIP had better insulation effect at 90 min, 120 min, 150 min after anesthesia induction and after surgery. There were 16 cases of complications in the No-MNIP group and 5 cases in the MNIP group postoperative, which have significant statistical difference.ConclusionIn this study, the incidence of intraoperative hypothermia was effectively reduced by adopting the multi-mode insulation scheme, thus reducing the incidence of incision infection and shortening the length of hospital stay of patients.

Analysis of the Incidence of Intraoperative Hypothermia and its Influencing Factors in Gynecological Patients Undergoing Laparoscopic Surgery

Analysis of the Incidence of Intraoperative Hypothermia and its Influencing Factors in Gynecological Patients Undergoing Laparoscopic Surgery

A descriptive study of the relationship between preoperative body temperature and intraoperative core temperature change in adults under general anaesthesia

Background: Despite numerous guidelines on perioperative temperature management, perioperative hypothermia remains common. Prewarming to prevent redistribution hypothermia is supported by evidence, but not widely practised. We investigate the measurement of preoperative mean body temperature as a potential tool for individualising the practice of prewarming. Methods: We hypothesised that patients who experience intraoperative hypothermia have a lower preoperative mean body temperature. A longitudinal study was conducted in adult patients presenting for ophthalmological surgery under general anaesthesia, to describe the relationship between the incidence of hypothermia within the first hour of anaesthesia and preoperative mean body temperature. Results: Sixty-five patients were enrolled. Twelve participants (18%) presented to the operating theatre hypothermic (core temperature < 36.0 °C). A further 28 (43%) became hypothermic during the procedure. All hypothermia events occurred within 60 minutes after induction of anaesthesia, and half of the events occurred within 19 minutes. The difference in preoperative mean body temperature between those with and without intraoperative hypothermia was only -0.2 °C (95% CI -0.4, 0.1). This is neither clinically relevant nor statistically noteworthy. In Cox proportional hazards analysis, BMI and ASA status compounded the observed association between preoperative mean body temperature and the incidence of intraoperative hypothermia. A higher BMI and ASA are associated with a lower incidence of hypothermia. Conclusion: We conclude that intraoperative hypothermia is common and occurs early after induction of anaesthesia. We observed no useful difference in preoperative mean body temperature to help distinguish between patients who become hypothermic and those who do not. Without a useful risk prediction tool, a generic approach to prewarming remains appropriate. Preoperative screening for pre-existing hypothermia should be practised, even in cases considered as low risk.

PP352 Systematic Review Of Clinical Effects Of Different Thermal Insulation Measures In Patients Undergoing Major Surgery

IntroductionHypothermia (core temperature &lt;36°C) during major surgeries could result in a number of adverse events such as surgical site infection, bleeding, and prolonged hospital stay. The incidence of intraoperative hypothermia was 44.3 percent in China in 2015, with only 10.7 percent of patients receiving effective hypothermia prevention measures during major surgeries. By systematically examining the adverse risks for patients using different warming measures (active and passive), our study discussed the potential of bringing the most effective one(s) into clinical guidelines.MethodsArticles, ongoing trials and grey literatures were retrieved from PubMed, The Cochrane Library and Clinical Trials till February 2019. Bair HuggerTM (BH) was determined to be the reference group and all randomized controlled trials including BH were included. In the control group, we kept all possible warming measures. Adverse effect indicators were decided using scoping reviews and then applied in literature screening. Type (open/endoscopic) and length of surgery were included in sub-group analysis.ResultsA total of forty-two studies were included, with twenty-seven of them passive insulation measures and fifteen active measures. Compared with passive measures, BH had significant advantages, such as in surgical site infection (risk ratio [RR] = 0.13, 95% confidence interval [CI]: 0.05, 0.80), chills (RR = 0.37, 95% CI: 0.25, 0.54) and hospitalization stay (mean difference [MD]=−1.27d, 95% CI: -2.05, -0.48). Compared with active insulation measures, BH had no significant advantages. Patients with open or longer surgeries (≥2 hours) experienced higher risks.ConclusionsGenerally, an active warming system is more effective in lowering risks (e.g., hypothermia, surgical site infection, chills, length of stay) than passive ones, especially for patients going through non-endoscopic or longer surgeries. Among the active warming systems, BH does the same job as other active insulation measures. Given that the practice of peri-operative hypothermia prevention using active warming systems is not popular in China, the use of BH and other active insulation measures during major surgeries are recommended to improve the safety and potentially reduce the cost of treating those clinical adverse events.

Thermal suit connected to a forced-air warming unit for preventing intraoperative hypothermia: A randomised controlled trial.

Inadvertent intraoperative hypothermia is a common occurrence in surgical patients. A thermal suit is an option for passive insulation. However, active warming is known to be more effective. Therefore, we hypothesised that a forced-air warming (FAW) unit connected to the thermal suit is superior to a commercial FAW blanket and a warming mattress in breast cancer surgery. Forty patients were randomised to this prospective, clinical trial to wear either the thermal suit or conventional hospital clothes under general anaesthesia. The Thermal suit group had a FAW unit set to 38°C and connected to the legs of the suit. The Hospital clothes group had a lower body blanket set to 38°C and a warming mattress set to 37°C. Core temperature was measured with zero-heat-flux sensor. The primary outcome was core temperature on admission to the recovery room. There was no difference in mean core temperatures at anaesthetic induction (P=.4) or on admission to the recovery room (P=.07). One patient in the Thermal suit group (5%) vs six patients in the Hospital clothes group (32%) suffered from intraoperative hypothermia (P=.04, 95% CI 1.9%-49%). Mean skin temperatures (MSTs) were higher in the Thermal suit group during anaesthesia. No burns or skin irritations were reported. Two patients in the Thermal suit group sweated. A thermal suit connected to a FAW unit was not superior to a commercial FAW blanket, although the incidence of intraoperative hypothermia was lower in patients treated with a thermal suit.

The low fresh gas flow anesthesia and hypothermia in neonates undergoing digestive surgeries: a retrospective before-after study

BackgroundBased on the previous investigation in our institution, the incidence of intraoperative hypothermia in neonates was high. Since September 1st, 2019, the recommendation had been launched to utilize ≤1 L/min fresh gas flow during the neonates’ surgical procedure. We therefore intended to evaluate the association between low fresh gas flow anesthesia and the occurrence of hypothermia in neonates undergoing digestive surgeries.MethodsA retrospective chart review, before-after study was conducted for neonates who underwent digestive surgeries. The primary outcomes were the incidence of hypothermia. The secondary outcomes included hospital mortality, the value of lowest temperature, blood loss, mean body temperature during the surgery, the length of hypothermia during the surgery and postoperative hospital length-of- stay (PLOS).Results249 neonates fulfilled the eligibility criteria. The overall incidence of intraoperative hypothermia was 81.9%. The low fresh gas flow anesthesia significantly reduced the odds of hypothermia [routine group: 149 (87.6%) versus low flow group: 55 (69.6%); p < 0.01]. Moreover, the low fresh gas flow anesthesia could reduce the length of hypothermia [routine group: 104 mins (50, 156) versus low flow group: 30 mins (0,100); p < 0.01], as well as elevate the value of lowest temperature for neonates [routine group: 35.1 °C (34.5, 35.7) versus low flow group: 35.7 °C (35.3, 36); p < 0.01]. After adjustment for confounding, low fresh gas flow anesthesia and the length of surgical time were independently associated with intraoperative hypothermia.ConclusionsLow fresh gas flow anesthesia is an effective way to alleviate hypothermia in neonates undergoing open digestive surgery.

Effect of temperature maintenance by forced-air warming blankets of different temperatures on changes in inflammatory factors in children undergoing congenital hip dislocation surgery.

BackgroundHypothermia is associated with many adverse clinical outcomes in pediatric patients, and thus, it is important to find an effective and safe method for preventing peri-operative hypothermia and its associated adverse outcomes in pediatric patients. This study aimed to investigate the effect of forced-air warming blankets with different temperatures on changes in the transforming growth factor-β (TGF-β), tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-10 levels in children undergoing surgical treatment for developmental displacement of the hip (DDH).MethodsThe study included 123 children undergoing surgery for DDH under general anesthesia. The patients were randomly assigned to three groups, using a random number table: the 32, 38, and 43°C groups according to the temperature setting of the forced-air warming blankets. For each patient, body temperature was recorded immediately after anesthesia induction and intubation (T0), at initial incision (T1), at 1 h after incision (T2), at 2 h after incision (T3), at the end of surgery (T4), immediately upon return to the ward after surgery (T5), and then at 12 h (T6), 24 h (T7), 36 h (T8), and 48 h (T9) after the surgery. The serum levels of TGF-β, TNF-α, IL-1β, and IL-10 were measured at T0 and T4 for all groups.ResultsThe number of patients with fever in the 38°C group was significantly less than those in the 32 and 43°C groups (χ2 = 6.630, P = 0.036). At T0, the body temperatures in the 38 and 43°C groups were significantly higher than that in the 32°C group (F = 17.992, P < 0.001). At T2, the body temperature was significantly higher in the 43°C group than those in the 32 and 38°C groups (F = 12.776, P < 0.001). Moreover, at T4, the serum levels of TGF-β (F = 3286.548, P < 0.001) and IL-10 (F = 4628.983, P < 0.001) were significantly increased in the 38°C group, and the serum levels of TNF-α (F = 911.415, P < 0.001) and IL-1β (F = 322.191, P < 0.001) were significantly decreased in the 38°C group, compared with the levels in the 32 and 43°C groups.ConclusionForce-air warming blankets set at 38°C maintained stable body temperature with less adverse outcome and effectively inhibited the inflammatory response in pediatric patients undergoing surgery for DDH.Clinical trial registrationChiCTR1800014820; http://www.chictr.org.cn/showproj.aspx?proj=25240.