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Stahl K, Schuette E, Schirmer P, Fuge J, Weber AL, Heidrich B, Schneider A, Pape T, Krauss T, Wedemeyer H, Lenzen H. Prevention of peri-interventional hypothermia during endoscopic retrograde cholangiopancreatography using a forced-air heating system. Endosc Int Open 2024; 12:E59-E67. [PMID: 38193008 PMCID: PMC10774017 DOI: 10.1055/a-2210-4799] [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: 08/12/2023] [Accepted: 10/27/2023] [Indexed: 01/10/2024] Open
Abstract
Background and study aims Perioperative hypothermia is associated with significant complications and can be prevented with forced-air heating systems (FAHS). Whether hypothermia occurs during prolonged endoscopic sedation is unclear and prevention measures are not addressed in endoscopic sedation guidelines. We hypothesized that hypothermia also occurs in a significant proportion of patients undergoing endoscopic interventions associated with longer sedation times such as endoscopic retrograde cholangiopancreaticography (ERCP), and that FAHS may prevent it. Patients and methods In this observational study, each patient received two consecutive ERCPs, the first ERCP following current standard of care without FAHS (SOC group) and a consecutive ERCP with FAHS (FAHS group). The primary endpoint was maximum body temperature difference during sedation. Results Twenty-four patients were included. Median (interquartile range) maximum body temperature difference was -0.9°C (-1.2; -0.4) in the SOC and -0.1°C (-0.2; 0) in the FAHS group ( P < 0.001). Median body temperature was lower in the SOC compared with the FAHS group after 20, 30, 40, and 50 minutes of sedation. A reduction in body temperature of > 1°C ( P < 0.001) and a reduction below 36°C ( P = 0.01) occurred more often in the SOC than in the FAHS group. FAHS was independently associated with reduced risk of hypothermia ( P = 0.006). More patients experienced freezing in the SOC group ( P = 0.004). Hemodynmaic and respiratory stability were comparable in both groups. Conclusions Hypothermia occurred in the majority of patients undergoing prolonged endoscopic sedation without active temperature control. FAHS was associated with higher temperature stability during sedation and better patient comfort.
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Affiliation(s)
- Klaus Stahl
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Eloise Schuette
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Paul Schirmer
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Anna-Lena Weber
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Benjamin Heidrich
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Andrea Schneider
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Thorben Pape
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Terence Krauss
- Department of Anaesthesiology, Hannover Medical School, Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Henrike Lenzen
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
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Chataule SM, Hazarika A, jain K, Chauhan R, Luthra A, Meena S, Aggarwal S, Sethi S. Preoperative Forced-Air Warming Strategy: Is It Effective in Averting Intraoperative Hypothermia in Elderly Trauma Surgical Patients? Cureus 2022; 14:e29305. [DOI: 10.7759/cureus.29305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/05/2022] Open
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Abstract
Abstract
Purpose of Review
This review summarizes the key issues for preoperative, peri- and intraoperative, and postoperative patient management for robotic-assisted thoracic surgery (RATS). It provides practical guidance for anesthesiologists and thoracic surgeons starting a RATS program.
Recent Findings
RATS is a new technological approach to execute minimal invasive chest operations. In management of RATS patients, the established ERAS principles for video-assisted thoracoscopic surgery (VATS) apply. In addition, RATS imposes additional conditions on anesthesiologists, nurses, and surgeons alike: The spatial constriction in operation theaters caused by the large robotic equipment longs for a reallocation of the anesthetist’s and surgeon’s working environment that may vary additionally depending on the type of surgery performed in the individual patient. Additionally, the implementation of a positive pressure carbon dioxide gas cavity in the pleura has a direct effect on patient cardio-circulatory and respiratory mechanics that have to be balanced by the anesthesiologist.
Summary
RATS advances by replacing open surgery approaches and will complement—but most likely not replace—video-assisted thoracoscopic surgery (VATS). RATS brings new specific intraoperative requirements to the anesthesiological and surgical team members that have to be implemented into clinical routine.
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Yoo JH, Ok SY, Kim SH, Chung JW, Park SY, Kim MG, Cho HB, Song SH, Cho CY, Oh HC. Efficacy of active forced air warming during induction of anesthesia to prevent inadvertent perioperative hypothermia in intraoperative warming patients: Comparison with passive warming, a randomized controlled trial. Medicine (Baltimore) 2021; 100:e25235. [PMID: 33761716 PMCID: PMC9281959 DOI: 10.1097/md.0000000000025235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/26/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the efficacy of peri-induction forced air warming to prevent inadvertent perioperative hypothermia, defined as a reduction in body temperature to <36.0°C during the perioperative period, in intraoperatively warmed patients receiving major surgery lasting >120 minutes. METHODS In total, 130 patients scheduled for elective surgery under general anesthesia lasting >120 minutes were divided into 2 groups: peri-induction warming (n = 65) and control (n = 65). Patients in the peri-induction warming group were warmed during the anesthetic induction period using a forced-air warmer set at 47°C, whereas patients in the control group were covered passively with a cotton blanket. All patients were warmed with a forced-air warmer during surgery. Body temperature was measured using a tympanic membrane thermometer in the pre- and postoperative periods and using a nasopharyngeal temperature probe during surgery. Patients were evaluated for shivering scale score, thermal comfort scale score, and satisfaction score in the post-anesthesia care unit. RESULTS The incidence rates of intraoperative and postoperative hypothermia were lower in the peri-induction warming group than in the control group (19.0% vs 57.1%, P < .001; 3.3% vs 16.9%, P = .013, respectively). Body temperature was higher in the peri-induction warming group (P < .001). However, intraoperative blood loss, as well as postoperative thermal comfort scale score, shivering scale score, and patient satisfaction score, were similar between groups. Post-anesthesia care unit duration was also similar between groups. CONCLUSIONS Peri-induction active forced air warming is an effective, simple, and convenient method to prevent inadvertent perioperative hypothermia in intraoperatively warmed patients undergoing major surgery lasting >120 minutes.
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Affiliation(s)
- Jae Hwa Yoo
- Department of Anesthesiology and Pain Medicine
| | - Si Young Ok
- Department of Anesthesiology and Pain Medicine
| | - Sang Ho Kim
- Department of Anesthesiology and Pain Medicine
| | | | | | - Mun Gyu Kim
- Department of Anesthesiology and Pain Medicine
| | - Ho Bum Cho
- Department of Anesthesiology and Pain Medicine
| | | | | | - Hong Chul Oh
- Department of Cardiovascular and thoracic surgery, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
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Yoo JH, Ok SY, Kim SH, Chung JW, Park SY, Kim MG, Cho HB, You GW. Effects of 10-min of pre-warming on inadvertent perioperative hypothermia in intraoperative warming patients: a randomized controlled trial. Anesth Pain Med (Seoul) 2020; 15:356-364. [PMID: 33329836 PMCID: PMC7713844 DOI: 10.17085/apm.20027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/21/2020] [Accepted: 06/02/2020] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to evaluate the efficacy of 10-min pre-warming in preventing inadvertent perioperative hypothermia, which is defined as a reduction in body temperature to less than 36.0℃ during the perioperative period in intraoperative warming patients. Methods In this prospective randomized study, 60 patients scheduled for elective surgery under general anesthesia lasting less than 120 min were divided into two groups: the 10-min pre-warming group (n = 30) and the control group (n = 30). Patients in the 10-min pre-warming group were pre-warmed for 10 min in the pre-anesthetic area using a forced-air warmer set at 47ºC. Intraoperatively, we warmed all patients with a forced-air warmer. Body temperature was measured using a tympanic membrane thermometer pre- or postoperatively and a nasopharyngeal temperature probe intraoperatively. Patients were evaluated on the shivering and thermal comfort scale in the pre-anesthetic area and post-anesthesia care unit. Results The incidences of intraoperative hypothermia and postoperative hypothermia were similar in both groups (10.7% vs. 28.6%, P = 0.177; 10.7% vs. 10.7%, P = 1.000 respectively). Body temperature was higher in the 10-min pre-warming group (P = 0.003). Thermal comfort during the pre-warming period was higher in the 10-min pre-warming group (P < 0.001). However, postoperative thermal comfort and shivering grades of both groups were similar. Conclusions Ten minutes of pre-warming has no additional effect on the prevention of inadvertent perioperative hypothermia in intraoperative warming patients.
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Affiliation(s)
- Jae Hwa Yoo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Si Young Ok
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sang Ho Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Ji Won Chung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sun Young Park
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Mun Gyu Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Ho Bum Cho
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Gyu Wan You
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Groene P, Zeuzem C, Baasner S, Hofmann-Kiefer K. The influence of body mass index on temperature management during general anaesthesia-A prospective observational study. J Eval Clin Pract 2019; 25:340-345. [PMID: 30450648 DOI: 10.1111/jep.13064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/16/2018] [Accepted: 10/11/2018] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES During general anaesthesia, body core temperature is influenced by several factors that are either anaesthesia-related (type and duration of anaesthesia and fluid management), surgery-related (type of surgery and extent of the surgical procedure), or patient-related (age, gender, body weight, and preoperative body core temperature). Interestingly, data concerning body mass index (BMI) and its influence on patients' temperature are sparse. The aim of this study was to evaluate the impact of BMI on body core temperature under general anaesthesia. METHODS A single centre, prospective, observational study was conducted at a university hospital. Two cohorts (lower limb surgery and abdominal surgery) were evaluated. Patients were treated according to actual German guidelines for the prevention of hypothermia. Temperature was measured sublingually prior to anaesthesia and during the first 60 minutes of anaesthesia. Each cohort was divided in three subgroups (BMI < 24 kg m-2 , BMI 25-34.9 kg m-2 , and BMI > 35 kg m-2 ) according to body weight. RESULTS A total of 206 patients were evaluated. One hundred four underwent lower limb surgery; 102 underwent abdominal surgery. After induction of anaesthesia, temperature dropped in all subgroups, but this decline was more pronounced in patients with lower BMI. Significant differences concerning temperature changes were observed in abdominal surgery between low and high BMI groups. After 60 minutes of anaesthesia, group-dependent temperature differences had levelled out, and relevant differences compared with preoperative temperatures could no longer be observed in any of the groups. CONCLUSION Current guidelines provide effective protection against perioperative hypothermia. In the current study, this was true for obese as well as normal weight patients.
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Affiliation(s)
- Philipp Groene
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Catharina Zeuzem
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Sandra Baasner
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
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Yoo JH, Ok SY, Kim SH, Park SY, Han YM, Kim D. The effect of 10 minutes of prewarming for prevention of inadvertent perioperative hypothermia: comparison with 30 minutes of prewarming. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.4.447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jae Hwa Yoo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Si Young Ok
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sang Ho Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sun Young Park
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yoo-mi Han
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Doyeon Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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