Preoperative Body Temperature Research Articles

Development and evaluation of a novel predictive nomogram for assessing the risk of intraoperative hypothermia in patients undergoing thoracoscopic pulmonary tumor surgery

BackgroundThe prevalence of unplanned intraoperative hypothermia during thoracoscopic pulmonary tumor resection under general anesthesia is considerable, which may result in numerous adverse reactions. ObjectiveThe aim of this study was to develop and validate a nomogram-based prediction model for assessing the risk of intraoperative hypothermia in patients undergoing thoracoscopic pulmonary tumor resection under general anesthesia. DesignThis was a retrospective study conducted at a tertiary class A hospital.The study included 506 adult patients who underwent thoracoscopic lung tumor resection under general anesthesia in 2022. MethodsThe clinical data of 506 patients who underwent thoracoscopic pulmonary tumor surgery from January 1 to December 31, 2022 were collected and randomly divided into the modeling group (n = 356) and the validation group (n = 50). The data of 356 patients were used establish a prediction model for intraoperative hypothermia. A total of 17 factors covering patient demographics, disease characteristics, and surgical conditions were gathered. The least absolute shrinkage and selection operator regression model was utilized to optimize the risk model's features. Multivariate logistic regression analysis was employed to construct the final predictive model. RresultsGender, body mass index, preoperative body temperature and operation time were used as predictors to construct the nomogram. The C-index of the model was 0.831 (95%CI: 0.799–0.863). The C-index of external validation was 0.820, which verified the calibration of the model. Decision curve analysis validated the clinical utility of the nomogram, particularly when using a threshold probability of unplanned intraoperative hypothermia 1 %.-74 %. ConclusionsThe nomogram constructed in this study can effectively predict the risk of intraoperative hypothermia in patients undergoing thoracoscopic lung tumor resection under general anesthesia. The nomogram incorporated readily available predictors such as sex, body mass index, preoperative body temperature, and duration of surgery.

Is Dexmedetomidine Effective on Postoperative Shivering in Patients Undergoing General Anesthesia for an Appendectomy? A Double–Blind, Randomized Clinical Trial

Background: Postoperative shivering (PS) is a mechanism to reduce heat loss and is the most frequent complication during the recovery period after general anesthesia. Shivering can lead to discomfort and is even risky in many patients; therefore, prevention is important. Objectives: Our study aims to determine the effect of dexmedetomidine on preventing shivering after general anesthesia in appendectomy patients. Methods: The present double–blind, randomized clinical trial divided 90 appendectomy patients into two groups. Randomization was performed using the www.random.org website from the numbers of sequence generator option. One group received 0.5 µg/kg of dexmedetomidine before induction of general anesthesia, and another group received normal saline as a placebo. Shivering and other outcomes were checked in both groups. To find a 50% reduction of this incidence, based on alpha error of 5% and beta error of 20%, the sample size of 45 people was determined for each group. A P-value ≤ 0.05 was considered statistically significant. Results: In total, 63 (70%) patients were male, and 27 (30%) were female. There were no significant differences between the two groups in terms of age (P = 0.412), weight (P = 0.460), temperature of serum for fluid therapy (P = 0.315), fluid volume (P = 0.736), perioperative body temperature (P = 0.418), preoperative body temperature (P = 0.540), and room temperature (P = 0.310). The severity of shivering was significantly lower in the dexmedetomidine group (60%) than in the placebo group (P < 0.001). There was no significant difference according to gender and severity of shivering between the two groups (P > 0.05). Conclusions: This study suggests that the administration of dexmedetomidine can prevent postoperative shivering.

Clinical and time-related predictors of sepsis in patients with obstructive uropathy due to ureteral stones in the emergency setting.

Well-defined clinical predictors of sepsis after upper tract drainage for obstructive uropathy due to ureteral stones are needed. We aim to determine whether sepsis after decompression of the upper urinary tract may be predicted by clinical and time-related factors, specifically delay time from symptom onset to hospital presentation (StH) and from hospital presentation to surgical decompression (HtD). In this single-center retrospective study, data from 196 consecutive patients presenting to the emergency department for obstructive uropathy due to ureteral stones and submitted to surgical decompression were evaluated. Postoperative sepsis was defined as an acute increase in ≥ 2 SOFA points and documented blood or urine cultures. Median StH and HtD were 24 (6-48) and 17 (10-30) hours, respectively. Thirty-three (16.8%) patients developed sepsis. Septic patients were more frequently female (75.8% vs. 37.4%, p < 0.001), had higher preoperative max body temperature (p < 0.001), white blood cells (WBC) count (p < 0.01), C-reactive protein (CRP) values (p < 0.001) and larger stone diameter (7.2 vs. 6mm, p = 0.02). StH and HtD did not differ according to sepsis status. Time for WBC normalization and CRP halving were longer for septic patients (all p < 0.02). At multivariable logistic regression analysis, max body temperature ≥ 38°C (OR 21.5; p < 0.001), female gender (OR 3.6; p = 0.02) and higher CRP (OR 1.1; p < 0.001) were independently associated with sepsis status. Clinical and laboratory parameters are associated with an increased risk of sepsis after decompression. StH and HtD timing are not associated with higher sepsis rates. In selected patients, urinary decompression could be delayed or primary ureteroscopy could be considered.

Effect of Prewarming on Postoperative Hypothermia, Vital Signs, and Thermal Comfort: A Randomized Controlled Trial.

This study aimed to determine the effects of preoperative active and passive warming on postoperative hypothermia, vital signs, and perception of thermal comfort in patients scheduled to undergo elective open abdominal surgery. This was a randomized controlled study. The study sample comprised 90 patients (30 in the active warming group, 30 in the passive warming group, and 30 in the control group) who agreed to participate and met the research criteria. According to the comparison of patients' vital signs, a statistically significant difference was observed in terms of patients' preoperative body temperature values (χ2 = 56.959; p = 0.000). A comparison of the patients' postoperative thermal comfort perception scores yielded a statistically significant difference (χ2 = 39.693; p = 0.000). Postoperative comfort scores in the active warming group were significantly higher than those in the passive warming and control groups. In conclusion, warming methods are effective in preventing undesirable postoperative hypothermia. The time to reach normothermia after surgery was shorter, vital signs were at a desirable level, and thermal comfort perceptions were higher in patients who were prewarmed. ClinicalTrials.gov (Identifier: NCT04997694).

Application and curative effect of laparoscopic purse-string sutures in the treatment of adult acute complicated appendicitis

ObjectiveTo investigate the effect of laparoscopic purse-string sutures in adult complicated appendicitis treatment.MethodsThe data of 568 adult cases of complicated appendicitis treated by laparoscopic appendectomy at the Hefei Second People’s Hospital, Anhui Province, China, from September 2018 to September 2021 were analysed retrospectively. The patients were divided into two groups: 295 cases in the laparoscopic purse-string suture treatment group (observation group) and 273 cases in the simple Hem-o-lok® clamp treatment group (control group). The baseline data collected included age, gender, preoperative body temperature, leukocyte count and percentage of neutrophils and the surgery time. The postoperative data collected included antibiotic treatment duration, drainage tube placement time and the incidence of complications.ResultsThere were no significant differences in the baseline data of the two groups, including age, gender, preoperative body temperature, leukocyte count and neutrophil percentage (all P > 0.05). Compared with the control group, the postoperative hospital length of stay, duration of antibiotic treatment, the recovery time of peripheral white blood cell and neutrophil counts and the incidence of postoperative complications in the observation group were significantly decreased (P < 0.05).ConclusionPurse-string sutures can effectively reduce the incidence of postoperative complications after a laparoscopic appendectomy for adult acute complicated appendicitis. There was faster postoperative recovery when patients’ appendiceal stumps were treated with laparoscopic purse-string sutures.

Intraoperative hypothermia in the neonate population: risk factors, outcomes, and typical patterns

The risk factors, outcomes, and typical patterns of intraoperative hypothermia were studied in neonates to better guide the application of insulation measures in the operating room. This retrospective study enrolled 401 neonates undergoing surgery under general anaesthesia with tracheal intubation, including abdominal surgery, thoracic surgery, brain surgery, and others. The study collected basic characteristics, such as age, sex, weight, birth weight, gestational week, primary diagnosis and American Society of Anaesthesiologists (ASA) grade. Perioperative data included preoperative body temperature, length of hospital stay, length of intensive care unit (ICU) stay, intubation time, postoperative bleeding, postoperative pneumonia, postoperative death, and total cost of hospitalization. Intraoperative data included surgical procedures, anaesthesia duration, operation duration, blood transfusion, fluid or albumin infusion, and application of vasoactive drugs. The incidence of intraoperative hypothermia (< 36 °C) was 81.05%. Compared to normothermic patients, gestational week (OR 0.717; 95% CI 0.577–0.890; P = 0.003), preoperative temperature (OR 0.228; 95% CI 0.091–0.571; P = 0.002), duration of anaesthesia (OR 1.052; 95% CI 1.027–1.077; P < 0.001), and type of surgery (OR 2.725; 95% CI 1.292–5.747; P = 0.008) were associated with the risk of intraoperative hypothermia. Patients with hypothermia had longer length of ICU stay (P = 0.001), longer length of hospital stay (P < 0.001), and higher hospital costs (P < 0.001). But there were no association between clinical outcomes and intraoperative hypothermia in the multivariable regression adjusted analysis. The lowest point of intraoperative body temperature was approximately 1 h 30 min. Then, the body temperature of patients successively entered a short plateau phase and a period of slow ascent. The greatest decrease in body temperatures occurred in preterm babies and neonates with preoperative hypothermia. The lowest core temperatures that occurred in neonates with preoperative hypothermia was lower than 35 °C. This study shows that there is a high incidence of intraoperative hypothermia in the neonate population. The intraoperative body temperature of neonates dropped to the lowest point in 1–1.5 h. The greatest decrease in core temperatures occurred in preterm babies and neonates with lower preoperative temperature.

Clinical research on minimally invasive rotary resection in the treatment of lactational breast abscess.

This study sought to compare the efficacy of minimally invasive rotatory resection plus catheter drainage and puncture abscess aspiration in the treatment of lactational breast abscess. The data of 80 patients with lactational breast abscess at the Department of Mammary Gland, Tianjin Central Hospital of Gynecology Obstetrics, from January 2019 to January 2020 were retrospectively collected. The patients were divided into the minimally invasive group (n=30) and the abscess aspiration group (n=50). Clinical data, including age, parity, preoperative body temperature, postpartum time, time of abscess cavity generation, diameter and position of abscess cavity, intraoperative drainage, bleeding, recovery time, and satisfaction score, were collected and compared between the 2 groups of patients. The baseline data between the 2 groups were not significantly different. The minimally invasive group had a higher single drainage volume and single bleeding volume (P<0.05), and lower cumulative pain score (P<0.05); the cumulative bleeding volume did not differ significantly between the 2 groups (P>0.05). For the abscess cavities with a diameter ≤5 cm, the single drainage volume, single bleeding volume, and single pain score in the minimally invasive group were significantly higher than those in the abscess aspiration group (P<0.05); the total drainage volume was similar between the 2 groups (P>0.05). For the abscess cavities with a diameter >5 cm, the single drainage volume and single bleeding volume in the minimally invasive group were significantly higher than those in the abscess aspiration group (P<0.05), while the cumulative bleeding volume, single pain score, and cumulative pain score were lower in the minimally invasive group (P<0.05). There was no significant difference in total drainage between the 2 groups (P>0.05). When the abscess cavity is ≤5 cm in diameter and the abscess is superficial, puncture and abscess aspiration may be more advantageous than the minimally invasive rotatory resection plus catheter drainage. When the abscess cavity is >5 cm in diameter and there are multiple abscesses or deep large abscess, the efficacy of minimally invasive rotary resection plus catheter drainage may be better than the puncture and abscess aspiration.

Effect of the prophylactic use of antibiotics on wound infection after cleft lip surgery.

To study the effect of preoperative prophylactic use of antibiotics on wound infection in patients with cleft lip. Aretrospective study was conducted on the clinical data of 1 361 patients who underwent one-stage cleft lip repair in the Department of Cleft Lip and Palate in West China Hospital of Stomatology, Sichuan University, from January 2015 to November 2018. The patients were divided into two groups according to whether prophylactic antibiotics were used or not. There were 594 patients in the prevention group, including 373 unilateral incomplete cleft lip (UICL) patients, 157 unilateral complete cleft lip (UCCL) patients, 25 bilateral incomplete cleft lip (BICL) patients, 39 bilateral complete cleft lip (BCCL) patients. There were 767 patients in the non-prophylactic group, including 482 UICL patients, 211 UCCL patients, 31 BICL patients, 43 BCCL patients. The relationship between preoperative and postoperative leukocyte count, preoperative and postoperative body temperature, and postoperative wound infection were compared between the two groups. No significant difference was observed in the leukocyte count and body temperature between both groups (P>0.05). The preoperative prophylactic use of antibiotics has no significant effect on the incidence of postoperative infection in patients undergoing cleft lip repair.

Risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis.

We sought to identify the risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis. The study retrospectively analyzed 497 patients who underwent laparoscopic appendectomies for uncomplicated appendicitis between January 2018 and December 2020. The patients were divided into an early discharge group (≤2 days) and a late discharge group (>2 days) based on the length of hospital stay (LOS). The patients were also divided into uneventful and complicated groups according to the need for additional treatment after standard follow-up. Thirty-seven patients (7.4%) were included in the late discharge group. The mean LOS of the late discharge groups was 3.9 days. There were significant differences according to age, preoperative C-reactive protein (CRP), and operative time between the 2 groups. Only operative time was significantly associated with prolonged LOS in multivariate analysis. Thirty-five patients (7.0%) were included in the complicated group. The mean duration of treatment in the uneventful and complicated groups was 7.4 and 25.3 days, respectively. Significant differences existed between the uneventful and complicated groups in preoperative body temperature, preoperative CRP levels, maximal appendix diameter, and the presence of appendicoliths. In multivariate analysis, preoperative CRP levels and maximal appendix diameter were independent predictors of delayed treatment completion. Shorter operative time is desirable to ensure minimal hospital stay in patients with uncomplicated appendicitis. Further efforts are needed to ensure that patients with uncomplicated appendicitis do not experience delayed treatment completion after laparoscopic appendectomies.

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.

The efficacy of active warming in preventing unplanned hypothermia during perioperative period in pediatric surgery patients in a tertiary care center

Aim: To investigate the effects of using the active warming method on children with hypothermia in the perioperative period and examining the effects of hypothermia on awakening time, pain, shivering and hospital stay. Methods: This study included patients 18 years of age and younger who underwent surgery in the pediatric surgery department of a tertiary hospital. The active warming group consisted of 28 patients and the control group consisted of 29 patients. The first group of patients was actively warmed during the surgery and the second group was treated as the control group and did not actively receive any warming therapy. Preoperative body temperatures of the cases were measured. In addition, body temperatures were recorded every 15 minutes in the intraoperative and postoperative periods. Results: There was no statistically significant difference in preoperative body temperature between the control group and the active warming group. When body temperature were examined in the intraoperative period, there was no significant difference between the groups at the first 15 minutes of operation; however, the mean of the body temperature in active warming group was significantly higher than the control group at the 30th, 45th , and 60th minutes of operation. It was determined that patients in the control group had a longer stay in the hospital and the amount of time for waking at the end of the anesthesia was shorter in the active heating group than in the control group. Conclusions: The results of our study suggest that active heating with a carbon fiber resistant system is an effective method to prevent unplanned hypothermia in operated children.

Factors affecting the length of hospital stay after laparoscopic appendectomy: A single center study.

AimThis study aimed to explore factors may affect the length of hospital stay after laparoscopic appendectomy.MethodsThe data of 636 patients undergoing laparoscopic appendectomy between July 2016 and July 2019 in Beijing Tsinghua Changgung Hospital were retrospectively analyzed. The patients were divided into group A (hospital stay ≤3 days, 348 patients) and group B (hospital stay >3 days, 288 patients) according to their hospital stay.Sex, age, disease onset time(time from onset to admission), nausea, vomiting, diarrhea, peritonitis, comorbidities, and history of appendicitis; preoperative body temperature (T), white blood cell (WBC) count, percentage of neutrophilic granulocytes, and preoperative C-reactive protein (CRP) level; time from diagnosis to surgery. appendix diameter, appendicolith, and ascites in ultrasound or CT; surgical time(the surgery start time was the time of skin incision, and the end time was the time the anesthesia intubation was removed), intraoperative blood loss (the volume of blood infiltrating into a gauze was calculated by weighing the gauze infiltrated with water and calculating the volume of water), intraoperative adhesions or effusions, and stump closure methods, convert to open appendectomy, appendix pathology(perforated or gangrenous appendicitis were defined as complicated appendicitis and simple or suppurative appendicitis were defined as uncomplicated appendicitis) and antibiotic treatment schemes were analyzed.ResultsSignificant differences were detected between group A and group B in age (37.10 ± 13.52y vs 42.94 ± 15.57y, P<0.01), disease onset time (21.36 ± 16.56 h vs 32.52 ± 27.99 h, P <0.01), time from diagnosis to surgery (8.63 ± 7.29 h vs 10.70 ± 8.47 h, P<0.01); surgical time(64.09 ± 17.24 min vs 86.19 ± 39.96 min, P < 0.01); peritonitis(52.9% vs 74%, P < 0.01), comorbidities (12.4% vs 20.5%, P < 0.01), appendicolith (27.6% vs 41.7%, P < 0.01), ascites before the surgery(13.8% vs 22.9%, P < 0.01), intraoperative adhesions or effusions(56% vs 80.2%, P < 0.01); preoperative temperature (37.11 ± 0.64°C vs 37.54 ± 0.90°C, P < 0.01); preoperative WBC count (13.06 ± 3.39 × 109/L vs 14.21 ± 4.54 × 109/L, P = 0.04);preoperative CRP level(18.99 ± 31.72 mg/L vs 32.46 ± 46.68 mg/L, P < 0.01); appendix diameter(10.22 ± 2.59 mm vs 11.26 ± 3.23 mm, P < 0.01); intraoperative blood loss (9.36 ± 7.29 mL vs 13.74 ± 13.49 mL, P < 0.01); using Hem-o-lok for stump closure(30.7% vs 38.5%, P = 0.04); complicated appendicitis (9.5% vs 45.8%, P < 0.01); and using ertapenem for antibiotic treatment after the surgery(4.3% vs 21.5%, P < 0.01). Multivariate analysis demonstrated that age (OR = 1.021; 95%CI = 1.007–1.036), peritonitis (OR = 1.603; 95% CI = 1.062–2.419), preoperative WBC count (OR = 1.084; 95% CI = 1.025–1.046), preoperative CRP level (OR = 1.010; 95% CI = 1.005–1.015), time from diagnosis to surgery (OR = 1.043; 95% CI = 1.015–1.072), appendicolith (OR = 1.852; 95% CI = 1.222–2.807), complicated appendicitis (OR = 3.536; 95% CI = 2.132–5.863), surgical time (OR = 1.025; 95% CI = 1.016–1.034), use of Hem-o-lok for stump closure (OR = 1.894; 95% CI = 1.257–2.852), and use of ertapenem for antibiotic treatment (OR = 3.076; 95% CI = 1.483–6.378) were the risk factors for a prolonged hospital stay.ConclusionsThe patient with appendicitis was older and had peritonitis, higher preoperative WBC count or CRP level, longer time from diagnosis to surgery, appendicolith, and complicated appendicitis, predicting a prolonged hospital stay. Shorter surgical time and the use of silk ligation for stump closure and cephalosporins + metronidazole for antibiotic treatment might be better choices to obtain a shorter hospital stay.

New perspectives in the prediction of postoperative complications for high-risk ulcerative colitis patients: machine learning preliminary approach.

Patients with acute severe and medical refractory ulcerative colitis have a high risk of postoperative complications after total abdominal colectomy (TAC). The objective of this retrospective study is to use machine learning to analyze and predict short-term outcomes. 32 patients with ulcerative colitis were treated with total abdominal colectomy between 2011 and 2017. Biographical data, preoperative therapy, blood chemistry, nutritional status, surgical technique, blood transfusion and preoperative length of stay were the features selected for the statistical analyses and were used as input for the machine learning algorithms to predict the rate of complications. Traditional statistical analysis showed an overall postoperative morbidity rate of 34% and a mortality rate of 3%. Preoperative low serum albumin levels (<2.5 g/dL) were related to a higher risk of minor infectious complications with statistical significance (p<0.05). Preoperative length of stay (>4 days), blood transfusions (≥1 unit) and body temperature (≥37.5°C) demonstrated a major impact on infectious morbidity with statistical significance (p<0.05). Patients treated with steroids and rescue therapy presented a higher risk of minor infectious complications (p<0.05). Evaluating only preoperative features, machine learning algorithms were able to predict minor postoperative complications with a high strike rate (84.3%), high sensitivity (87.5%) and high specificity (83.3%) during the testing phase. Machine learning is demonstrated to be useful in predicting the rate of minor postoperative complications in high-risk ulcerative colitis patients, despite the small sample size. It represents a major step forward in data analysis by implementing a retrospective study from a prospective point of view.

Comparison of Body Temperature, Normothermia, and Extubation Times of Patients Heated with Forced Air Warming Method Based on Whether Patients Underwent On-Pump or Off-Pump Coronary Artery Bypass Graft.

AimThis study aimed to compare the body temperature, normothermia, and extubation times of patients heated with forced air warming method based on whether they underwent on-pump or off-pump coronary artery bypass graft.MethodThis quasi-experimental study comprised 109 patients who underwent coronary artery bypass graft operation in the cardiovascular surgery department of a university hospital and a private hospital in Afyonkarahisar. Patients were divided into the following two groups: group 1 comprised 65 patients who underwent on-pump coronary artery bypass graft and group 2 comprised 44 patients who underwent off-pump coronary artery bypass graft. All patients included in the study were heated with forced air warming method. Preoperative and postoperative data were collected using the Patient Identification Form and the Patient Tracking Form, consisting of 16 items in total. Data were analyzed using the Statistical Package for the Social Sciences 18.0 software.ResultsEven though the preoperative body temperature, postoperative first body temperature, second hour body temperature, and extubation time did not exhibit a significant difference depending on the operating method, a significant difference was observed regarding the first, third, fourth, and fifth hour body temperatures and time to reach normothermia based on the operating method (p<0.05). Notably, the off-pump group’s body temperatures in the first, third, fourth, and fifth hours were higher compared with the on-pump group. Furthermore, the off-pump group reached normothermia (145.22±72.54 minutes) earlier or faster compared with the on-pump group (206.84±89.30 minutes). The body temperatures, extubation times, and normothermia were not observed to exhibit significant differences based on the gender (p>0.05). A statistically significant relation was not observed between the patient’s body temperature and their age (p>0.05). However, a low but positive and significant (p<0.05) correlation was observed between the extubation times (r=0.197) and age, as well as time to reach normothermia (r=0.237) and age.ConclusionThis study concluded that forced air warming method is an effective technique to minimize the time to regain normothermia among patients who underwent the on- and off-pump coronary artery bypass graft.

Comparison of three different fluid warming techniques used to maintain euthermia in patients who underwent cesarean section – A retrospective audit

Context: Intraoperative hypothermia is a leading cause of morbidity in the perioperative period. This retrospective audit study was planned to assess the efficacy of three different active warming devices used in maintaining euthermia in patients who underwent lower segment cesarean section (LSCS). Aims: Audit of the three different fluid warming techniques in maintaining euthermia in patients who underwent cesarean sections. Settings and Design: A retrospective audit. Materials and Methods: In total, 698 patients were included in the study who underwent LSCS and were divided on the basis of the warming technique used into Group 1 (n = 241, blood warming bath), Group 2 (n = 238, cabinet), and Group 3 (n = 219, inline warmer). The preoperative core body temperature was compared in each group with the intraoperative body temperature as well as with core body temperature measured 20 minutes after shifting the patient in the postoperative room as per the entries made in the central anesthesia registry. The incidence of the shivering was also noted from the data for each group separately. Statistical Analysis Used: One-way analysis of variance was applied for comparing the mean (SD) between the three groups and unpaired t-test was used to compare two mean (SD) values.P value

Investigation of inadvertent hypothermia incidence and risk factors.

This study was conducted to determine the incidence of inadvertent hypothermia in operative patients and the risk factors that are involved in the development of hypothermia. This prospective, descriptive, cross-sectional study was conducted from January 2016to August 2016 with 144 patients who over the age of 18 years, underwent general surgery, orthopedic surgery, urologic surgery, neurosurgery, and plastic and reconstructive surgery. Data was collected with the "Hypothermia Data Collection Form." Body temperature was measured by the tympanic membrane in the waiting room, operating room, and PACU. Overall, 89% of the patients (n=129) were normothermic in the preoperative phase; 74.30% of the patients (n=107) in intraoperative phase and 75.70% of the patients (n=109) in postoperative phase were hypothermic. American Society of Anesthesiologist (ASA) score, preoperative body temperature, operating room temperature, and using heating method at operation were found to be effective in the development of inadvertent hypothermia during the operating period. It was determined that premedication, preoperative and postoperative body temperature, and the operating room temperature were effective for inadvertent hypothermia in the postoperative period. As a result of the study, it was determined the rate of inadvertent hypothermia was high during and after surgery. Preoperative and intraoperative patient body temperature and operating room temperature were found to be effective in preventing inadvertent hypothermia.

The significance of the immediate drainage in urinary stones with infection

Objective To discuss drainage as soon as possible for the treatment of urinary stones with infection on the necessity and importance and security. Methods Between December 2015 and December 2016, clinical data of 45 patients with urinary stones with infection were analyzed, 22 patients were treated by percutaneous nephroscope and 23 cases of patients underwent ureteral stent implantation. All patients admitted to hospital with different degree of fever, different degrees of perirenal exudation in the affected sides of the patients and routine blood WBC, neutrophil percentage(NEU%), C-reactive protein(CRP), Serum procalcitonin(PCT), higher routine urine white blood cells increased. All patients were performed micro-colostomy drainage under local anesthesia by percutaneous nephroscope or ureteral stent implantation under cystoscope within 2-24 h after preoperative examination, and stage II endoscopic lithotripsy after controlling infection. Results All patients were successfully completed surgery. Preoperative temperature (38.60±0.87)℃, the third day after the body temperature of (36.80±0.21)℃ were found, compared with preoperative body temperature, there was significant difference(P<0.05). Preoperative routine blood leukocytes was (18.2±1.2)×109/L, three days after treatment was (5.6±1.4)×109/L, there was significant difference(P<0.05). There was significant difference in neutrophil percentage, CRP and PCT preoperation and third day after operation[(91.3±4.1)% vs.(65.2±6.2)%, (96.3±21.4)mg/L vs.(21.3±3.2) mg/L, (8.3±2.2) vs.(0.07±0.01), P<0.05]. No septic shock occurred in all patients. Conclusions Immediate drainage on urinary stones with infection is crucial, it should control infection as soon as possible to reduce the incidence of septic shock. Key words: Urinary Calculi; Cross Infection; Drainage

Safety and utility of direct laryngoscopy and bronchoscopy in patients hospitalized with croup.

Acute croup is a common admitting diagnosis for pediatric patients. If a patient is not responding to medical management for presumed croup, the otolaryngology team is occasionally consulted for direct laryngoscopy and bronchoscopy (DLB) to rule out tracheitis or another airway pathology. We conducted a study to determine if inpatient DLB in acute croup is safe and efficacious and to correlate preoperative vital signs with intraoperative findings. We reviewed the charts of 521 patients with an admitting diagnosis of acute tracheitis, acute laryngotracheitis, or croup. Of this group, 18 patients-11 boys and 7 girls, aged 1 month to 3.3 years (mean: 1.3 yr)-had undergone inpatient DLB. Comorbidities, complications, and level of care were also analyzed. Five patients (28%) had gastrointestinal reflux disease (GERD), and 4 had previously undergone intubation (22%). Eleven patients (61%) had concurrent airway pathology, 7 of whom (39%) required operative intervention. Preoperative mean body temperature and the increase in mean temperature were significantly higher in tracheitis patients than in the non-tracheitis patients. Preoperative change in respiratory rate was elevated when another airway pathology was present (p = 0.047). Only patients who were in the intensive care unit (ICU) preoperatively were intubated in the operating room, and only 1 patient required a postoperative escalation in the level of care. Our study found that performing inpatient DLB in patients hospitalized with croup is reasonably safe and provides a sufficient yield for identifying tracheitis or other airway pathology in selected populations. Preoperative vital signs can be suggestive of tracheitis or additional unexpected airway pathology. Recurrent croup, a history of GERD or previous intubation, and preoperative admission to the ICU increase the yield of DLB.

Outcomes of Infant Cardiac Surgery for Congenital Heart Disease Concomitant With Persistent Pneumonia: A Retrospective Cohort Study

There is still controversy about whether an infant should have cardiac surgery concomitant with ongoing persistent pneumonia. This study analyzes the outcome of surgical treatment for infants with left-to-right shunt congenital heart disease accompanied with persistent pneumonia and discusses the perioperative management strategies for these cases. This is a retrospective cohort study. This study was conducted in an academic hospital and is a single-center study. In this study, the authors analyzed the data of 94 infants admitted to our hospital from January 2014 to May 2016 who underwent surgical correction for left-to-right shunt congenital heart disease. Fifty cases without pneumonia were included as a control group, and 44 cases with unresolved persistent pneumonia were included as a study group. The clinical characteristics between the 2 groups were compared, and the perioperative safety and short-term prognosis were evaluated. There was no significant difference in sex composition between the 2 groups. Infants in the pneumonia group were younger and had a lower body weight (p < 0.001). There was a significant difference in types of congenital heart disease between the 2 groups (p < 0.001). Preoperative body temperature and heart rate of infants in the pneumonia group were higher than those in the control group (p < 0.001). The cardiopulmonary bypass time in the pneumonia group was significantly longer than that of the control group (p = 0.001). Perioperative major complications were not significantly different between the 2 groups. The postoperative ventilator-assisted time, duration of intensive care unit stay, and length of hospital stay were longer in the pneumonia group (p < 0.001). Only 1 patient in the control group died of severe low cardiac output syndrome. The authors conclude that in the presented cases, no mortality or major morbidity was observed related to the practice of performing surgery in infants with signs of persistent pneumonia. The authors conclude that it is likely to be safe and effective for infants to receive cardiac surgery for left-to-right shunt congenital heart disease in the presence of persistent pneumonia.

The Influence of Preoperative Interventions on Postoperative Surgical Wound Healing in Patients Without Risk Factors: A Systematic Review.

Poor wound healing and scar formation remain critical problems in daily surgical practice. Generally, most attention is paid to intra- and postoperative interventions to improve wound healing after surgery, while preoperative interventions remain unsatisfactorily explored. In this systematic review, the available literature on the beneficial effects of preoperative interventions on wound healing and scar formation have been summarized and compared. A comprehensive and systematic search has been conducted in MEDLINE, Pubmed, Embase, Web of Science, and Cochrane, supplemented by reference and citation tracking. All preoperative interventions and all clinically relevant outcome parameters have been considered for inclusion, due to the expected limited availability of literature. A total of 13 studies were included, which were all randomized trials. No cohort studies or retrospective studies have been identified. All studies described different preoperative interventions and outcome parameters and could hence not be pooled and compared. Eight studies showed significantly better wound healing after a preoperative intervention. The individual studies have been summarized in this review. This systemic review shows that preoperative interventions can be beneficial in improving wound healing and scar formation. In selected cases, wound healing was found to benefit from a higher preoperative body temperature, topical vitamin E application, and low patient stress levels.