Intraoperative Temperature Management Research Articles

Modified intraoperative temperature management prevents prolonged length of stay after head and neck surgery with free flap reconstruction

The present study aimed to investigate the association between intraoperative body temperature and prolonged length of stay (PLOS) after free flap reconstruction. A total of 753 patients who underwent head and neck surgery with free flap reconstruction were collected and randomly assigned into primary and validation cohorts. In the primary cohort, univariable and multivariable analyses were conducted to evaluate associations between intraoperative time-weighted (TW) temperature (TW average [TWA] temperature, TW hypothermia and TW hyperthermia) and PLOS. Nomograms were developed with and without intraoperative TW temperature, and validated in the validation cohort. Severe intraoperative TW hypothermia (OR = 1.004; 95% CI: 1.000, 1.007; p = 0.032) was identified as an independent risk factor for PLOS. Intraoperative TWA temperature and TW hypothermia showed linear related predictive effect for PLOS. The nomogram incorporating intraoperative TW temperature showed higher C-index (0.652, 95% CI: 0.591, 0.713) and improved net reclassification improvement for non-event (0.277, 95% CI: 0.118, 0.435; p < 0.001). Lower TWA temperature with mild TW hypothermia had a preventive effect on PLOS with a linear association, which may provide a modified range for intraoperative temperature management. The proposed nomogram incorporating intraoperative TW temperature could be used to develop personalized preventive strategies for PLOS after free flap reconstruction. IRB numberSYSEC-KY-KS-2022-037. Clinical trial registration numberNot applicable.

Update on current enhanced recovery after surgery (ERAS) pathways for hip and knee arthroplasty: a review of the literature

Enhanced recovery after surgery (ERAS) pathways for total hip and knee arthroplasty require continuous, comprehensive updates with the most current evidence-based guidelines. Guidelines are rapidly evolving in this topic because of interest in rapid recovery and outpatient total joint arthroplasty. This review article summarizes current literature to provide recommendations involving preoperative patient education and patient optimization, preoperative fasting and carbohydrate loading, analgesia, mode of anesthesia, intraoperative temperature management, hemostasis, postoperative nausea and vomiting management, early mobilization, and thromboprophylaxis. By promoting consensus, the authors aim to improve ERAS utilization and ultimately improve patient outcomes while also decreasing lengths of stay.

Comparison of Perioperative Active or Routine Temperature Management on Postoperative Quality of Recovery in PACU in Patients Undergoing Thoracoscopic Lobectomy: A Randomized Controlled Study.

BackgroundWhether intraoperative temperature management can help patients recover quickly in the postanesthesia care unit (PACU) still remains to be investigated. This study aimed to investigate the effect of intraoperative temperature management on the quality of postoperative recovery of patients who underwent pulmonary lobectomy in the PACU.MethodsTotally, 98 patients aged 45–60 years with a body mass index of 20–25 kg/m2 who underwent elective thoracoscopic lobectomy were enrolled. Patients were categorized into two groups using a random number table: the conventional group received routine intervention to maintain normothermia (Group C, n = 49) and the aggressive group received integrated interventions (Group A, n = 49). In Group C, normothermic fluid was infused intravenously, the heating blanket was turned on when the intraoperative temperature was <35.0 °C, and the warming was stopped when the temperature reached 36.5 °C. In Group A, the fluid heated to 37 °C was infused intravenously, and the heating blanket was used intraoperatively. When the body temperature was >37 °C, the heating blanket was turned off, and when the body temperature was <36.5 °C, the heating blanket was turned on to continue heating.ResultsSteward awakening scores at 1 min and 5 min after extubation and PaO2 levels at 15 min after extubation were higher in Group A than in Group C (P < 0.05); incidence of chills, nausea, and vomiting in the PACU was lower in Group A than in Group C (P < 0.05); and length of stay in the PACU was shorter in Group A than in Group C (P < 0.05).ConclusionAggressive intraoperative temperature management of patients undergoing thoracoscopic lobectomy can improve the quality of postoperative recovery in the PACU through a safe and smooth transition compared with routine insulation measures.

Assessment of intraoperative temperature management at the University Teaching Hospital of Kigali: A quality improvement project

Background: Due to the inhibition of thermoregulation by anesthetics, hypothermia occurs in 50% of patients undergoing general and neuraxial anesthesia without active warming. High-quality research has shown the negative effects of intraoperative hypothermia including increased rates of surgical site infections, increased hospital length of stay, increased cardiac morbidity and increased rate of transfusion. The University Teaching Hospital of Kigali commonly known as CHUK is the largest public referral hospital in Rwanda. The International Standards for Safe Anesthesia were not being met regarding intraoperative temperature management at CHUK. However, due to high ambient temperature in the operating room, it was unknown if this was a significant problem and worth investment, in a health system, with limited resources. Methods: After institutional review board approval, a two-stage descriptive cross-sectional quality improvement project was performed. The first stage was to assess current management of intra-operative temperature, determine if there was a significant rate of hypothermia and establish risk factors for developing intra-operative hypothermia in this clinical setting. The second stage was to determine if locally available warming techniques, an underbody warming blanket, significantly reduced the incidence of intra-operative hypothermia. Results: The primary result of the study was a 58% incidence of hypothermia with current standard practice. This was reduced to 6% with the use of an underbody water blanket. Temperature was measure intraoperatively in only 6% of cases and never documented. Adult patients and patients undergoing neuraxial anesthesia were more likely to experience hypothermia. Conclusions: Intraoperative hypothermia is common at CHUK despite high ambient operating room temperature. Monitoring and documentation of temperature is not occurring on a regular basis. The use of underbody water body, though not the gold standard for intraoperative warming, was effective in this study and a realistic solution in an environment with limited resources.

Assessment of intraoperative temperature management at the University Teaching Hospital of Kigali: A quality improvement project

Assessment of intraoperative temperature management at the University Teaching Hospital of Kigali: A quality improvement project

Maternal temperature in emergency caesarean section (MATES): an observational multicentre study

BackgroundTemperature regulation in women undergoing emergency caesarean section is a complex topic about which there is a paucity of evidence-based recommendations. The adverse effects of inadvertent peri-operative hypothermia are well described. Hyperthermia is also associated with adverse neonatal outcomes, an increased risk of obstetric intervention and increased treatment for suspected sepsis. We conducted a multi-centre observational cohort study to identify the prevalence of hypothermia and hyperthermia during emergency caesarean section. sParticipants undergoing emergency caesarean section were recruited across 14 sites in the UK. The primary end point was maternal temperature in the recovery room. Temperature was measured using a zero heat-flux temperature monitoring device. ResultsTwo hundred and sixty-five participants were recruited over a 12-month period. The prevalence of hypothermia (<36.0°C) was 10.7% and the prevalence of hyperthermia (>37.5°C) was 14.7% on admission to recovery. The prevalence of hypothermia, normothermia, and hyperthermia differed among type of anaesthesia: 71.4% of the hypothermic group had received a spinal anaesthetic whereas 76.9% of the hyperthermic group had received epidural top-up anaesthesia. There was a significant decrease in maternal temperature between the time of delivery and admission to the recovery room of 0.20°C (95% CI 0.15 to 0.25, P<0.001). ConclusionsBoth hypothermia and hyperthermia are prevalent findings in mothers who undergo emergency caesarean section. Therefore, accurate temperature measurement is essential to ensure that an appropriate intra-operative temperature management strategy is employed.

Seen and Ignored: Are We Undermining Studies of Brain Health Interventions Before We Start?

Seen and Ignored: Are We Undermining Studies of Brain Health Interventions Before We Start?

Correlation of nasopharyngeal temperature with transcutaneous carotid artery temperature of adult patients under general anesthesia in rural tertiary care hospital.

Intraoperative temperature management is one of the important aspects in successful outcome of the surgical patient. Both anesthesia and surgery significantly have an impact on internal thermoregulation of the human body. We conducted this study to correlate nasopharyngeal temperature with transcutaneous carotid artery temperature of adult patients under general anesthesia (GA) in our rural institution.

Improving intraoperative temperature management in elective repeat cesarean deliveries: a retrospective observational cohort study

BackgroundInadvertent perioperative hypothermia (< 36 °C) occurs frequently during elective cesarean delivery and most institutions do employ perioperative active warming. The purpose of this retrospective observational cohort study was to determine if the addition of preoperative forced air warming in conjunction with intraoperative underbody forced air warming improved core temperature and reducing inadvertent perioperative hypothermia during elective repeat elective cesarean delivery with neuraxial anesthesia.MethodsWe evaluated the addition of perioperative active warming to standard passive warming methods (preheated intravenous/irrigation fluids and cotton blankets) in 120 parturients scheduled for repeat elective cesarean delivery (passive warming, n = 60 vs. active + passive warming, n = 60) in a retrospective observational cohort study. The primary outcomes of interest were core temperature at the end of the procedure and a decrease in inadvertent perioperative hypothermia (< 36 °C). Secondary outcomes were surgical site infections and adverse markers of neonatal outcome.ResultsThe mean temperature at the end of surgery after instituting the active warming protocol was 36.0 ± 0.5 °C (mean ± SD, 95% CI 35.9–36.1) vs. 35.4 ± 0.5 °C (mean ± SD, 95% CI 35.3–35.5) compared to passive warming techniques (p < 0.001) and the incidence of inadvertent perioperative hypothermia at the end of the procedure was less in the active warming group - 68% versus 92% in the control group (p < 0.001). There was no difference in surgical site infections or neonatal outcomes.ConclusionsPerioperative active warming in combination with passive warming techniques was associated with a higher maternal temperature and lower incidence of inadvertent perioperative hypothermia with no detectable differences in surgical site infections or indicators of adverse neonatal outcomes.

602 Managing Hypothermia in the Surgical Burn Patient

Abstract Introduction It is known, hypothermia, core body temperature at or below 36oC/96.8oF, can lead to dangerous complications for burn patients. Due to loss of their protective thermoregulation, burn patients are at an increased risk of hypothermia during surgery. Findings from a Quality Assurance audit revealed burn patients were returning from surgery hypothermic and hemodynamically unstable. There was little evidence of intra-operative temperature management in the electronic medical record (EMR) or reported to the nurse upon the patients’ return from the operating room (OR). Only 73% of patients had temperatures recorded during their surgery and of those, 40% had a drop of temperature &amp;gt;2 degrees from their baseline. The purpose of this collaborative evidence-based quality assurance project was to improve temperature management in the operating room and prevent hypothermia in the intra and post operative periods. Our aim was to develop warming methods pre-operatively that would establish a goal for keeping the patients’s temperature within 2 degrees of their baseline preoperative temperature during surgery. Methods A literature search obtained from CINAHL, Cochrane, EMBASE, and MEDLINE from 2010–2018, provided current surgical guidelines and evidence-based practices for managing surgical hypothermia in burn patients (levels of evidence I, III, V, &amp; VI). Recommendations from the burn unit staff for preoperative warming initiatives were listed and shared with the OR staff. Hemodynamic documentation, including core temperature, estimated blood loss, and intra-operative warming methods were monitored for twelve months after the Burn Unit Warming Protocol was implemented. Progress was reported quarterly in our Burn and Trauma Quality Committees. Results After implementing the Burn Unit Warming Protocol, temperature management of the burn patient improved. Intra-operative warming methods were initiated. Patients began returning from surgery warmer with improved hemodynamics. 96% of the patients had their temperatures recorded and managed intra-operatively. Of those patients, only 2.6% had a drop in temperature &amp;gt; 2 degrees from their pre-operative baseline. Conclusions Implementing a nurse-driven warming protocol from the pre-operative stage through surgery can aid in reducing post-operative hypothermia in burn patients. Applicability of Research to Practice Managing hypothermia will help reduce complications that can lead to increase morbidity and mortality in burn patients.

Intraoperative Temperature Management.

Intraoperative Temperature Management.

A prospective observational study testing liquid crystal phase change type thermometer placed on skin against oesophageal/pharyngeal placed thermometers in participants undergoing general anesthesia

sBackgroundPatient outcomes are influenced by intraoperative temperature management. Oesophageal/pharyngeal temperature monitoring is the standard of care at our institute but is not well tolerated in awake patients. Many non-invasive temperature monitors have been studied. Only the TraxIt® Wearable Children’s Underarm Thermometer which contains liquid crystals that undergo phase changes according to temperature is available at our institution. We tested these non-invasive monitors against our standard of care which is the oesophageal/pharyngeal temperature monitor.MethodsWe conducted a prospective observational study of 100 patients receiving general anaesthesia for elective surgery. Patients were eligible for inclusion if they were ≥ 18 years old, were planned to have a general anaesthetic > 60 min during which no body cavity (chest or abdomen) would be opened. Patient temperature was measured with an oesophageal/pharyngeal thermistor probe and skin surface temperature monitors placed over the forehead, in the axilla, over the sternum, and behind the ear (over major vessels to the brain). Temperatures were recorded and then analysed using Altman-Bland plots. Pre-determined clinically relevant limits of agreement were set at −/+ 0.5 °C.ResultsFrom the 100 patients we collected 500 data points for each monitor with an average monitoring time of 102 min (30–300 min) across a range of surgical procedures. None of the skin surface temperature monitors achieved the pre-determined limits of agreement and results were impacted by the use of a forced air warmer.ConclusionThe TraxIt® Wearable Children’s Underarm Thermometers are not suitable for temperature monitoring during general anaesthesia.

Intraoperative Temperature Management.

Intraoperative Temperature Management.

Clinical Evaluation of Fluido Compact&amp;lt;sup&amp;gt;&amp;#174;&amp;lt;/sup&amp;gt;: A New Intravenous Fluid Warmer

Unintended peri-operative hypothermia is very common in surgical patients and is associated with adverse outcomes. Perioperative use of forced-air and intravenous fluid warmers is recommended for hypothermia prevention. This study evaluated the ease of use of Fluido® Compact, a new fluid warming device, and its ability to help as part of the intraoperative patient temperature management. It was used in 36 patients undergoing scheduled surgery at risk of hypothermia under regional, general or combined anesthesia, of more than one hour duration and with a predicted intravenous fluid administration of at least 1000 ml. The fluid warmer is very easy to set up. The disposable cassette has a very low (3 ml) priming volume and it is easy to handle and to place inside the warming module. Once connected to the main power outlet, it is ready to deliver fluid at target temperature in just a few seconds. Control panel is intuitive, and the one button operation system makes it safe and convenient. The combination of peri-operative patient surface warming with Mistral®-Air forced-air warming system and intravenous fluid warming with Fluido® Compact, that allowed the administration of IV perfusions at body temperature at the rate needed thus avoiding heat loss, helps to maintain intraoperative core temperature between 36.4°C and 36.8°C. A group of patients undergo a variety of surgical procedures with neuraxial, general or combined epidural-general anesthesia.

Intraoperative Temperature Management Means More than Being Warm at the End of the Case.

Intraoperative Temperature Management Means More than Being Warm at the End of the Case.

The effect of electrically heated humidifier to intraoperative temperature management in elderly patients receiving open abdominal surgery

The effect of electrically heated humidifier to intraoperative temperature management in elderly patients receiving open abdominal surgery

Intraoperative temperature management.

Intraoperative temperature management.

ICU and Intra-Operative Temperature Management

ICU and Intra-Operative Temperature Management

Survey on intraoperative temperature management in Europe

Inadvertent perioperative hypothermia causes serious morbidity in surgical patients. However, recent reports suggest that patients might still be hypothermic after elective surgery. We thus surveyed intraoperative temperature monitoring and management practices in Europe. Postal survey of 801 representative hospitals from 17 European countries on the same day. The questions addressed the number of surgical procedures and type of anaesthesia performed, mode and site of temperature monitoring and method of patient warming. Mean and standard error of the mean or count and percentage were calculated. The t-test or contingency table analysis with the Fisher's exact test were used. Eight thousand and eighty-three surgical procedures were assessed from 316 responding hospitals (39.4%). Overall, patient temperature monitored in 19.4% and 38.5% of the patients were actively warmed. Under general anaesthesia, body temperature was monitored in 25% and during regional anaesthesia in 6%, P = 0.0005. Nasopharyngeal temperature was most often taken under general anaesthesia, while tympanic temperature was preferred during regional anaesthesia. Under general anaesthesia, 43% of patients were actively warmed as compared to 28% with regional anaesthesia, P = 0.0005. Forced-air warming was the method of choice for both general and regional anaesthesia. Intraoperative temperature monitoring is still uncommon and hence active patient warming is not a standard of care in Europe. Awareness of perioperative hypothermia is critical to its prevention, and thus temperature monitoring is a pre-requisite. The objective is to maintain normothermia in patients throughout surgery. A European practice guideline for perioperative patient temperature management is warranted.

Water warming garment versus forced air warming system in prevention of intraoperative hypothermia during liver transplantation: a randomized controlled trial [ISRCTN32154832

BackgroundThe authors compared two strategies for the maintenance of intraoperative normothermia during orthotopic liver transplantation (OLT): the routine forced-air warming system and the newly developed, whole body water garment.MethodsIn this prospective, randomized and open-labelled study, 24 adult patients were enrolled in one of two intraoperative temperature management groups during OLT. The water-garment group (N = 12) received warming with a body temperature (esophageal) set point of 36.8°C. The forced air-warmer group (N = 12) received routine warming therapy using upper- and lower-body forced-air warming system. Body core temperature (primary outcome) was recorded intraoperatively and during the two hours after surgery in both groups.ResultsThe mean core temperatures during incision, one hour after incision and during the skin closing were significantly higher (p < 0.05, t test with Bonferroni corrections for the individual tests) in the water warmer group compared to the control group (36.7 ± 0.1, 36.7 ± 0.2, 36.8 ± 0.1 vs 36.1 ± 0.4, 36.1 ± 0.4, 36.07 ± 0.4°C, respectively). Moreover, significantly higher core temperatures were observed in the water warmer group than in the control group during the placement of cold liver allograft (36.75 ± 0.17 vs 36.09 ± 0.38°C, respectively) and during the allograft reperfusion period (36.3 ± 0.26 vs 35.52 ± 0.42°C, respectively). In addition, the core temperatures immediately after admission to the SICU (36.75 ± 0.13 vs 36.22 ± 0.3°C, respectively) and at one hr (36.95 ± 0.13 vs 36.46 ± 0.2°C, respectively) were significantly higher in the water warmer group, compared to the control group, whereas the core temperature did not differ significantly afte two hours in ICU in both groups.ConclusionsThe investigated water warming system results in better maintenance of intraoperative normothermia than routine air forced warming applied to upper- and lower body.