Incidence Of Postoperative Hypothermia Research Articles

Effect of timing of intraoperative administration of paracetamol on postoperative shivering: A randomised double-blind controlled trial.

Paracetamol (PCM) has an anti-shivering effect and may also exacerbate intraoperative hypothermia. This study compares the incidence of shivering as the primary outcome and the incidence of perioperative hypothermia (<36°C) and the time to the analgesic requirement as secondary outcomes when PCM was administered after induction of anaesthesia or towards the end of surgery. In this randomised study, 225 adult patients of either gender undergoing elective surgical procedures under general anaesthesia with an expected duration of surgery of 1-4 h were studied. They received intravenous (IV) PCM 15 mg/kg (maximum 1 g) immediately after anaesthesia induction (Early PCM group), 30 min before completion of surgery (Late PCM group) or no PCM (Control group). IV morphine 0.1 mg/kg was administered for analgesia in all three groups. The Chi-square test and repeated measures analysis of variance followed by Tukey's test were used for statistical analysis. The incidence of shivering was lower in Late PCM (12%) than in Early PCM (29.3%) (P = 0.009) and Control groups (30.6%) (P = 0.005). The incidence of postoperative hypothermia was also significantly lower in the Late PCM group than in the Early PCM (P = 0.002) and Control groups (P = 0.016). Early PCM and Control groups did not significantly differ. The number of patients requiring postoperative analgesia was smaller, and the time to the analgesic requirement was longer in Late PCM compared to other groups. Administration of IV PCM 30 min before completion of surgery results in a lower incidence of postoperative shivering and hypothermia when compared to PCM administered after induction of anaesthesia or no PCM.

Risk factors of post-operative hypothermia

The core body temperature less than 36ºC or 96.8ºF at the post operative period, is called hypothermia. In the postoperative phase, there are various reasons are developing the hypothermia. This may include surgical site infections, blood transfusions during or after surgery, recovery room or Intensive care unit stay etc. this factors may be modifiable through the nursing practice. Objective: objective of this study was to identify the risk factors of post operative hypothermia. Method: a hospital based case-control study was undertaken. All the postoperative patients (N=250) that underwent anaesthesia were included. The body temperature was measured after immediately after surgery at the arrival of recovery room in post operative period. Analysis was done using the software SPSS version 20.00. Results: the incidence of post operative hypothermia immediately at recovery room was 185 (74%) were having hypothermia and 65 (26%) were having no hypothermia. ‘t’ value of Duration of surgery was 0.816 and ‘p’ value was 0.015, ‘t’ value of Duration of anaesthesia was 0.758 and ‘p’ value was 0.007, ‘t’ value of Post operative room temperature was -2.489 and ‘p’ value was 0.00, Chi-square value of Magnitude of procedure was 32.674 and ‘p’ value was 0.01.

Construction and validation of postoperative hypothermia prediction model for patients undergoing joint replacement surgery.

To construct and validate a postoperative hypothermia prediction model for patients undergoing joint replacement surgery. Postoperative hypothermia is one of the harmful perioperative complications in patients undergoing joint replacement surgery. The previous studies mainly focused on intraoperative hypothermia prediction models. The prediction model for postoperative hypothermia in patients with joint replacement surgery was understudied. Cohort study. We collected data from 503 participants undergoing joint replacement surgery in a tertiary hospital from January 2019 to December 2021. Of those, 404 cases were assigned to the modelling and 99 to the validation groups. Logistic regression was used to construct the model. The AUC was used to test the predictive effect of the model. Finally, 99 cases were used to verify the application effect of the model. A TRIPOD checklist was used to guide the reporting of this study. The factors entered into the prediction model were age, intraoperative hypothermia, BMI, heat preservation measures and platelet (PLT). The model was constructed as follows: Logit (P)=.537 + 3.669 × 1 (intraoperative hypothermia) + .030 × age - .289 × BMI + 2.857 × 1 (intraoperative insulation measures) + .003 × PLT. Hosmer-Lemeshow test, p=.608, the area under the receiver operating characteristic curve (AUC) was .861. The Youden index was .530, the sensitivity was .599 and the specificity was .93. The incidence of postoperative hypothermia in the modelling group was 42.93% (173/404), and that in the verification group was 43.43% (43/99), χ2=.012, p=.912. The correct practical application rate was 87.88%. This model has a good application effect. The current prediction model provided a reference for clinical screening of patients with high-risk hypothermia after joint replacement surgery. Clinical nurses can use the developed prediction model to predict the occurrence of postoperative hypothermia and provide a reference for the preventive measure.

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.

Incidence of postoperative hypothermia and its risk factors in adults undergoing orthopedic surgery under brachial plexus block: A retrospective cohort study.

Postoperative hypothermia increases patient mortality and morbidity. However, the incidence of, and risk factors for, postoperative hypothermia in patients undergoing surgery under brachial plexus block (BPB) as the primary method of anesthesia remain unclear. This study aimed to determine the incidence of, and risk factors for, postoperative hypothermia in patients undergoing surgery under BPB. We retrospectively analyzed 660 patients aged ≥ 19 years who underwent orthopedic surgery under BPB in our hospital between October 2014 and October 2019. Postoperative hypothermia was defined as a tympanic membrane temperature < 36 °C when the patient arrived in the post-anesthesia care unit. Multivariate logistic regression analysis was performed to identify the independent risk factors for postoperative hypothermia. Postoperative hypothermia was observed in 40.6% (268/660) of patients. Independent risk factors for postoperative hypothermia were lower baseline core temperature before anesthesia (odds ratio [OR] 0.355; 95% confidence interval [CI] 0.185-0.682), alcohol abuse (OR 2.658; 95% CI 1.105-6.398), arthroscopic shoulder surgery (OR 2.007; 95% CI 1.428-2.820), use of fentanyl (OR 1.486; 95% CI 1.059-2.087), combined use of midazolam and dexmedetomidine (OR 1.816; 95% CI 1.268-2.599), a larger volume of intravenous fluid (OR 1.001; 95% CI 1.000-1.002), and longer duration of surgery (OR 1.010; 95% CI 1.004-1.017). Postoperative hypothermia is common in adult patients undergoing orthopedic surgery under BPB. The risk factors identified in this study should be considered to avoid postoperative hypothermia in these patients.

Postoperative hypothermia in geriatric patients undergoing arthroscopic shoulder surgery

Background: Hypothermia below 36°C is a common problem during arthroscopic shoulder surgery. Geriatric patients are more vulnerable to perioperative hypothermia. The present study compared postoperative hypothermia between geriatric and young adult patients receiving arthroscopic shoulder surgery. Methods: Data were collected retrospectively from a geriatric group (aged 65 or more, n = 29), and a control group (aged 19-64, n = 33) using the anesthesia records of patients who had undergone arthroscopic shoulder surgery. The primary outcome measure was the incidence of hypothermia upon arrival in the postanesthesia care unit (PACU). The secondary outcome measure was the decrease in body temperature from admission into the operating room to admission into the PACU. Results: The incidence of hypothermia was 93.1% and 54.5% in the geriatric and control groups, respectively, demonstrating a significant difference between the groups (P < 0.001). Comparison between body temperature revealed a decrease of 1.5 ± 0.6°C and 1.0 ± 0.4°C in the geriatric and control groups, respectively, showing a significant difference between the groups (P < 0.001). The degree of hypothermia was significantly different between the groups (P = 0.027). No shivering was observed in either of the two groups, but the incidence of thermal discomfort was higher in the geriatric group than in the control group (P = 0.021). Conclusions: In geriatric patients undergoing arthroscopic shoulder surgery, both the incidence of postoperative hypothermia and the associated temperature drop are more prominent than those in young adult patients. Additional warming methods will be needed to prevent postoperative hypothermia in geriatric patients. Keywords: Aged; Arthroscopy; Hypothermia

Forced-Air Warming for Rewarming and Comfort Following Laparoscopy: A Randomized Controlled Trail.

We investigated the efficacy of a forced-air warming (FAW) system on postoperative rewarming and comfort in patients undergoing laparoscopic surgery. In this randomized controlled trial, a total of 127 participants were randomly divided into the FAW group ( n = 64) and control group ( n = 63). The esophageal temperature was measured every 30 min during surgery, and the tympanic temperature and comfort levels were measured preoperatively and in the postanesthesia care unit (PACU). Data analysis used the generalized estimating equation. We found that there was a lower incidence of postoperative hypothermia in the FAW group compared with the control group, as well as a higher body temperature between 30 and 180 min in the PACU, a shorter time for rewarming, and a higher comfort level. Taken together, these results suggest that FAW is an effective rewarming technique for laparoscopic patients during surgery and in the PACU that improves comfort levels.

Combination of warming blanket and prewarmed intravenous infusion is effective for rewarming in infants with postoperative hypothermia in China.

Postoperative hypothermia in the postanesthesia care unit (PACU) in neonates and infants is a well-known serious complication as it can increase the risk of blood loss, wound infections, and cardiac arrhythmias. To identify an effective rewarming method for neonates and infants in China with postoperative hypothermia, an open-label, randomized, and controlled study was performed to compare the effects of three different rewarming methods. Neonates and infants (<1year) admitted to the PACU after surgery between June 2011 and November 2012 in a local hospital were investigated. Patients diagnosed with hypothermia were randomly divided into three groups and rewarmed with only blanket (blanket group), blanket plus electric blanket (heating blanket group), and blanket plus prewarmed intravenous (i.v.) infusion (warmed infusion group). From the beginning of rewarming, the rectal temperature was recorded every 10min up to 180min. The incidence of postoperative hypothermia in neonates and infants was 5.9%. Patients rewarmed with warming blanket plus prewarmed i.v. infusions showed the shortest rewarming time (67.0±2.6min, P=0.02) and highest rewarming efficiency (0.027±0.0008°C·min(-1) , P=0.039). The combination of conventional blanket rewarming and prewarmed i.v. infusion was shown to be an effective rewarming method for hypothermic infants in China.

Post-operative Hypothermia in Surgical Patients at University of Gondar Hospital, Ethiopia

Background: Hypothermia (i.e., temperature <36°C) is a common incident in the immediate postoperative period. However, it is usually diagnosed and treated infrequently. Maintaining normal body temperature will reduce hospital stay, surgical site infection, postoperative blood transfusions, pressure ulcers, subjective discomfort and mortality. The aim of this study was to identify magnitude and factors associated with postoperative hypothermia. Methods: Hospital based cross sectional study was conducted at University of Gondar Hospital. All consecutive postoperative (N= 384) patients that underwent scheduled or emergency surgery were included. Tympanic membrane temperature was measured before surgery and on arrival at recovery room via clinical nurses. Analysis was done using version 20 SPSS and binary logistic regression was utilized to identify associated factors. Result: The incidence of postoperative hypothermia at Recovery Room was 30.72%. Of these, 30 (27.96%) and 43 (34.44%) were mild and moderate respectively, with no severe hypothermia. Surgical patient operated under general anesthesia was more likely to develop postoperative hypothermia than spinal anesthesia (AOR, 1.84; 95% CI, 1.17; 3.24). Additionally, those with higher ASA physical status were at higher risk of postoperative hypothermia (AOR, 1.99; 95% CI, 1.16; 3.44). Temperature was not routinely taken by health care providers in the preoperative and intraoperative period. Conclusion and recommendation: Incidence of postoperative hypothermia at Recovery Room was high. Patient with high ASA physical status and operated under general anesthesia were significant factors for the development of postoperative hypothermia. Anesthesia providers along with perioperative surgical team should participate to reduce the occurrence of postoperative hypothermia with early prediction and diagnosis, especially in high risk groups.

Impact de la prise en charge anesthésique sur la ventilation postopératoire en salle de surveillance postinterventionnelle

IntroductionControl of residual muscle paralysis and hypothermia reduce postoperative complications rate. Short context sensitive half life anaesthetic agents allow a better adjustment of anaesthesia depth according to surgical requirement and a safe early extubation. Using a large clinical database, impact of these three strategies was assessed on clinical criteria such as use of neostigmine in postanaesthesia care unit (PACU), temperature, sedation score at the arrival into PACU and mechanical ventilation weaning. MethodsThis is a retrospective study on two separated periods. Since 2001, clinical events are entered into the database during and after anaesthesia in the same file. Agreement of anaesthesia staff to these strategies was assessed by the proportion of patients receiving modern anaesthetic agents (desflurane, sevoflurane and remifentanil) and the use of warming devices. Clinical impact was assessed by the number of patients receiving neostigmine in PACU, sedation score and temperature at the arrival in PACU and number of patients with mechanical ventilation in PACU. ResultsBetween the two periods (12,033 and 11,805 patients, respectively), use of sevoflurane, desflurane and remifentanil markedly increased, as well as the use of warming devices. Number of patients with neuromuscular reversal in PACU decreased from 73 to 11 and sedation score improved dramatically. Incidence of postoperative ventilation in PACU decreased from 1.1% (n=132) to 0.2% (n=30). Incidence of postoperative hypothermia was not changed during the two periods but incidence of hypothermia in the mechanically ventilated patient increased from 34.1 to 46.6%. Length of stay in PACU decreased from 122 to 114minutes (p<0.05). DiscussionImplementation of new intraoperative protocols induced major effects on postoperative clinical parameters and especially postoperative mechanical ventilation. Failure of our hypothermia prevention associated with a fast return of consciousness lead to wean from mechanical ventilation hypothermic patients. Risks of this strategy were not estimated.

Re: Incidence of Postoperative Hypothermia and the Relationship to Clinical Variables

Re: Incidence of Postoperative Hypothermia and the Relationship to Clinical Variables