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Bräuer A, Fazliu A, Brandes IF, Vollnhals F, Grote R, Menzel M. Evaluation of the Temple Touch Pro™ noninvasive core-temperature monitoring system in 100 adults under general anesthesia: a prospective comparison with esophageal temperature. J Clin Monit Comput 2023; 37:29-36. [PMID: 35377051 PMCID: PMC9852212 DOI: 10.1007/s10877-022-00851-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/16/2022] [Indexed: 01/24/2023]
Abstract
Perioperative hypothermia is still common and has relevant complication for the patient. An effective perioperative thermal management requires essentially an accurate method to measure core temperature. So far, only one study has investigated the new Temple Touch Pro™ (Medisim Ltd., Beit-Shemesh, Israel). during anesthesia Therefore, we assessed the agreement between the Temple Touch Pro™ thermometer (TTP) and distal esophageal temperature (TEso) in a second study. After approval by the local ethics committee we studied 100 adult patients undergoing surgery with general anesthesia. Before induction of anesthesia the TTP sensor unit was attached to the skin above the temporal artery. After induction of anesthesia an esophageal temperature probe was placed in the distal esophagus. Recordings started 10 min after placement of the esophageal temperature probe to allow adequate warming of the probes. Pairs of temperature values were documented in five-minute intervals until emergence of anesthesia. Accuracy of the two methods was assessed by Bland-Altman comparisons of differences with multiple measurements. Core temperatures obtained with the TTP in adults showed a mean bias of -0.04 °C with 95% limits of agreement within - 0.99 °C to + 0.91 °C compared to an esophageal temperature probe. We consider the TTP as a reasonable tool for perioperative temperature monitoring. It is not accurate enough to be used as a reference method in scientific studies, but may be a useful tool especially for conscious patients undergoing neuraxial anesthesia or regional anesthesia with sedation. Trial registration This study was registered in the German Clinical Trials Register (DRKS-ID: 00024050), day of registration 12/01/2021.
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Affiliation(s)
- Anselm Bräuer
- Department of Anesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Albulena Fazliu
- Department of Anesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Ivo F Brandes
- Department of Anesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Falk Vollnhals
- Department of Anesthesiology, Emergency Medicine, Intensive Care Medicine and Pain Therapy, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Rolf Grote
- Department of Anesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.,Department of Anesthesiology, Emergency Medicine, Intensive Care Medicine and Pain Therapy, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Matthias Menzel
- Department of Anesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.,Department of Anesthesiology, Emergency Medicine, Intensive Care Medicine and Pain Therapy, Klinikum Wolfsburg, Wolfsburg, Germany
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Guo L, Shi J, Liu D, Wang Y, Tong H, Feng Y, Yu P, Lv Y, Li E, Wang C. Measurement of exhaled breath temperature in patients under general anesthesia: A feasibility study. Biomed Rep 2023; 18:18. [PMID: 36776785 PMCID: PMC9912139 DOI: 10.3892/br.2023.1600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023] Open
Abstract
The aim of the present study was to investigate the respiratory parameters that influence the exhaled breath temperature (EBT) and the feasibility of using the latter to monitor the core temperature under general endotracheal anesthesia. A total of 20 patients undergoing abdominal surgery were included in the present study. At the first stage of the experiment, the respiratory rate was adjusted, while the other respiratory parameters [tidal volume, inspiratory and expiratory time ratio (TI:TE), and positive end expiratory pressure (PEEP)] were maintained at a constant level. At the second stage, the tidal volume was adjusted, while the other respiratory parameters were maintained at a constant level. At the third stage, the TI:TE was adjusted, while the other parameters were maintained at a constant level. At the fourth stage, PEEP was adjusted, while the other parameters were maintained at a constant level. In each experiment, the EBT, the maximum temperature of exhaled air in each min, the inhaled air temperature and the nasopharyngeal temperature (T nose) were recorded every min. During the first stage of the experiment, no significant difference was noted in the EBT at different levels of respiratory rate. During the second, third and fourth stage, no significant difference was noted in the EBT at different tidal volumes, TI:TE and PEEP, respectively. The EBT was significantly correlated with the T nose. Overall, the present study demonstrated that the EBT of patients undergoing abdominal surgery under general endotracheal anesthesia was not affected by the examined respiratory parameters and that it could be considered a feasible method of monitoring core temperature.
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Affiliation(s)
- Libo Guo
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Jinghui Shi
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Desheng Liu
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Yue Wang
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Hongshuang Tong
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Yue Feng
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Pulin Yu
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Yanji Lv
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Enyou Li
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Changsong Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China,Correspondence to: Professor Changsong Wang, Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang, Harbin, Heilongjiang 150001, P.R. China
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Yan Y, Geng J, Cui X, Lei G, Wu L, Wang G. Thoracic Paravertebral Block Decreased Body Temperature in Thoracoscopic Lobectomy Patients: A Randomized Controlled Trial. Ther Clin Risk Manag 2023; 19:67-76. [PMID: 36713292 PMCID: PMC9880011 DOI: 10.2147/tcrm.s392961] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/12/2023] [Indexed: 01/21/2023] Open
Abstract
Purpose Thoracic paravertebral block (TPVB) may be highly beneficial for thoracoscopic lobectomy patients, but it may increase the risk of hypothermia. Apart from its anesthetic-reducing effects, this randomized controlled trial aimed to investigate the hypothermic effect of TPVB, and thus optimize its clinical use. Patients and methods Adult patients were randomly allocated to two groups: TPVB + general anesthesia (GA) group or GA group. In the TPVB+GA group, the block was performed after GA induction by an experienced but unrelated anesthesiologist. Both the lower esophageal and axillary temperature were recorded at the beginning of surgery (T0) and every 15 min thereafter (T1-T8), and the end of surgery (Tp). The primary outcome was the lower esophageal temperature at Tp. The secondary outcomes included lower esophageal temperature from T0-T8 and axillary temperature from T0-Tp. The total propofol, analgesics, and norepinephrine consumption and the incidence of adverse events were also recorded. Results Forty-eight patients were randomly allocated to the TPVB+GA (n=24) and GA (n=24) groups. The core temperature at the end of the surgery was lower in the TPVB+GA group than the GA group (35.90±0.30°C vs 36.35±0.33°C, P<0.001), with a significant difference from 45 min after the surgery began until the end of the surgery (P<0.05). In contrast, the peripheral temperature showed a significant difference at 60 min after the surgery began till the end (P<0.05). TPVB+GA exhibited excellent analgesic and sedative-sparing effects compared to GA alone (P<0.001), though it increased norepinephrine consumption due to hypotension (P<0.001). Conclusion Although thorough warming strategies were used, TPVB combined with GA remarkably reduced the body temperature, which is an easily neglected side effect. Further studies on the most effective precautions are needed to optimize the clinical use of TPVB.
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Affiliation(s)
- Yanhong Yan
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jiao Geng
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xu Cui
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Guiyu Lei
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Lili Wu
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Guyan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China,Correspondence: Guyan Wang, Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomingxiang, Beijing, 100730, People’s Republic of China, Tel +86-13910985139, Fax +86-10-58268017, Email
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Sender D, Doyal A. Hyperkalemic periodic paralysis with paramyotonia and the anaesthetic implications. BMJ Case Rep 2023; 16:16/1/e251699. [PMID: 36596627 DOI: 10.1136/bcr-2022-251699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Hyperkalemic periodic paralysis (HyperKPP) is a rare disease with significant anaesthetic implications. We compare two perioperative courses in the same patient. The first surgery resulted in paralysis and a protracted hospitalisation, while the second surgery resulted in a same-day discharge. Various anaesthetic techniques may be used; however, clear communication surrounding optimisation both for home medications (eg, continuing potassium wasting diuretics) and avoidance of triggering medications (primarily: depolarising neuromuscular blockers), along with thermoregulation and glucose management plans, is critical and best performed early by an anaesthetic precare clinic. Our cases highlight the physiological underpinnings in managing patients with HyperKPP.
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Affiliation(s)
- David Sender
- Anesthesiology, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Alexander Doyal
- Anesthesiology, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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Zhao J, Le Z, Chu L, Gao Y, Zhang M, Fan J, Ma D, Hu Y, Lai D. Risk factors and outcomes of intraoperative hypothermia in neonatal and infant patients undergoing general anesthesia and surgery. Front Pediatr 2023; 11:1113627. [PMID: 37009296 PMCID: PMC10050592 DOI: 10.3389/fped.2023.1113627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/21/2023] [Indexed: 04/04/2023] Open
Abstract
Objective The incidence of intraoperative hypothermia remains high in pediatric patients during anesthesia and surgery even though core body temperature monitoring and warming systems have been greatly improved in recent years. We analyzed the risk factors and outcomes of intraoperative hypothermia in neonates and infants undergoing general anesthesia and surgery. Methods The data on the incidence of intraoperative hypothermia, other clinical characteristics, and outcomes from electronic records of 1,091 patients (501 neonates and 590 infants between 28 days and 1 year old), who received general anesthesia and surgery, were harvested and analyzed. Intraoperative hypothermia was defined as a core temperature below 36°C during surgery. Results The incidence of intraoperative hypothermia in neonates was 82.83%, which was extremely higher than in infants (38.31%, p < 0.001)-the same as the lowest body temperature (35.05 ± 0.69°C vs. 35.40 ± 0.68°C, p < 0.001) and the hypothermia duration (86.6 ± 44.5 min vs. 75.0 ± 52.4 min, p < 0.001). Intraoperative hypothermia was associated with prolonged PACU, ICU, hospital stay, postoperative bleeding, and transfusion in either age group. Intraoperative hypothermia in infants was also related to prolonged postoperative extubation time and surgical site infection. After univariate and multivariate analyses, the age (OR = 0.902, p < 0.001), weight (OR = 0.480, p = 0.013), prematurity (OR = 2.793, p = 0.036), surgery time of more than 60 min (OR = 3.743, p < 0.001), prewarming (OR = 0.081, p < 0.001), received >20 mL/kg fluid (OR = 2.938, p = 0.004), and emergency surgery (OR = 2.142, p = 0.019) were associated with hypothermia in neonates. Similar to neonates, age (OR = 0.991, p < 0.001), weight (OR = 0.783, p = 0.019), surgery time >60 min (OR = 2.140, p = 0.017), pre-warming (OR = 0.017, p < 0.001), and receive >20 mL/kg fluid (OR = 3.074, p = 0.001) were relevant factors to intraoperative hypothermia in infants along with the ASA grade (OR = 4.135, p < 0.001). Conclusion The incidence of intraoperative hypothermia was still high, especially in neonates, with a few detrimental complications. Neonates and infants each have their different risk factors associated with intraoperative hypothermia, but younger age, lower weight, longer surgery time, received more fluid, and no prewarming management were the common risk factors.
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Affiliation(s)
- Jialian Zhao
- Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhenkai Le
- Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lihua Chu
- Department of Anesthesiology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Gao
- Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Manqing Zhang
- Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jiabin Fan
- Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Daqing Ma
- Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, United Kingdom
| | - Yaoqin Hu
- Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Correspondence: Dengming Lai Yaoqin Hu
| | - Dengming Lai
- Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Correspondence: Dengming Lai Yaoqin Hu
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Yan L, Tan J, Chen H, Xiao H, Zhang Y, Yao Q, Li Y. A Nomogram for Predicting Unplanned Intraoperative Hypothermia in Patients With Colorectal Cancer Undergoing Laparoscopic Colorectal Procedures. AORN J 2023; 117:e1-e12. [PMID: 36573748 DOI: 10.1002/aorn.13845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/09/2022] [Accepted: 07/18/2022] [Indexed: 12/29/2022]
Abstract
Unplanned intraoperative hypothermia is a complication that can lead to a variety of negative outcomes, such as cardiovascular events. We aimed to develop and validate an intraoperative hypothermia risk prediction nomogram for patients with colorectal cancer undergoing laparoscopic colorectal procedures. We conducted a prospective cohort study with 1,091 patients (ie, 765 in the training cohort, 326 in the validation cohort) from October 2020 to November 2021. We included six predictors in the nomogram model: body mass index, diabetes diagnosis, ambient temperature, ambient humidity, duration of surgery, and use of a forced-air warmer. The model performed well, and the area under the curve was 0.855. These results, together with an external validation value, mean that health care professionals can use the nomogram to calculate the intraoperative hypothermia risk for patients undergoing laparoscopic colorectal procedures and make clinical decisions based on the results.
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Zheng G, Zhang J, Liu J, Chen C, Zhang L, Cao F. A meta-analysis of randomized controlled trials: efficiency and safety of ondansetron in preventing post-anesthesia shivering during cesarean section. Arch Gynecol Obstet 2023; 307:223-231. [PMID: 35325278 DOI: 10.1007/s00404-022-06523-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/08/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Although ondansetron was considered to prevent post-anesthesia shivering during cesarean section, its efficiency remained controversial. Our review was conducted to estimate the efficiency and safety of ondansetron in preventing post-anesthesia shivering during cesarean section. METHODS The literature were searched from their inception to October 2020 without restriction of language. All randomized controlled trials investigating the efficacy of ondansetron versus placebo in preventing shivering during cesarean section under neuraxial anesthesia were included. The meta-analysis was conducted using Stata software. RESULTS Eleven randomized controlled studies with a total of 748 individuals were finally included in our meta-analysis. Our results manifested that intravenous ondansetron compared with intravenous placebo significantly reduced the incidence of post-anesthesia shivering (PAS) (RR 0.53, 95% CI 0.14-0.68). Subgroup analysis according to doses of ondansetron indicated that the efficacy of 4 mg doses of ondansetron (RR 0.37, 95% CI 0.21-0.64) is equivalent to that of 8 mg doses of ondansetron (RR 0.61, 95% CI 0.47-0.81) in preventing PAS. In addition, the intravenous ondansetron led to a lower incidence of hypotension than intravenous placebo (OR 0.47, 95% CI 0.32-0.70). We could not demonstrate differences in the incidence of bradycardia between intravenous ondansetron and intravenous placebo. CONCLUSION Our results found that intravenous ondansetron was effective in preventing shivering during cesarean section under neuraxial anesthesia, and had an advantage in reducing the incidence of hypotension compared with intravenous placebo.
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Affiliation(s)
- Guanghao Zheng
- Fuzhou Medical College of Nanchang University, No.9 Donglin Road, Fuzhou, 344000, China
| | - Jieyu Zhang
- Fuzhou Medical College of Nanchang University, No.9 Donglin Road, Fuzhou, 344000, China
| | - Jianpin Liu
- Fuzhou Medical College of Nanchang University, No.9 Donglin Road, Fuzhou, 344000, China
| | - Chunxiang Chen
- Fuzhou Medical College of Nanchang University, No.9 Donglin Road, Fuzhou, 344000, China
| | - Li Zhang
- Fuzhou Medical College of Nanchang University, No.9 Donglin Road, Fuzhou, 344000, China
| | - Fei Cao
- Fuzhou Medical College of Nanchang University, No.9 Donglin Road, Fuzhou, 344000, China.
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Tisdale K, Bringer A, Kiourti A. A Core Body Temperature Retrieval Method for Microwave Radiometry when Tissue Permittivity is Unknown. IEEE JOURNAL OF ELECTROMAGNETICS, RF AND MICROWAVES IN MEDICINE AND BIOLOGY 2022; 6:470-476. [PMID: 36439285 PMCID: PMC9696197 DOI: 10.1109/jerm.2022.3171092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This paper presents a novel method for core temperature retrieval using microwave radiometry when complex permittivity and heat transfer parameters of the tissue layers of the human subject are unknown. Previous works present methods for core temperature retrieval, but these methods do not account for population variation in the relevant electromagnetic and thermal parameters, which can increase measurement error beyond the clinically acceptable limit of 0.5°C. Pennes' bioheat model of a six-tissue-layer human head model combined with a coherent electromagnetic model simulate experimental data. To retrieve core temperature, nonlinear least squares optimization is then used to minimize the difference between the simulated experimental data and an exponential model for physical temperature and the coherent electromagnetic model. By using 20 frequencies spanning from 1-5 GHz, core temperature is retrieved while accounting for population variation in the permittivity and thermal parameters. A Monte Carlo simulation in which the thermal parameters and permittivity vary according to literature-derived, population-representative distributions and the core body temperature varies from 18-46°C is used to assess the utility of the retrieval method. Different antenna patterns are tested to explore the effect on retrieval accuracy. The retrieval method has a retrieval error of <0.1°C when only the thermal parameters are unknown and a retrieval error of <0.5°C when the thermal parameters and permittivity are unknown, which is within the clinically acceptable error range of 0.5°C. These results help progress the field of medical microwave radiometry toward being a clinically viable noninvasive measurement that is accurate when measuring all patients.
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Affiliation(s)
- Katrina Tisdale
- The Ohio State University ElectroScience Laboratory, Columbus, OH, 43212 USA
| | - Alexandra Bringer
- The Ohio State University ElectroScience Laboratory, Columbus, OH, 43212 USA
| | - Asimina Kiourti
- The Ohio State University ElectroScience Laboratory, Columbus, OH, 43212 USA
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Zhong JW, Sessler DI, Mao G, Jerome A, Chandran N, Szmuk P. Optimal Positioning of Nasopharyngeal Temperature Probes in Infants and Children: A Prospective Cohort Study. Anesth Analg 2022; 136:986-991. [PMID: 36730063 DOI: 10.1213/ane.0000000000006312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The nasopharynx is an easily accessible core-temperature monitoring site, but insufficient or excessive nasopharyngeal probe insertion can underestimate core temperature. Our goal was to estimate optimal nasopharyngeal probe insertion depth as a function of age. METHODS We enrolled 157 pediatric patients who had noncardiac surgery with endotracheal intubation in 5 groups: (1) newborn to 6 months old, (2) infants 7 months to 1 year old, (3) children 13 to 23 months old, (4) children 2 to 5 years old, and (5) children 6 to 12 years old. A reference esophageal temperature probe was inserted at an appropriate depth based on each patient's height. A nasopharyngeal temperature probe was inserted from the naris at 10 cm in newborn and infants, 15 cm in children aged 1 to 5 years old, and 20 cm in children who were 6 years or older. The study nasopharyngeal probes were withdrawn 1, 2.5, or 2 cm (depending on age) 10 times at 5-minute intervals. Optimal probe insertion distances were defined by limits of agreement (LOAs) between nasopharyngeal and esophageal temperatures <0.5 °C. RESULTS Optimal nasopharyngeal temperature probe position ranged from 6 to 10 cm in infants up to 6 months old, 7 to 8 cm in infants 7 to 12 months old, 7.5 to 12 cm in children 13 to 23 months old, and 10 to 12 cm in children aged 6 years and older. The 95% LOAs were <0.5 °C for all age categories except the 2- to 5-year-old group where the limits extended from -0.67 °C to 0.52 °C at 9 cm. At the optimal position within each age range, the bias (average nasopharyngeal-to-esophageal temperature difference) was ≤0.1 °C. CONCLUSIONS Nasopharyngeal thermometers accurately measure core temperature, but only when probes are inserted a proper distance, which varies with age. As with much in pediatrics, nasopharyngeal thermometer insertion depths should be age appropriate.
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Affiliation(s)
- John W Zhong
- From the University of Texas Southwestern Medical Center and Children's Health of Dallas, Dallas, Texas
| | - Daniel I Sessler
- Department of Outcome Research, Anesthesiology Institute, Cleveland Clinic; Cleveland, Ohio
| | - Guangmei Mao
- Department of Outcome Research, Anesthesiology Institute, Cleveland Clinic; Cleveland, Ohio
| | - Aveline Jerome
- From the University of Texas Southwestern Medical Center and Children's Health of Dallas, Dallas, Texas
| | - Neethu Chandran
- From the University of Texas Southwestern Medical Center and Children's Health of Dallas, Dallas, Texas
| | - Peter Szmuk
- From the University of Texas Southwestern Medical Center and Children's Health of Dallas, Dallas, Texas.,Outcome Research Consortium, Cleveland, Ohio
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Longhao P, Yoon SZ, Choi YJ, Xu GS, Kim D, Lim CH. Increase in body temperature in pediatric patients after costal cartilage harvest in microtia reconstruction: A retrospective observational study. Medicine (Baltimore) 2022; 101:e31140. [PMID: 36253997 PMCID: PMC9575776 DOI: 10.1097/md.0000000000031140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Previous evidence has clearly shown that maintaining normothermia in children undergoing surgery is difficult and is associated with adverse outcomes. Therefore, this study aimed to retrospectively analyze the changes in body temperature over time in 2 different types of microtia reconstruction surgeries, namely, embedding, and elevation surgeries. METHODS We performed a retrospective chart review of patients who underwent microtia reconstruction (embedding and elevation) between July 2012 and February 2015 (n = 38). The changes in body temperature between the 2 types of surgeries were compared. RESULTS During microtia reconstruction, the body temperature in the embedding surgery group was significantly higher than that in the elevation surgery group from 1 hour after the start of surgery to 1 day after the surgery (P < .001). Time, group, and time-group interaction were associated with an increase in body temperature (P < .001) but not the warming method. CONCLUSION We found an increase in body temperature in patients with microtia who underwent embedding surgery (autologous costal cartilage harvest surgery), and this was related to the type of surgery and not to the warming method. Therefore, further research is warranted to determine the cause of the increase in body temperature during this surgery.
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Affiliation(s)
- Piao Longhao
- Biomedical Center, Korea University Medical Center, Seoul, Republic of Korea
| | - Seung Zhoo Yoon
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yoon Ji Choi
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi- do, Republic of Korea
- * Correspondence: Yoon Ji Choi, Department of Anesthesiology and Pain Medicine, Korea National University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do 15355, Republic of Korea (e-mail: )
| | - Guo-Shan Xu
- Biomedical Center, Korea University Medical Center, Seoul, Republic of Korea
| | - Dahyeon Kim
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi- do, Republic of Korea
| | - Choon-Hak Lim
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Muroya K, Ueda K, Wada K, Kotoda M, Matsukawa T. Novel ultrashort-acting benzodiazepine remimazolam lowers shivering threshold in rabbits. Front Pharmacol 2022; 13:1019114. [PMID: 36313309 PMCID: PMC9614037 DOI: 10.3389/fphar.2022.1019114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
Shivering after surgery or during therapeutic hypothermia can lead to serious complications, such as myocardial infarction and respiratory failure. Although several anesthetics and opioids are shown to have anti-shivering effects, their sedative and respiratory side effects dampen the usefulness of these drugs for the prevention of shivering. In the present study, we explored the potential of a novel ultrashort-acting benzodiazepine, remimazolam, in the prevention of shivering using a rabbit model of hypothermia. Adult male Japanese white rabbits were anesthetized with isoflurane. The rabbits received saline (control), remimazolam (either 0.1 or 1 mg/kg/h), or remimazolam + flumazenil, a selective γ-aminobutyric acid (GABA) type A receptor antagonist (n = 6 each). Thirty minutes after discontinuation of the drugs, cooling was initiated by perfusing 10°C water via a plastic tube positioned in the colon until the animal shivered. Core body temperature and hemodynamic and physiological parameters were recorded. Remimazolam at 1 mg/kg/h significantly lowered the core temperature change during shivering (−2.50 ± 0.20°C vs. control: −1.00 ± 0.12°C, p = 0.0009). The effect of 1 mg/kg/h remimazolam on the core temperature change was abolished by flumazenil administration (−0.94 ± 0.16°C vs. control: −1.00 ± 0.12°C, p = 0.996). Most of the hemodynamic and physiological parameters did not differ significantly among groups during cooling. Remimazolam at a clinically relevant dose successfully suppressed shivering in rabbits via the GABA pathway even after its anesthetic effects likely disappeared. Remimazolam may have the potential to prevent shivering in patients undergoing surgery or therapeutic hypothermia.
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Affiliation(s)
- Kenji Muroya
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Kenta Ueda
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Keiichi Wada
- Surgical Center, University of Yamanashi Hospital, University of Yamanashi, Yamanashi, Japan
| | - Masakazu Kotoda
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
- *Correspondence: Masakazu Kotoda,
| | - Takashi Matsukawa
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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Bardia A, Deshpande R, Michel G, Yanez D, Dai F, Pace NL, Schuster K, Mathis MR, Kheterpal S, Schonberger RB. Demonstration and Performance Evaluation of Two Novel Algorithms for Removing Artifacts From Automated Intraoperative Temperature Data Sets: Multicenter, Observational, Retrospective Study. JMIR Perioper Med 2022; 5:e37174. [PMID: 36197702 PMCID: PMC9591708 DOI: 10.2196/37174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The automated acquisition of intraoperative patient temperature data via temperature probes leads to the possibility of producing a number of artifacts related to probe positioning that may impact these probes' utility for observational research. OBJECTIVE We sought to compare the performance of two de novo algorithms for filtering such artifacts. METHODS In this observational retrospective study, the intraoperative temperature data of adults who received general anesthesia for noncardiac surgery were extracted from the Multicenter Perioperative Outcomes Group registry. Two algorithms were developed and then compared to the reference standard-anesthesiologists' manual artifact detection process. Algorithm 1 (a slope-based algorithm) was based on the linear curve fit of 3 adjacent temperature data points. Algorithm 2 (an interval-based algorithm) assessed for time gaps between contiguous temperature recordings. Sensitivity and specificity values for artifact detection were calculated for each algorithm, as were mean temperatures and areas under the curve for hypothermia (temperatures below 36 C) for each patient, after artifact removal via each methodology. RESULTS A total of 27,683 temperature readings from 200 anesthetic records were analyzed. The overall agreement among the anesthesiologists was 92.1%. Both algorithms had high specificity but moderate sensitivity (specificity: 99.02% for algorithm 1 vs 99.54% for algorithm 2; sensitivity: 49.13% for algorithm 1 vs 37.72% for algorithm 2; F-score: 0.65 for algorithm 1 vs 0.55 for algorithm 2). The areas under the curve for time × hypothermic temperature and the mean temperatures recorded for each case after artifact removal were similar between the algorithms and the anesthesiologists. CONCLUSIONS The tested algorithms provide an automated way to filter intraoperative temperature artifacts that closely approximates manual sorting by anesthesiologists. Our study provides evidence demonstrating the efficacy of highly generalizable artifact reduction algorithms that can be readily used by observational studies that rely on automated intraoperative data acquisition.
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Affiliation(s)
- Amit Bardia
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Ranjit Deshpande
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States
| | - George Michel
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States
| | - David Yanez
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States
| | - Feng Dai
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States
| | - Nathan L Pace
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, United States
| | - Kevin Schuster
- Department of Surgery, Yale School of Medicine, New Haven, CT, United States
| | - Michael R Mathis
- Department of Anesthesiology, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Robert B Schonberger
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States
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63
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Sharma R, Huang Y, Dizdarevic A. Blood Conservation Techniques and Strategies in Orthopedic Anesthesia Practice. Anesthesiol Clin 2022; 40:511-527. [PMID: 36049878 DOI: 10.1016/j.anclin.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Orthopedic surgery procedures involving joint arthroplasty, complex spine, long bone and pelvis procedure, and trauma and oncological cases can be associated with a high risk of bleeding and need for blood transfusion, making efforts to optimize patient care and reduce blood loss very important. Patient blood management programs incorporate efforts to optimize preoperative anemia, develop transfusion protocols and restrictive hemoglobin triggers, advance surgical and anesthesia practice, and use antifibrinolytic therapies. Perioperative management of anticoagulant therapies, a multidisciplinary decision-making task, weighs in risks and benefits of thromboembolic risk and surgical bleeding and is patient- and surgery-specific.
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Affiliation(s)
- Richa Sharma
- Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th Street, PH 5, New York, NY 10032, USA. https://twitter.com/Drsharma_richa
| | - Yolanda Huang
- Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th Street, PH 5, New York, NY 10032, USA
| | - Anis Dizdarevic
- Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th Street, PH 5, New York, NY 10032, USA.
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64
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Sullivan G, Spencer M. Heat and temperature. BJA Educ 2022; 22:350-356. [PMID: 36033933 PMCID: PMC9402786 DOI: 10.1016/j.bjae.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 11/19/2022] Open
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Sang BH, Lee C, Lee DY. Prospective comparative analysis of noninvasive body temperature monitoring using zero heat flux technology (SpotOn sensor) compared with esophageal temperature monitoring during pediatric surgery. PLoS One 2022; 17:e0272720. [PMID: 35939499 PMCID: PMC9359523 DOI: 10.1371/journal.pone.0272720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
Abstract
Maintaining body temperature in pediatric patients is critical, but it is often difficult to use currently accepted core temperature measurement methods. Several studies have validated the use of the SpotOn sensor for measuring core temperature in adults, but studies on pediatric patients are still lacking. The aim of this study was to investigate the accuracy of the SpotOn sensor compared with that of esophageal temperature measurement in pediatric patients intraoperatively. Children aged 1–8 years with American Society of Anesthesiology Physical Condition Classification I or II scheduled to undergo elective ear surgery for at least 30 min under general anesthesia were enrolled. Body core temperature was measured every 15 min after induction till the end of anesthesia with an esophageal probe, axillary probe, and SpotOn sensor. We included 49 patients, providing a total 466 paired measurements. Analysis of Pearson rank correlation between SpotOn and esophageal pairs showed a correlation coefficient (r) of 0.93 (95% confidence interval [CI] 0.92–0.94). Analysis of Pearson rank correlation between esophageal and axillary pairs gave a correlation coefficient (r) of 0.89 (95% CI 0.87–0.91). Between the SpotOn and esophageal groups, Bland-Altman analysis revealed a bias (SD, 95% limits of agreement) of -0.07 (0.17 [-0.41–0.28]). Between the esophageal and axillary groups, Bland-Altman analysis showed a bias (SD, 95% limits of agreement) of 0.45 (0.22 [0–0.89]). In pediatric patients during surgery, the SpotOn sensor showed high correlation and agreement with the esophageal probe, which is a representative core temperature measurement method.
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Affiliation(s)
- Bo-Hyun Sang
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Cener, CHA University School of Medicine, Seongnam, Republic of Korea
- * E-mail:
| | - Changjin Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Cener, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Da Yeong Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Cener, CHA University School of Medicine, Seongnam, Republic of Korea
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66
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Cho SA, Chang M, Lee SJ, Sung TY, Cho CK. Prewarming for Prevention of Hypothermia in Older Patients Undergoing Hand Surgery Under Brachial Plexus Block. Ann Geriatr Med Res 2022; 26:175-182. [PMID: 35722781 PMCID: PMC9271397 DOI: 10.4235/agmr.22.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/07/2022] [Indexed: 11/05/2022] Open
Abstract
Background Older patients are more vulnerable to inadvertent perioperative hypothermia. Prewarming contributes to the prevention of inadvertent perioperative hypothermia in patients under general or neuraxial anesthesia. However, the effects of brachial plexus block (BPB) on thermoregulation and the efficacy of prewarming in the prevention of hypothermia in older patients undergoing surgery with BPB remain unclear. This study evaluated the effects of BPB on thermoregulation and the efficacy of prewarming during BPB in older patients. Methods Patients aged ≥65 years were randomly allocated to receive either standard preoperative insulation (control group, n=20) or preanesthetic forced-air warming for 20 minutes before BPB (prewarming group, n=20). During the perioperative period, tympanic temperatures were measured. Thermal comfort scores and shivering grades were also obtained. Results The tympanic temperatures at the end of surgery did not differ between the groups (36.9°C±0.5°C and 37.0°C±0.4°C in the control and prewarming groups, respectively; p=0.252). The maximum temperature change was significantly lower in the prewarming group compared to the control group (0.36°C±0.4°C and 0.65°C±0.3°C, respectively; p=0.013). The hypothermia incidence and severity, thermal comfort scores, and shivering grades did not differ between the groups. Conclusion Regardless of the application of prewarming, BPB did not cause a clinically significant impairment of thermoregulation. Moreover, the efficacy of prewarming appeared to be low; thus, it may not be routinely required in patients undergoing orthopedic hand surgery under BPB.
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Affiliation(s)
- Sung-Ae Cho
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Minhye Chang
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Seok-Jin Lee
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Tae-Yun Sung
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
- Corresponding Author: Tae-Yun Sung, MD, PhD Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, 158, Gwangeodong-ro, Seo-gu, Daejeon 35365, Korea E-mail:
| | - Choon-Kyu Cho
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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67
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Nguyen AP, Tran M, Khoche S, Gabriel RA, Schmidt U. Surgical Site Infection in Thoracic Surgery Is Not Associated With Perioperative Hypothermia. Cureus 2022; 14:e26427. [PMID: 35915695 PMCID: PMC9337793 DOI: 10.7759/cureus.26427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction: The Surgical Care Improvement Project (SCIP) added the SCIP-Inf-10 measure to mandate that all surgical patients have perioperative temperature management to reduce surgical site infection. While the basis of this measure originated in colorectal surgery, we hypothesized that this would also apply to thoracic surgery patients. Methods: This was a retrospective single-center pilot study reviewing two years of thoracic surgery cases for the incidence and duration of hypothermia during the operation and surgical site infection occurring within 30 days. Hypothermia was defined as a core temperature of < 36° C. Results: A total of 317 patients were included in the study. Sixty-two percent of patients were identified as hypothermic. The average intraoperative temperature was 35.4°C ± 0.8°C in the hypothermic group and 36.4°C ± 0.3°C in the normothermic group. There were four surgical site infections in the study with three cases from the <36°C group (p = 1). There was no difference in average post-anesthesia care unit length of stay between the groups. The average hospital length of stay was 5.5 ± 5.2 days for the hypothermic group and 8.6 ± 12.8 days for the normothermic group (p=0.0024). Conclusion: Perioperative hypothermia was common in thoracic surgery and did not have a negative impact on surgical site infection.
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Kurosaka C, Maruyama T, Yamada S, Hachiya Y, Ueta Y, Higashi T. Estimating core body temperature using electrocardiogram signals. PLoS One 2022; 17:e0270626. [PMID: 35763529 PMCID: PMC9239487 DOI: 10.1371/journal.pone.0270626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/13/2022] [Indexed: 11/18/2022] Open
Abstract
Suppressing the elevation in core body temperature is an important factor in preventing heatstroke. However, there is still no non-invasive method to sense core body temperature. This study proposed an algorithm that estimates core body temperature based on electrocardiogram signals. A total of 12 healthy men (mean age ± SD = 39.6 ± 13.4) performed an ergometric exercise load test under two conditions of exercise load in an environmental chamber adjusted to a temperature of 35°C and humidity of 50%. Vital sensing data such as electrocardiograms, core body temperatures, and body surface temperatures were continuously measured, and physical data such as body weight were obtained from participants pre- and post-experiment. According to basic physiological knowledge, heart rate and body temperature are closely related. We analyzed the relationship between core body temperature and several indexes obtained from electrocardiograms and found that the amount of change in core body temperature had a strong relationship with analyzed data from electrocardiograms. Based on these findings, we developed the amount of change in core body temperature estimation model using multiple regression analysis including the Poincaré plot index of the ECG R-R interval. The estimation model showed an average estimation error of -0.007°C (average error rate = -0.02%) and an error range of 0.457–0.445°C. It is suggested that continuous core body temperature change can be estimated using electrocardiogram signals regardless of individual characteristics such as age and physique. Based on this applicable estimation model, we plan to enhance estimation accuracy and further verify efficacy by considering clothing and environmental conditions.
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Affiliation(s)
- Chie Kurosaka
- Department of Human, Information and Life Sciences, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
- * E-mail:
| | - Takashi Maruyama
- Department of Physiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shimpei Yamada
- Department of Occupational Safety and Health Management, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yuriko Hachiya
- Department of Occupational and Community Health Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoichi Ueta
- Department of Physiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toshiaki Higashi
- Nishinihon Occupational Health Service Center, Kitakyushu, Japan
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69
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Scott RW, Fredriksen K. Barriers to body temperature monitoring among prehospital personnel: a qualitative study using the modified nominal group technique. BMJ Open 2022; 12:e058910. [PMID: 35732398 PMCID: PMC9226913 DOI: 10.1136/bmjopen-2021-058910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To identify and explore barriers that healthcare professionals working as prehospital care (PHC) providers at the University Hospital of North Norway experience with temperature monitoring and discover solutions to these problems. STUDY DESIGN Qualitative study using the modified nominal group technique. MATERIALS AND METHODS 14 experienced healthcare professionals working in air and ground emergency medical services were invited to the study. Initially, each participant was asked to suggest through email topics of importance regarding barriers to prehospital thermometry. Afterwards, they received a list of all disparate topics and were asked to individually rank them by importance. The top-ranked topics were discussed in a consensus meeting. The meeting was audio-recorded and a transcript was written and then analysed through an inductive thematic analysis. RESULTS 13 participants accepted the invitation. 63 suggestions were reduced to 24 disparate topics after removal of duplicates. Twelve highly ranked topics were discussed during the consensus meeting. Thematic analysis revealed 47 codes that were grouped together into six overarching themes, of which four described challenges to monitoring and two described potential solutions: equipment dissatisfaction, little focus on patient temperature, fear of iatrogenic complications, thermometry subordinated, more focus on temperature and simplification of thermometry. CONCLUSION To increase the frequency of temperature measurement on correct indication, we suggest introducing PHC protocols that specify patients and conditions where an accurate temperature measurement should have high priority. Furthermore, there is a profound need for more suitable techniques for temperature monitoring in the prehospital setting.
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Affiliation(s)
- Remi William Scott
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Knut Fredriksen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
- Emergency Medical Services, University Hospital of North Norway, Tromso, Norway
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Chang M, Cho SA, Lee SJ, Sung TY, Cho CK, Jee YS. Comparison of the effects of dexmedetomidine and propofol on hypothermia in patients under spinal anesthesia: a prospective, randomized, and controlled trial. Int J Med Sci 2022; 19:909-915. [PMID: 35693746 PMCID: PMC9149636 DOI: 10.7150/ijms.72754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/01/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Redistribution hypothermia caused by vasodilation during anesthesia is the primary cause of perioperative hypothermia. Propofol exerts a dose-dependent vasodilatory effect, whereas dexmedetomidine induces peripheral vasoconstriction at high plasma concentrations. This study compared the effects of dexmedetomidine and propofol on core temperature in patients undergoing surgery under spinal anesthesia. Methods: This prospective study included 40 patients (aged 19-70 years) with American Society of Anesthesiologists Physical Status class I-III who underwent elective orthopedic lower-limb surgery under spinal anesthesia. Patients were randomly allocated to a dexmedetomidine or propofol group (n = 20 per group). After induction of spinal anesthesia, patients received dexmedetomidine (loading dose: 1 μg/kg over 10 min; maintenance dose: 0.2-0.7 μg/kg/h) or propofol (loading dose: 75 μg/kg over 10 min; maintenance dose: 12.5-75 μg/kg/min). The doses of sedatives were titrated to maintain moderate sedation. During the perioperative period, tympanic temperatures, thermal comfort score, and shivering grade were recorded. Results: Core temperature at the end of surgery did not differ significantly between the groups (36.4 ± 0.4 and 36.1 ± 0.7°C in the dexmedetomidine and propofol groups, respectively; P = 0.118). The lowest perioperative temperature, incidence and severity of perioperative hypothermia, thermal comfort score, and shivering grade did not differ significantly between the groups (all P > 0.05). Conclusions: In patients undergoing spinal anesthesia with moderate sedation, the effect of dexmedetomidine on patients' core temperature was similar to that of propofol.
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Affiliation(s)
| | | | | | - Tae-Yun Sung
- Department of Anesthesiology and Pain medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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71
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Fiorini K, Tamasi T, Dorie J, Hegazy AF, Lee TY, Slessarev M. Non-Invasive Monitoring of Core Body Temperature for Targeted Temperature Management in Post-Cardiac Arrest Care. Front Med (Lausanne) 2022; 9:810825. [PMID: 35492302 PMCID: PMC9043456 DOI: 10.3389/fmed.2022.810825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/03/2022] [Indexed: 12/30/2022] Open
Abstract
Importance Accurate monitoring of core body temperature is integral to targeted temperature management (TTM) following cardiac arrest. However, there are no reliable non-invasive methods for monitoring temperature during TTM. Objectives We compared the accuracy and precision of a novel non-invasive Zero-Heat-Flux Thermometer (SpotOn™) to a standard invasive esophageal probe in a cohort of patients undergoing TTM post-cardiac arrest. Design, Setting, and Participants We prospectively enrolled 20 patients undergoing post-cardiac arrest care in the intensive care units at the London Health Sciences Centre in London, Canada. A SpotOn™ probe was applied on each patient's forehead, while an esophageal temperature probe was inserted, and both temperature readings were recorded at 1-min intervals for the duration of TTM. Main outcomes and Measures We compared the SpotOn™ and esophageal monitors using the Bland–Altman analysis and the Pearson correlation, with accuracy set as a primary outcome. Secondary outcomes included precision and correlation. Bias exceeding 0.1°C and limits of agreement exceeding 0.5°C were considered clinically important. Results Sixteen (80%) of patients had complete data used in the final analysis. The median (interquartile range) duration of recording was 38 (12–56) h. Compared to the esophageal probe, SpotOn™ had a bias of 0.06 ± 0.45°C and 95% limits of agreement of −0.83 to 0.95°C. The Pearson correlation coefficient was 0.97 (95% confidence interval 0.9663–0.9678), with a two-tailed p < 0.0001. Conclusion and Relevance The SpotOn™ is an accurate method that may enable non-invasive monitoring of core body temperature during TTM, although its precision is slightly worse than the predefined 0.5°C when compared to invasive esophageal probe.
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Affiliation(s)
- Kyle Fiorini
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Division of Critical Care, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - Tanya Tamasi
- Kidney Clinical Research Unit, Lawson Health Research Institute, London, ON, Canada
| | - Justin Dorie
- Kidney Clinical Research Unit, Lawson Health Research Institute, London, ON, Canada
| | - Ahmed F Hegazy
- Division of Critical Care, Department of Medicine, London Health Sciences Centre, London, ON, Canada.,Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, London, ON, Canada
| | - Ting-Yim Lee
- Department of Medical Imaging and Biophysics, Western University, London, ON, Canada.,Imaging Program, Lawson Health Research Institute, London, ON, Canada
| | - Marat Slessarev
- Division of Critical Care, Department of Medicine, London Health Sciences Centre, London, ON, Canada.,Kidney Clinical Research Unit, Lawson Health Research Institute, London, ON, Canada.,Brain and Mind Institute, Western University, London, ON, Canada
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Murphy B, McCaul C. C, O'Flaherty D. Over-exposed? Infra-red thermography and the assessment of spinal anaesthesia’ – a reply. Int J Obstet Anesth 2022; 51:103565. [DOI: 10.1016/j.ijoa.2022.103565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
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Perioperative temperature monitoring practices in Australia: A multidisciplinary cross-sectional survey. Collegian 2022. [DOI: 10.1016/j.colegn.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Zhu J, Hu H, Deng X, Cheng X, Li Y, Chen W, Zhang Y. Risk factors analysis and nomogram construction for blood transfusion in elderly patients with femoral neck fractures undergoing hemiarthroplasty. INTERNATIONAL ORTHOPAEDICS 2022; 46:1637-1645. [PMID: 35166874 DOI: 10.1007/s00264-022-05347-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/10/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Elderly patients with femoral neck fractures (FNFs) undergoing hemiarthroplasty usually have poor physical condition. The main aim of this study was to identify risk factors for blood transfusion in these patients and construct a nomogram to intuitively predict the requirement of transfusion. The secondary purpose was to examine the relationship between blood transfusion and complications within 30 days post-operatively. Our hypothesis was that chronic kidney disease (CKD) and hypoalbuminemia may increase the requirement of transfusion. METHODS Data of 414 elderly patients undergoing hemiarthroplasty for FNFs were retrospectively collected. Univariate and multiple regression analysis were performed to identify independent risk factors for blood transfusion, which were used to construct a nomogram subsequently. The discrimination and calibration of the nomogram model were assessed with concordance index (C-index), the area under receiver operating characteristic curve (AUC), and calibration curve. Furthermore, the complications of blood transfusion within 30 days post-operatively were also analyzed. RESULTS Out of 414 patients, 127 (30.7%) received a blood transfusion. Independent risk factors for blood transfusion included CKD, hypoalbuminemia, pre-operative anaemia, general anaesthesia, higher American Society of Anesthesiologists score, more intraoperative blood loss, and longer surgical time. Increased hidden blood loss, deep vein thrombosis, superficial wound infection, and prolonged hospital stays were more common in transfused patients. The C-index of the nomogram model was 0.848 (95% CI = 0.811-0.885), and the AUC value was 0.859. The calibration curve showed a good consistency between the actual transfusion and the predicted probability. DISCUSSION We observed a transfusion rate of 30.7% in elderly FNF patients undergoing hemiarthroplasty. CKD and hypoalbuminemia were firstly identified as independent risk for blood transfusion. In addition, blood transfusion can increase the occurrence of early post-operative complications. CONCLUSION Targeted pre-operative intervention, such as optimizing CKD and correcting hypoalbuminemia is essential and highly regarded.
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Affiliation(s)
- Jian Zhu
- Shanxi Bethune Hospital, Shanxi Academy of Medical Science, No. 99, Longcheng Street, Taiyuan, 030032, Shanxi Province, China.,School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China.,Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Hongzhi Hu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China
| | - Xiangtian Deng
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China.,Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xiaodong Cheng
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yonglong Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yingze Zhang
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China. .,Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China.
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75
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Are Non-Contact Thermometers an Option in Anaesthesia? A Narrative Review on Thermometry for Perioperative Medicine. Healthcare (Basel) 2022; 10:healthcare10020219. [PMID: 35206834 PMCID: PMC8872024 DOI: 10.3390/healthcare10020219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 11/22/2022] Open
Abstract
Measurement of core body temperature—clinical thermometry—provides critical information to anaesthetists during perioperative care. The value of this information is determined by the accuracy of the measurement device used. This accuracy must be maintained despite external influences such as the operating room temperature and the patient’s thermoregulatory defence. Presently, perioperative thermometers utilise invasive measurement sites. The public health challenge of the COVID-19 pandemic, however, has highlighted the use of non-invasive, non-contact infrared thermometers. The aim of this article is to review common existing thermometers used in perioperative care, their mechanisms of action, accuracy, and practicality in comparison to infrared non-contact thermometry used for population screening during a pandemic. Evidence currently shows that contact thermometry varies in accuracy and practicality depending on the site of measurements and the method of sterilisation or disposal between uses. Despite the benefits of being a non-invasive and non-contact device, infrared thermometry used for population temperature screening lacks the accuracy required in perioperative medicine. Inaccuracy may be a consequence of uncontrolled external temperatures, the patient’s actions prior to measurement, distance between the patient and the thermometer, and the different sites of measurement. A re-evaluation of non-contact thermometry is recommended, requiring new studies in more controlled environments.
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76
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Semiconductor Polymer Carbon Composite Coated Fabric for Warm Beds in Hospital. ADSORPT SCI TECHNOL 2022. [DOI: 10.1155/2022/2115406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patients suffering from diseases that occur due to spreading of virus like fever and cold will have decrease in body temperature. They feel cold in the normal body and room temperature conditions. For the comfort of these patients, an electric under blanket is designed which warms up the patient to maintain the normal body temperature. The heated under body supports include a heater assembly and a layer of compressible support material. The heater assembly includes a flexible heating element, multiplex polyester, and a temperature sensor. The flexible heater element may include a fabric, which coated with a conductive or semiconductive polymer. The heated under body support may also include a water resistant shell, whereas it may encase the heater assembly and the compressible support material. The material used for outer shell and inner heating element has simulated in COMSOL tool for analyzing the heat transfer between them. The proto type model has simulated in PROTEUS software, which includes Arduino UNO and thermistor. This analysis will give the result whether the material can be used as the under garment for warming the patient.
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77
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Işıklı AG, Fındık ÜY. Determining the Effectiveness of Forced-Air Warming Blankets in Maintaining Postoperative Body Temperature: A Randomized Controlled Trial. J Perianesth Nurs 2022; 37:533-539. [PMID: 35012871 DOI: 10.1016/j.jopan.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study is to determine the effectiveness of forced-air warming blankets in normalizing body temperature in the postoperative period. DESIGN Randomized controlled trial METHODS: The study sample consisted of patients (N = 67) who underwent lung lobectomy in the Thoracic Surgery Service of a university hospital. Forced-air warming blankets were used in the treatment group and 100% cotton blankets were used in the control group. Patients' body temperatures were monitored using a tympanic thermometer until it reached 37°C. FINDINGS The body temperature of the patients in the treatment group reached 37°C in a shorter time than that of the patients in the control group (52.27 ± 29.79 min and 139.0 ± 81.93 min, respectively; P < .001), and that the perception of comfort of the patients in the treatment and control groups increased (P < .001) after warming. CONCLUSIONS We recommend that forced-air warming blankets are used for patients undergoing lung lobectomy in order to reach normal body temperature in a shorter time.
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Affiliation(s)
- Ayşe Gökce Işıklı
- Trakya University, Balkan Campus, Health Research and Practice Centre of Trakya University, Thoracic Surgery Department, Edirne, Turkey.
| | - Ümmü Yıldız Fındık
- Trakya University Faculty of Health Sciences Nursing Department, Trakya University Balkan Campus, Edirne, Turkey
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78
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Boyer J, Eckmann J, Strohmayer K, Koele W, Federspiel M, Schenk M, Weiss G, Krause R. Investigation of Non-invasive Continuous Body Temperature Measurements in a Clinical Setting Using an Adhesive Axillary Thermometer (SteadyTemp®). Front Digit Health 2022; 3:794274. [PMID: 34970650 PMCID: PMC8712449 DOI: 10.3389/fdgth.2021.794274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
Since the human body reacts to a variety of different diseases with elevated body temperature, measurement of body temperature remains relevant in clinical practice. The absolute temperature value for fever definition is still arbitrary and depends on the measuring site, as well as underlying disease and individual factors. Hence, a simple threshold for fever definition is outdated and a definition which relies on the relative changes in the individual seems reasonable as it takes these individual factors into account. In this prospective multicentric study we validate an adhesive axillary thermometer (SteadyTemp®) which allows continuous non-invasive temperature measurements. It consists of a patch to measure temperature and a smartphone application to process and visualize gathered data. This article provides information of the new diagnostic possibilities when using this wearable device and where it could be beneficial. Furthermore, it discusses how to interpret the generated data and when it is not practical to use, based on its characteristics and physiological phenomena.
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Affiliation(s)
- Johannes Boyer
- Department of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | | | | | | | | | | | - Gregor Weiss
- Das Kinderwunsch Institut Schenk GmbH, Dobl, Austria
| | - Robert Krause
- Department of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,BioTechMed Graz, Graz, Austria
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79
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Cho SA, Yoon S, Lee SJ, Jee YS, Cho CK, Sung TY. Clinical efficacy of short-term prewarming in elderly and adult patients: A prospective observational study. Int J Med Sci 2022; 19:1548-1556. [PMID: 36185326 PMCID: PMC9515690 DOI: 10.7150/ijms.77578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/23/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Short-term prewarming effectively reduces intraoperative hypothermia in adult patients. However, few data exist regarding its efficacy in elderly patients. Elderly people have a reduced ability to regulate their body temperature, which affects the efficacy of prewarming. This study aimed to compare the clinical efficacy of short-term pre-warming in elderly patients with that in adult patients. Methods: We enrolled 25 adult (20-50 years) and 25 elderly (> 65 years) patients scheduled for ureteroscopic stone surgery under general anaesthesia. All patients received preanaesthetic forced-air warming for 20 min. The core temperature was measured using an infrared tympanic thermometer during awakening and nasopharyngeal thermistors during anaesthesia. Incidence and severity of intraoperative hypothermia (< 36°C) was compared. Postoperative shivering and number of patients requiring active warming in the post-anaesthesia care unit were also assessed. Results: Intraoperative hypothermia was more frequent in elderly than in adult patients (58.3% vs. 12.0%; relative risk 2.6; 95% confidence interval 1.5 to 4.6; effect size h = 1.010; p = 0.001). The severity of intraoperative hypothermia showed a significant intergroup difference (p = 0.002). Postoperative shivering was more frequent in elderly than in adult patients (33.3% vs. 8.0%, p = 0.037). A greater number of elderly patients in the post-anaesthesia care unit required active warming (33.3% vs. 8.0%, p = 0.037). Conclusions: The effects of short-term prewarming on the prevention of hypothermia and maintenance of perioperative normothermia are not the same in the elderly and adult patients.
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Affiliation(s)
- Sung-Ae Cho
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
| | - Sieun Yoon
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Seok-Jin Lee
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
| | - Young-Seok Jee
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
| | - Choon-Kyu Cho
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
| | - Tae-Yun Sung
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
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80
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Ryalino C, Galag FR, Senapathi TA, Subagiartha M, Sutawan IKJ, Pradhana A. The effect of body temperature changes on inflammation response and patients’ comfort in patients undergoing laparotomy with general anesthesia. BALI JOURNAL OF ANESTHESIOLOGY 2022. [DOI: 10.4103/bjoa.bjoa_12_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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81
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Murphy B, McCaul C CL, O'Flaherty D. Infrared thermographic assessment of spinal anaesthesia-related cutaneous temperature changes during caesarean section. Int J Obstet Anesth 2021; 49:103245. [PMID: 35012810 DOI: 10.1016/j.ijoa.2021.103245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/18/2021] [Accepted: 12/12/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Assessment of adequacy of spinal anaesthesia prior to obstetric surgery is extremely important but can be problematic because currently available clinical assessment methods are indirect and subjective. As the sympathectomy associated with spinal anaesthesia is known to cause vasodilation and heat redistribution, we sought to assess whether spinal anaesthesia led to significant and consistent cutaneous temperature changes as measured by infrared thermography. METHODS Following ethics committee approval, this observational study was conducted in a tertiary level obstetric centre. Participants included women undergoing elective caesarean section under spinal anaesthesia. Following consent, a Flir T540 infrared camera captured thermographic images over the feet, patella, buttock, iliac crests, xiphisternum and axilla. Temperature was measured prior to spinal needle insertion (T0) and following clinical assessment when the block was deemed adequate. RESULTS Thirty patients were included. Baseline temperature varied considerable by site. Spinal anaesthesia altered skin temperature in all areas of interest: right and left hallux (mean of differences (MD) +4.0°C and 5.2°C respectively, P <0.0001), right and left plantar (MD +6.1°C and 6.8°C respectively, P <0.0001), patella (MD -0.33°C, P=0.0445), buttock (MD -0.5°C, P=0.009), iliac crest (MD -0.7°C, P=0.0004), xiphisternum (MD -0.95°C, P <0.0001) and axilla (MD -0.71°C, P=0.0002). CONCLUSIONS Following spinal anaesthesia thermographic imaging identified different patterns of skin temperature changes, with pronounced temperature increases measured in the feet and cooling of a lesser amplitude in the thoracic and lumbar dermatomes. Infrared thermography has the potential to provide objective measurement of sympathectomy.
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Affiliation(s)
- B Murphy
- The Rotunda Hospital, Dublin, Ireland; Connolly Hospital Blanchardstown, Dublin, Ireland.
| | - C L McCaul C
- The Rotunda Hospital, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine and Medical Sciences, University College Dublin, Ireland
| | - D O'Flaherty
- The Rotunda Hospital, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
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82
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Jeon HJ, Choi HS, Bang EJ, Lee KW, Kim SH, Lee JM, Kim ES, Keum B, Tae Jeen Y, Lee HS, Chun HJ, Jeong S, Kim JH. Efficacy and safety of a thermosensitive hydrogel for endoscopic submucosal dissection: An in vivo swine study. PLoS One 2021; 16:e0260458. [PMID: 34882721 PMCID: PMC8659419 DOI: 10.1371/journal.pone.0260458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022] Open
Abstract
Injectable thermo-sensitive chitosan hydrogels have recently been developed for the use of submucosal fluids in endoscopic submucosal dissections (ESD). This study aimed to investigate the efficacy and safety of chitosan hydrogels during ESD. Submucosal fluids were administered as follows: 0.9% normal saline (NS), 0.4% hyaluronic acid (HA) and chitosan/β-glycerophosphate (CS/GP) hydrogel. Each solution was administered twice into the stomach and colon of a pig, with a total of 72 ESD procedures performed on 12 pigs. The injected volume and procedure-related parameters were recorded and analyzed. ESDs that created ulcers after 7 days were histologically compared. All ESD specimens were resected en bloc. The total injected volumes during ESD of the stomach (NS, 16.09±3.27 vs. HA, 11.17±2.32 vs. CS/GP, 9.44±2.33; p<0.001) and colon (NS, 9.17±1.80 vs. HA, 6.67±1.50 vs. CS/GP, 6.75±1.57; p = 0.001) were significantly different. Hydrogel showed significant differences from normal saline in terms of fluid power (mm2/vol; NS, 35.70±9.00 vs. CS/GP 57.48±20.77; p = 0.001) and consumption rate (vol/min; NS, 2.59±0.86 vs. CS/GP, 1.62±0.65; p = 0.013) in the stomach. Histological examination revealed preserved muscularis propria, although the chitosan hydrogel resulted in a partial inflammatory response, with a hypertrophied submucosal layer. Chitosan hydrogel was found to be superior to normal saline, with an efficacy similar to that of hyaluronic acid. Nonetheless, long-term histological changes should be evaluated before clinical implementation.
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Affiliation(s)
- Han Jo Jeon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Eun Ju Bang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kang Won Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Min Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung Jeong
- Department of Biosystems & Biomaterials Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Jong Hyuk Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States of America
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States of America
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83
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An inherently dangerous fluid warmer design. J Clin Monit Comput 2021; 36:909-915. [PMID: 34860322 DOI: 10.1007/s10877-021-00786-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022]
Abstract
A Hotline® fluid warmer is a device commonly used by anesthesia providers in the operating room to warm and infuse blood products and large fluid volumes. The purpose of the fluid warmer is to counter heat loss, which occurs under anesthesia. Despite normal checks performed prior to its use, we discovered a breach in the fluid warming set attached to the Hotline® fluid warmer during blood administration. The breach contaminated the patient's sterile intravenous line. We describe the quality and safety processes we undertook in detail. We discuss the notion that monitoring alarms are an important safety feature of most modern devices utilized by anesthesia providers. We believe the Hotline® fluid warmer lacks a crucial monitor for detecting a breach within the fluid warming set, and therefore recommend the addition of an alarm to improve this device's safety.
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84
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Lee SY, Bong CL, Siow YN, Allen JC. Tympanic membrane-infrared thermometry against zero heat flux thermometry for detection of postoperative hypothermia in children. Eur J Anaesthesiol 2021; 38:1299-1302. [PMID: 34735400 DOI: 10.1097/eja.0000000000001492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Shu Ying Lee
- From the Department of Paediatric Anaesthesia, KK Women's and Children's Hospital (SYL, CLB, YNS) and Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore (JCA)
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85
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Reeves N, White J, Bird S, Shinkwin M, Cornish J, Torkington J. Warmed and humidified insufflation to prevent perioperative hypothermia and improve the quality of recovery in elective laparoscopic colorectal resection patients: a feasibility study for a triple-blind randomized controlled trial. Colorectal Dis 2021; 23:3262-3271. [PMID: 34747558 DOI: 10.1111/codi.15984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/26/2021] [Accepted: 10/31/2021] [Indexed: 02/08/2023]
Abstract
AIM The use of standard CO2 for insufflation during laparoscopic colorectal surgery may be associated with cooling and drying of the peritoneal cavity, contributing to perioperative hypothermia. The aim of this work was the assess the feasibility of a study to compare insufflation of warmed, humidified CO2 (WHCO2) (using HumiGard, Fisher and Paykel Healthcare) with standard measures and its impact on the quality of recovery of surgical patients. METHOD A single-centre, triple-blind, feasibility, randomized controlled trial (RCT) of adults scheduled for planned laparoscopic colorectal surgery. The primary outcome was recruitment. Secondary outcomes included feasibility of blinding, acceptability to patients and suitability of objective measures: patient-reported quality of recovery using a validated questionnaire (QoR-40), patient pain scores and semi-continuous core temperature measurements. RESULTS Thirty-nine participants were randomized to either the WHCO2 group (n = 19) or standard care alone (n = 20). Recruitment to the study was successful and acceptable to patients. Blinding of the surgeons, patients and assessors was effective. Response rates to QoR-40 were high but ceiling effects were observed, indicating that the tool was unsuitable in this population. Fewer patients in the WHCO2 group reported postoperative nausea and vomiting (PONV) at days 1 (53% vs. 65%) and 3 (37% vs. 60%). The median hospital length of stay was 5.5 days in the standard care group and 4 days in the WHCO2 group. CONCLUSION A study of WHCO2 for insufflation in laparoscopic colorectal surgery would be highly acceptable to both patients and researchers. Potential reductions in PONV and hospital length of stay in patients treated with WHCO2 merit further investigation. The design of the full-scale RCT will benefit from this feasibility study.
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Affiliation(s)
| | - Judith White
- Cedar, Cardiff and Vale University Health Board, Cardiff, UK
| | - Samuel Bird
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Michael Shinkwin
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Julie Cornish
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Jared Torkington
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
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86
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Theroux MC, Campbell JW. Anesthetic Concerns of Children With Skeletal Dysplasia. Neurosurg Clin N Am 2021; 33:37-47. [PMID: 34801140 DOI: 10.1016/j.nec.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Children with skeletal dysplasia present unique challenges for safe anesthetic care including differences in the anatomy of the respiratory system, possibility of cervical spine instability or spinal stenosis, and a unique body habitus. Even seemly routine anesthesia can result in respiratory arrest or spinal cord injury. These complications can largely be avoided by proper planning such as appropriate techniques for the intubation of difficult airways, recognition of cervical instability, neuromonitoring for any anesthesia over an hour in patients with severe spinal stenosis, and preoperative assessment of the trachea and avoidance of neuraxial anesthesia in children with Morquio syndrome.
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Affiliation(s)
- Mary C Theroux
- Department of Anesthesia, Nemours/AI duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA
| | - Jeffrey W Campbell
- Division of Pediatric Neurosurgery, Nemours/AI duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA.
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87
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Wallisch C, Zeiner S, Scholten P, Dibiasi C, Kimberger O. Development and internal validation of an algorithm to predict intraoperative risk of inadvertent hypothermia based on preoperative data. Sci Rep 2021; 11:22296. [PMID: 34785724 PMCID: PMC8595364 DOI: 10.1038/s41598-021-01743-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/02/2021] [Indexed: 11/08/2022] Open
Abstract
Intraoperative hypothermia increases perioperative morbidity and identifying patients at risk preoperatively is challenging. The aim of this study was to develop and internally validate prediction models for intraoperative hypothermia occurring despite active warming and to implement the algorithm in an online risk estimation tool. The final dataset included 36,371 surgery cases between September 2013 and May 2019 at the Vienna General Hospital. The primary outcome was minimum temperature measured during surgery. Preoperative data, initial vital signs measured before induction of anesthesia, and known comorbidities recorded in the preanesthetic clinic (PAC) were available, and the final predictors were selected by forward selection and backward elimination. Three models with different levels of information were developed and their predictive performance for minimum temperature below 36 °C and 35.5 °C was assessed using discrimination and calibration. Moderate hypothermia (below 35.5 °C) was observed in 18.2% of cases. The algorithm to predict inadvertent intraoperative hypothermia performed well with concordance statistics of 0.71 (36 °C) and 0.70 (35.5 °C) for the model including data from the preanesthetic clinic. All models were well-calibrated for 36 °C and 35.5 °C. Finally, a web-based implementation of the algorithm was programmed to facilitate the calculation of the probabilistic prediction of a patient's core temperature to fall below 35.5 °C during surgery. The results indicate that inadvertent intraoperative hypothermia still occurs frequently despite active warming. Additional thermoregulatory measures may be needed to increase the rate of perioperative normothermia. The developed prediction models can support clinical decision-makers in identifying the patients at risk for intraoperative hypothermia and help optimize allocation of additional thermoregulatory interventions.
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Affiliation(s)
- C Wallisch
- Section for Clinical Biometrics, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - S Zeiner
- Department of Anesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - P Scholten
- Department of Anesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - C Dibiasi
- Department of Anesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBI-DHPS), Medical University of Vienna, Vienna, Austria
| | - O Kimberger
- Department of Anesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBI-DHPS), Medical University of Vienna, Vienna, Austria
- Outcomes Research Consortium, Cleveland, OH, USA
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88
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Effect of prewarming on body temperature in short-term bladder or prostatic transurethral resection under general anesthesia: A randomized, double-blind, controlled trial. Sci Rep 2021; 11:20762. [PMID: 34675311 PMCID: PMC8531284 DOI: 10.1038/s41598-021-00350-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/11/2021] [Indexed: 01/10/2023] Open
Abstract
Perioperative hypothermia causes postoperative complications. Prewarming reduces body temperature decrease in long-term surgeries. We aimed to assess the effect of different time-periods of prewarming on perioperative temperature in short-term transurethral resection under general anesthesia. Randomized, double-blind, controlled trial in patients scheduled for bladder or prostatic transurethral resection under general anesthesia. Eligible patients were randomly assigned to receive no-prewarming or prewarming during 15, 30, or 45 min using a forced-air blanket in the pre-anesthesia period. Tympanic temperature was used prior to induction of anesthesia and esophageal temperature intraoperatively. Primary outcome was the difference in core temperature among groups from the induction of general anesthesia until the end of surgery. Repeated measures multivariate analysis of covariance modeled the temperature response at each observation time according to prewarming. We examined modeled contrasts between temperature variables in subjects according to prophylaxis. We enrolled 297 patients and randomly assigned 76 patients to control group, 74 patients to 15-min group, 73 patients to 30-min group, and 74 patients to the 45-min group. Temperature in the control group before induction was 36.5 ± 0.5 °C. After prewarming, core temperature was significantly higher in 15- and 30-min groups (36.8 ± 0.5 °C, p = 0.004; 36.7 ± 0.5 °C, p = 0.041, respectively). Body temperature at the end of surgery was significantly lower in the control group (35.8 ± 0.6 °C) than in the three prewarmed groups (36.3 ± 0.6 °C in 15-min, 36.3 ± 0.5 °C in 30-min, and 36.3 ± 0.6 °C in 45-min group) (p < 0.001). Prewarming prior to short-term transurethral resection under general anesthesia reduced the body temperature drop during the perioperative period. These time-periods of prewarming also reduced the rate of postoperative complications.Study Registration Registered at ClinicalTrials.gov (Identifier: NCT03630887).
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89
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Xu F, Zhang C, Liu C, Bi S, Gu J. Relationship Between First 24-h Mean Body Temperature and Clinical Outcomes of Post-cardiac Surgery Patients. Front Cardiovasc Med 2021; 8:746228. [PMID: 34631839 PMCID: PMC8494946 DOI: 10.3389/fcvm.2021.746228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/26/2021] [Indexed: 02/05/2023] Open
Abstract
Background: This study was aimed to investigate the relationship between first 24-h mean body temperature and clinical outcomes of post cardiac surgery patients admitted to intensive care unit (ICU) in a large public clinical database. Methods: This is a retrospectively observational research of MIMIC III dataset, a total of 6,122 patients included. Patients were divided into 3 groups according to the distribution of body temperature. Multivariate cox analysis and logistic regression analysis were used to investigate the association between abnormal temperature, and clinical outcomes. Results: Hypothermia (<36°C) significantly associated with increasing in-hospital mortality (HR 1.665, 95%CI 1.218–2.276; p = 0.001), 1-year mortality (HR 1.537, 95% CI 1.205–1.961; p = 0.001), 28-day mortality (HR 1.518, 95% CI 1.14–2.021; p = 0.004), and 90-day mortality (HR 1.491, 95% CI 1.144–1.943; p = 0.003). No statistical differences were observed between short-term or long-term mortality and hyperthermia (>38°C). Hyperthermia was related to the extended length of ICU stay (p < 0.001), and hospital stay (p < 0.001). Conclusion: Hypothermia within 24h after ICU admission was associated with the increased mortality of post cardiac surgery patients. Enhanced monitoring of body temperature within 24h after cardiac surgery should be taken into account for improving clinical outcomes.
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Affiliation(s)
- Fei Xu
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, Chengdu Women's & Children's Central Hospital, UESTC, Chengdu, China
| | - Cheng Zhang
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, Chengdu Women's & Children's Central Hospital, UESTC, Chengdu, China
| | - Chao Liu
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, Chengdu Women's & Children's Central Hospital, UESTC, Chengdu, China
| | - Siwei Bi
- West China of Medical School, Sichuan University, Chengdu, China
| | - Jun Gu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
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90
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Kümin M, Jones CI, Woods A, Bremner S, Reed M, Scarborough M, Harper CM. Resistant fabric warming is a viable alternative to forced-air warming to prevent inadvertent perioperative hypothermia during hemiarthroplasty in the elderly. J Hosp Infect 2021; 118:79-86. [PMID: 34637849 DOI: 10.1016/j.jhin.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Surgical site infection (SSI) is associated with inadvertent perioperative hypothermia (IPH). This can be prevented by active patient warming. However, results from comparisons of warming techniques are conflicting. They are based mostly on elective surgery, are from small numbers of patients, and are dominated by the market leader, forced-air warming (FAW). Furthermore, the definition of hypothermia is debatable and systematic reviews of warming systems conclude that a stricter control of temperature is required to study the benefits of warming. AIM To analyse core temperatures in detail in a large subset of elderly patients who took part in a randomized trial of patient warming following hemiarthroplasty who had received constant zero-flux thermometry to record their temperature. METHODS Regression models with a fixed effect for warming group and covariates related to temperature were compared for 257 participants randomized to FAW or resistant fabric warming (RFW) from a prior clinical trial. FINDINGS Those in the RFW group were -0.08°C cooler and had a cumulative hypothermia score -1.87 lower than those in the FAW group. There was no difference in the proportion of hypothermic patients at either <36.5°C or <36.0°C. CONCLUSIONS This is the first study to provide accurate temperature measurements in patients undergoing a procedure predominantly under regional rather than general anaesthetic. It shows that RFW is a viable alternative to FAW for preventing IPH during hemiarthroplasty. Further studies are needed to measure the benefits of patient warming in terms of clinically important outcomes.
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Affiliation(s)
- M Kümin
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - C I Jones
- Brighton and Sussex Medical School, Brighton, UK
| | - A Woods
- Milton Keynes University Hospitals NHS Foundation Trust, Milton Keynes, UK
| | - S Bremner
- Brighton and Sussex Medical School, Brighton, UK
| | - M Reed
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - M Scarborough
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C M Harper
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
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91
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Charles-Lozoya S, Cobos-Aguilar H, Manilla-Muñoz E, De La Parra-Márquez ML, García-Hernández A, Rangel-Valenzuela JM. Survival at 30 days in elderly patients with hip fracture surgery who were exposed to hypothermia: Survival study. Medicine (Baltimore) 2021; 100:e27339. [PMID: 34596139 PMCID: PMC8483871 DOI: 10.1097/md.0000000000027339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/09/2021] [Indexed: 01/05/2023] Open
Abstract
The effect of hypothermia as a mortality risk factor at 30 days in the elderly who had hip fracture (HF) surgery is still controversial because it may be due to a set of poorly identified factors. In this study, we aim to determine if exposure to intra and immediate postoperative hypothermia increases the incidence of mortality at 30 days in elderly patients who had HF surgery.Survival study in the elderly who had HF surgery with and without exposure to hypothermia. Sociodemographic, anesthetic and surgical factors were collected. The temperature of the rectum was measured at the end of the surgery and in the recovery room. The effect of hypothermia was analyzed by the incidence of mortality at 30 days. Other results were considered, such as, surgical site infection (SSI), blood transfusions, and influence of implants used in the 30-day mortality.Three hundred eighty five subjects were eligible, to include 300. Inadvertent hypothermia was 12%, the 30-day overall mortality was 9% and in subjects with hypothermia it was 25% (P = .002). Subjects with hypothermia had a higher risk of SSI (relative risk 4.2, 95% confidence interval 1.3-13.6, P = .03) and receive more transfusions (relative risk 3.6, 95% confidence interval 2.0-6.5, P < .001).Elderly subjects with HF exposed to hypothermia who undergo hip hemiarthroplasty and who receive 2 or more blood transfusions during their treatment, are at greater risk of dying after 30 days of the surgery. Hypothermia, as a possible causative factor of mortality, should continue to be studied.
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Affiliation(s)
- Sergio Charles-Lozoya
- Health Science Division, Division of Plastic and Reconstructive Surgery, Unit of Hip and Pelvis Orthopedic Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social, Monterrey, N.L., México
- Health Science Division, Vice-rectory of Health Science, Universidad de Monterrey, San Pedro Garza García, N.L., México
| | - Héctor Cobos-Aguilar
- Health Science Division, Vice-rectory of Health Science, Universidad de Monterrey, San Pedro Garza García, N.L., México
| | - Edgar Manilla-Muñoz
- Health Science Division, Vice-rectory of Health Science, Universidad de Monterrey, San Pedro Garza García, N.L., México
| | - Miguel Leonardo De La Parra-Márquez
- Health Science Division, Division of Plastic and Reconstructive Surgery, Unit of Hip and Pelvis Orthopedic Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social, Monterrey, N.L., México
| | - Adrián García-Hernández
- Health Science Division, Division of Plastic and Reconstructive Surgery, Unit of Hip and Pelvis Orthopedic Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social, Monterrey, N.L., México
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92
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Chen HY, Su LJ, Wu HZ, Zou H, Yang R, Zhu YX. Risk factors for inadvertent intraoperative hypothermia in patients undergoing laparoscopic surgery: A prospective cohort study. PLoS One 2021; 16:e0257816. [PMID: 34555101 PMCID: PMC8460038 DOI: 10.1371/journal.pone.0257816] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background Inadvertent intraoperative hypothermia is frequent during open surgeries; however, few studies on hypothermia during laparoscopic abdominal surgery have been reported. We aimed to investigate the incidence and risk factors for hypothermia in patients undergoing laparoscopic abdominal surgery. Methods This single-center prospective cohort observational study involved patients undergoing laparoscopic surgery between October 2018 and June 2019. Data on core body temperature and potential variables were collected. A multivariate logistic regression analysis was performed to identify the risk factors associated with hypothermia. A Cox regression analysis was used to verify the sensitivity of the results. Results In total, 690 patients were included in the analysis, of whom 200 (29.0%, 95% CI: 26%−32%) had a core temperature < 36°C. The core temperature decreased over time, and the incident hypothermia increased gradually. In the multivariate logistic regression analysis, age (OR = 1.017, 95% CI: 1.000–1.034, P = 0.050), BMI (OR = 0.938, 95% CI: 0.880–1.000; P = 0.049), baseline body temperature (OR = 0.025, 95% CI: 0.010–0.060; P < 0.001), volume of irrigation fluids (OR = 1.001, 95% CI: 1.000–1.001, P = 0.001), volume of urine (OR = 1.001, 95% CI: 1.000–1.003, P = 0.070), and duration of surgery (OR = 1.010, 95% CI: 1.006–1.015, P < 0.001) were significantly associated with hypothermia. In the Cox analysis, variables in the final model were age, BMI, baseline body temperature, volume of irrigation fluids, blood loss, and duration of surgery. Conclusions Inadvertent intraoperative hypothermia is evident in patients undergoing laparoscopic surgeries. Age, BMI, baseline body temperature, volume of irrigation fluids, and duration of surgery are significantly associated with intraoperative hypothermia.
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Affiliation(s)
- Huai-Ying Chen
- Department of Nursing, Ningde Municipal Hospital of Ningde Normal University, Ningde, China
- * E-mail:
| | - Li-Jing Su
- Department of Nursing, Ningde Municipal Hospital of Ningde Normal University, Ningde, China
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Hang-Zhou Wu
- Department of Medical Insurance, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hong Zou
- Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, China
| | - Rong Yang
- Department of Medical Record Management, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yi-Xia Zhu
- Department of Anesthesiology, Ningde Municipal Hospital of Ningde Normal University, Ningde, China
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93
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Cutuli SL, Osawa EA, Eyeington CT, Proimos H, Canet E, Young H, Peck L, Eastwood GM, Glassford NJ, Bailey M, Bellomo R. Accuracy of non-invasive body temperature measurement methods in critically ill patients: a prospective, bicentric, observational study. CRIT CARE RESUSC 2021; 23:346-353. [PMID: 38046071 PMCID: PMC10692569 DOI: 10.51893/2021.3.oa12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The accuracy of different non-invasive body temperature measurement methods in intensive care unit (ICU) patients is uncertain. We aimed to study the accuracy of three commonly used methods. Design: Prospective observational study. Setting: ICUs of two tertiary Australian hospitals. Participants: Critically ill patients admitted to the ICU. Interventions: Invasive (intravascular and intra-urinary bladder catheter) and non-invasive (axillary chemical dot, tympanic infrared, and temporal scanner) body temperature measurements were taken at study inclusion and every 4 hours for the following 72 hours. Main outcome measures: Accuracy of non-invasive body temperature measurement methods was assessed by the Bland-Altman approach, accounting for repeated measurements and significant explanatory variables that were identified by regression analysis. Clinical adequacy was set at limits of agreement (LoA) of 1°C compared with core temperature. Results: We studied 50 consecutive critically ill patients who were mainly admitted to the ICU after cardiac surgery. From over 375 observations, invasive core temperature (mostly pulmonary artery catheter) ranged from 33.9°C to 39°C. On average, the LoA between invasive and non-invasive measurements methods were about 3°C. The temporal scanner showed the worst performance in estimating core temperature (bias, 0.66°C; LoA, -1.23°C, +2.55°C), followed by tympanic infrared (bias, 0.44°C; LoA, -1.73°C, +2.61°C) and axillary chemical dot methods (bias, 0.32°C; LoA, -1.64°C, +2.28°C). No methods achieved clinical adequacy even accounting for significant explanatory variables. Conclusions: The axillary chemical dot, tympanic infrared and temporal scanner methods are inaccurate measures of core temperature in ICU patients. These non-invasive methods appeared unreliable for use in ICU patients.
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Affiliation(s)
- Salvatore L. Cutuli
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eduardo A. Osawa
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | | | - Helena Proimos
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Emmanuel Canet
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Helen Young
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Leah Peck
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Glenn M. Eastwood
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Neil J. Glassford
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne Health, Melbourne, VIC, Australia
- Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne Health, Melbourne, VIC, Australia
- Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC, Australia
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94
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Incidence of Severe Hypothermia and Its Impact on Postoperative Surgical Complications and Time Delay to Adjunct Treatments in Breast Surgery Cancer Patients: A Case-Controlled Study. J Clin Med 2021; 10:jcm10163702. [PMID: 34441999 PMCID: PMC8397141 DOI: 10.3390/jcm10163702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/24/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: Unintended postoperative hypothermia frequently occurs upon arrival in the post anesthesia care unit (PACU). As part of our quality assurance program in anesthesia, we regularly monitor the incidence of this complication through our anesthesia information management system (AIMS). In this case-controlled retrospective study, our goal was to detect the incidence of unintended severe hypothermia in our breast surgery cancer patients, and subsequently to analyze the consequence of this complication in terms postoperative cutaneous infection, as well as its impact on further complementary treatment, such as radiotherapy and chemotherapy. Methods: This study was a retrospective analysis conducted through our AIMS system from 2015 through 2019, with extraction criteria based on year, type of surgery (breast), and temperature upon arrival in PACU. A tympanic temperature of less than 36 °C was considered to indicate hypothermia. Severe hypothermia was considered for patients having a temperature lower than 35.2 °C (hypothermic) (n = 80), who were paired using a propensity score analysis with a control group (normothermic) (n = 80) of other breast cancer surgery patients. Extracted data included time of surgery, sex, age, ASA status, and type and duration of the intervention. Results: The mean incidence of hypothermia was 21% from 2015 through 2019. The body mass index (BMI) was significantly lower in the hypothermia group before matching, 23.5 ± 4.1 vs. 26.4 ± 6.1 kg/m2 in normothermic patients (p < 0.05). The hypothermia group also had significantly fewer monitoring and active warming devices. No difference was noted for wound complications. Time to complementary chemotherapy and or radiotherapy did not differ between groups (52 ± 21 days in group hypothermia vs 49 ± 22 days in the control group). Conclusion: Severe intraoperative hypothermia remains an important quality assurance issue in our breast surgery cancer patients, but we could not detect any long-term effect of hypothermia.
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95
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Sümer I, Uysal H, Yeşiltaş S, Türkay M. The Effect of Intraoperative Body Temperature on Postoperative Nausea and Vomiting in Pediatric Patients. J Perianesth Nurs 2021; 36:706-710. [PMID: 34362639 DOI: 10.1016/j.jopan.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/25/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Pediatric patients are at greater risk for both perioperative hypothermia and postoperative nausea and vomiting (PONV). The primary aim of this study was to investigate whether there is a relationship between intraoperative body temperature and PONV in children undergoing anesthesia. The secondary aim was to investigate the relationship between PONV and intraoperative fentanyl use, age and duration of operation. DESIGN A prospective cohort study METHODS: The study included 80 children who were undergoing lower abdominal surgery. Body temperature was monitored after routine preoperative preparation and standard induction. Analgesic and antiemetic requirements and the presence of nausea and vomiting were assessed postoperatively on the 30th minute and the 6th, 12th and 24th hour. FINDINGS The children with or without PONV were compared. At the postoperative 6th hour, the incidence of nausea was statistically significant in the children with a mean body temperature below 36°C (P = 0.044; P < 0.05). The mean duration of the surgery was statistically significant longer in the children with PONV (P = 0.001; P = 0.004; P <0.05). Mean body temperature was not statistically significant when comparing children with and without vomiting(P > 0.05). CONCLUSION While a body temperature below 36°C increases the incidence of postoperative nausea, it does not cause an increase in the incidence of vomiting. A long operation time in pediatric patients causes an increase in the incidence of PONV. Although not statistically significant, PONV is encountered more than twice as much in patients receiving intraoperative fentanyl administration.
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Affiliation(s)
- Ismail Sümer
- Department of Anesthesiology, Bezmialem Vakıf University, Istanbul, Turkey.
| | - Harun Uysal
- Department of Anesthesiology, Bezmialem Vakıf University, Istanbul, Turkey
| | - Serdar Yeşiltaş
- Department of Anesthesiology, Bezmialem Vakıf University, Istanbul, Turkey
| | - Meltem Türkay
- Department of Anesthesiology, Bezmialem Vakıf University, Istanbul, Turkey
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96
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Öner Cengiz H, Uçar S, Yilmaz M. The Role of Perioperative Hypothermia in the Development of Surgical Site Infection: A Systematic Review. AORN J 2021; 113:265-275. [PMID: 33646586 DOI: 10.1002/aorn.13327] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/22/2020] [Accepted: 05/13/2020] [Indexed: 11/08/2022]
Abstract
Surgical patients may experience inadvertent perioperative hypothermia, a condition that can cause a variety of complications, including surgical site infection (SSI). The authors of this systematic review used the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines to examine the role of perioperative hypothermia in the development of SSI. The authors searched the PubMed, Cumulative Index Nursing and Allied Health Literature, Cochrane, and ScienceDirect databases for eligible articles published between January 2008 and November 2018 and identified seven studies that met the inclusion criteria. The results of this review indicate that the relationship between hypothermia and SSI is closely related to the type of the surgical intervention performed (eg, emergent, colorectal), and that severe hypothermia (eg, <35.0° C [95.0° F]) can increase the risk of developing an SSI. Perioperative nurses should monitor patients for inadvertent hypothermia and prevent its occurrence when possible.
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97
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Kameda N. Clinical accuracy of non-contact forehead infrared thermometer and infrared tympanic thermometer in postoperative adult patients: A comparative study. J Perioper Pract 2021; 32:142-148. [PMID: 34292793 DOI: 10.1177/17504589211022314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Core temperature monitoring is important for the assessment and prevention of possible postoperative complications. The aim of the present study was to examine the agreement between the core temperature values and the forehead, tympanic membrane and axillary values in postoperative adult patients in clinical practice. The study measured the core temperature of 65 patients undergoing scheduled abdominal surgery using SpotOn™ and compared these with those obtained using non-contact forehead infrared, infrared tympanic and axillary thermometers. Correlation and Bland-Altman analyses were conducted for these comparisons. All temperatures were recorded at 4h intervals after postoperative arrival to the ward. Forehead temperature recordings showed a good correlation with the core temperature with excellent accuracy and was comparable to the tympanic temperature. Both forehead and tympanic thermometers can rapidly and effectively measure the core temperature during early postoperative period. Considering patients' safety, non-contact forehead infrared thermometers may be useful for postoperative monitoring.
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Affiliation(s)
- Norihiro Kameda
- Graduate school of Nursing Sciences, St. Luke's International University, Tokyo, Japan
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98
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Perioperative Hypothermia in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147541. [PMID: 34299991 PMCID: PMC8308095 DOI: 10.3390/ijerph18147541] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/15/2022]
Abstract
Background: First described by paediatric anaesthesiologists, perioperative hypothermia is one of the earliest reported side effects of general anaesthesia. Deviations from normothermia are associated with numerous complications and adverse outcomes, with infants and small children at the highest risk. Nowadays, maintenance of normothermia is an important quality metric in paediatric anaesthesia. Methods: This review is based on our collection of publications regarding perioperative hypothermia and was supplemented with pertinent publications from a MEDLINE literature search. Results: We provide an overview on perioperative hypothermia in the paediatric patient, including definition, history, incidence, development, monitoring, risk factors, and adverse events, and provide management recommendations for its prevention. We also summarize the side effects and complications of perioperative temperature management. Conclusions: Perioperative hypothermia is still common in paediatric patients and may be attributed to their vulnerable physiology, but also may result from insufficient perioperative warming. An effective perioperative warming strategy incorporates the maintenance of normothermia during transportation, active warming before induction of anaesthesia, active warming during anaesthesia and surgery, and accurate measurement of core temperature. Perioperative temperature management must also prevent hyperthermia in children.
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99
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Munday J, Higgins N, Jones L, Vagenas D, Van Zundert A, Keogh S. Zero-Heat-Flux and Esophageal Temperature Monitoring in Orthopedic Surgery: An Observational Study. J Multidiscip Healthc 2021; 14:1819-1827. [PMID: 34285500 PMCID: PMC8286425 DOI: 10.2147/jmdh.s313310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/14/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Perioperative hypothermia prevention requires regular, accurate, and consistent temperature monitoring. Zero-heat-flux (ZHF) thermometry offers a non-invasive, measurement method that can be applied across all surgical phases. The purpose of this study was to measure agreement between the zero-heat-flux device and esophageal monitoring, sensitivity, and specificity to detect hypothermia and patient acceptability amongst patients undergoing upper and lower limb orthopedic surgery. Patients and Methods This prospective, observational study utilized Bland–Altman analysis and Lin’s concordance coefficient to measure agreement between devices, sensitivity and specificity to detect hypothermia and assessed patient acceptability amongst 30 patients between December 2018 and June 2019. Results Bias was observed between devices via Bland Altman, with bias dependent on actual temperature. The mean difference ranged from −0.16°C at 34.9°C (where the mean of ZHF was lower than the esophageal device) to 0.46°C at 37.25°C (where the mean of ZHF was higher than esophageal device), with 95% limits of agreement (max) upper LOA = 0.80 to 1.41, lower LOA = −1.12 to −0.50. Seventy-five percentage of zero-heat-flux measurements were within 0.5°C of esophageal readings. Patient acceptability was high; 96% (n=27) stated that the device was comfortable. Conclusion ZHF device achieved lesser measurement accuracy with core (esophageal) temperature compared to earlier findings. Nonetheless, due to continuous capability, non-invasiveness and patient reported acceptability, the device warrants further evaluation. Title Registration The study was registered at www.ANZCTR.org.au (reference: ACTRN12619000842167).
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Affiliation(s)
- Judy Munday
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Department of Health and Nursing Science, Faculty of Health and Sports Sciences, University of Agder, Grimstad, Norway
| | - Niall Higgins
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Lee Jones
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Research Methods Group, Institute of Health and Biomedical Innovation (IHBI), Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Dimitrios Vagenas
- Research Methods Group, Institute of Health and Biomedical Innovation (IHBI), Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - André Van Zundert
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia & Queensland University of Technology, Brisbane, QLD, Australia
| | - Samantha Keogh
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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Cruz FAFD, Falcão LFDR, Amaral JLGD, Silva HCAD. Evaluation of dexmedetomidine anesthesia-related temperature changes: preliminary retrospective observational study. Braz J Anesthesiol 2021; 72:232-240. [PMID: 34214520 PMCID: PMC9373578 DOI: 10.1016/j.bjane.2021.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 02/15/2021] [Accepted: 02/27/2021] [Indexed: 10/30/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Dexmedetomidine is a potent adrenergic alpha-2 agonist, and analgesic, sedative, anxiolytic and sympatholytic. Given there have been reports of dexmedetomidine associated temperature changes, in which these events have been associated with complications, our objective was to describe both temperature increase and decrease, during the intra and postoperative period (initial 24 hours), and factors associated, in patients who received dexmedetomidine for anesthesia/sedation in the surgical suite. METHOD Retrospective observational study, analyzing charts of patients ≥ 18 years submitted to anesthesia/sedation with dexmedetomidine, between 1/1/2017 and 31/12/2017. Upper temperature threshold was considered ≥ 37.8 °C, and lower, < 35 °C. The association with dexmedetomidine was assessed by the OMS/UMC causality system and by the Naranjo algorithm. RESULTS The sample included 42 patients who received dexmedetomidine and whose temperature data were available, with predominance of men 26 (62%), 49.4/16.5 years old (mean/standard deviation), and weight 65/35.8 kg. None of the patients presented intraoperative temperature equal to or above 37.8 °C or below 35 °C. During the postoperative period, one patient presented an increase ≥ 37.8 °C (2.4%) and three, temperature decrease < 35 °C (7%). Surgery/anesthesia time and exposure time to dexmedetomidine were not appropriate linear predictors of maximum temperature. Older age (p < 0.01), longer exposure to dexmedetomidine (p < 0.05) and shorter surgery time (p < 0.01) were significant linear predictors for lower minimum temperature. CONCLUSIONS Increase ≥ 37.8 °C/decrease < 35 °C of temperature possibly associated with dexmedetomidine did not occur in the intraoperative period and had a low frequency during the postoperative period.
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Affiliation(s)
- Felipe Aparecido Ferreira da Cruz
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brazil
| | - Luiz Fernando Dos Reis Falcão
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brazil
| | - José Luiz Gomes do Amaral
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brazil
| | - Helga Cristina Almeida da Silva
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brazil.
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