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Brandes IF, Tirilomis T, Nemeth M, Wieditz J, Bräuer A. Intraoperative zero-heat-flux thermometry overestimates nasopharyngeal temperature by 0.39 °C: an observational study in patients undergoing congenital heart surgery. J Clin Monit Comput 2024:10.1007/s10877-024-01204-8. [PMID: 39127818 DOI: 10.1007/s10877-024-01204-8] [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: 04/03/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024]
Abstract
During surgery for congenital heart disease (CHD) temperature management is crucial. Vesical (Tves) and nasopharyngeal (TNPH) temperature are usually measured. Whereas Tves slowly responds to temperature changes, TNPH carries the risk of bleeding. The zero-heat-flux (ZHF) temperature monitoring systems SpotOn™ (TSpotOn), and Tcore™ (Tcore) measure temperature non-invasively. We evaluated accuracy and precision of the non-invasive devices, and of Tves compared to TNPH for estimating temperature. In this prospective observational study in pediatric and adult patients accuracy and precision of TSpotOn, Tcore, and Tves were analyzed using the Bland-Altman method. Proportion of differences (PoD) and Lin´s concordance correlation coefficient (LCC) were calculated. Data of 47 patients resulted in sets of matched measurements: 1073 for TSpotOn vs. TNPH, 874 for Tcore vs. TNPH, and 1102 for Tves vs. TNPH. Accuracy was - 0.39 °C for TSpotOn, -0.09 °C for Tcore, and 0.07 °C for Tves. Precisison was between - 1.12 and 0.35 °C for TSpotOn, -0.88 to 0.71 °C for Tcore, and - 1.90 to 2.05 °C for Tves. PoD ≤ 0.5 °C were 71% for TSpotOn, 71% for Tcore, and 60% for Tves. LCC was 0.9455 for TSpotOn, 0.9510 for Tcore, and 0.9322 for Tves. Temperatures below 25.2 °C (TSpotOn) or 27.1 (Tcore) could not be recorded non-invasively, but only with Tves. Trial registration German Clinical Trials Register, DRKS00010720.
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Affiliation(s)
- Ivo F Brandes
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Theodor Tirilomis
- Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Marcus Nemeth
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Johannes Wieditz
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Anselm Bräuer
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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2
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Qiu Q, Yang Z, Zhang Y, Zeng W, Yang K, Liang C, Alifu A, Huang H, Chen J, Zhang M, Wu D, Guo X, Jin S, Lin Y, Chuo J, Zhang H, Song X, Iyer RS. Reducing postoperative hypothermia in infants: Quality improvement in China. Paediatr Anaesth 2024; 34:773-782. [PMID: 38775778 DOI: 10.1111/pan.14910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Unintended postoperative hypothermia in infants is associated with increased mortality and morbidity. We noted consistent hypothermia postoperatively in more than 60% of our neonatal intensive care (NICU) babies. Therefore, we set out to determine whether a targeted quality improvement (QI) project could decrease postoperative hypothermia rates in infants. OBJECTIVES Our SMART aim was to reduce postoperative hypothermia (<36.5°C) in infants from 60% to 40% within 6 months. METHODS This project was approved by IRB at Guangzhou Women and Children's Medical Center, China. The QI team included multidisciplinary healthcare providers in China and QI experts from Children's Hospital of Philadelphia, USA. The plan-do-study-act (PDSA) cycles included establishing a perioperative-thermoregulation protocol, optimizing the transfer process, and staff education. The primary outcome and balancing measures were, respectively, postoperative hypothermia and hyperthermia (axillary temperature < 36.5°C, >37.5°C). Data collected was analyzed using control charts. The factors associated with a reduction in hypothermia were explored using regression analysis. RESULTS There were 295 infants in the project. The percentage of postoperative hypothermia decreased from 60% to 37% over 26 weeks, a special cause variation below the mean on the statistical process control chart. Reduction in hypothermia was associated with an odds of 0.17 (95% CI: 0.06-0.46; p <.001) for compliance with the transport incubator and 0.24 (95% CI: 0.1-0.58; p =.002) for prewarming the OR ambient temperature to 26°C. Two infants had hyperthermia. CONCLUSIONS Our QI project reduced postoperative hypothermia without incurring hyperthermia through multidisciplinary team collaboration with the guidance of QI experts from the USA.
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Affiliation(s)
- Qianqi Qiu
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zixin Yang
- Department of Neonatology, Beijing Children's Hospital, Beijing, China
| | - Yong Zhang
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wen Zeng
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, Chengdu, China
| | - Kuiyan Yang
- Department of Neonatal Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Cuiping Liang
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ailixiati Alifu
- Department of Cardiothoracic Surgery, Hainan Women and Children's Medical Center, Hainan, China
| | - Haibo Huang
- Department of Neonatology, The University of Hong Kong-Shenzhen hospital, Shenzhen, China
| | - Jun Chen
- Department of Neonatology, Foshan Women and Children's hospital, Guangdong, China
| | - Meixue Zhang
- Department of Operating Theatre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Dongmei Wu
- Department of Surgical Neonatal Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaoping Guo
- Department of Neonatal Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Saifen Jin
- Department of Operating Theatre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yuzhen Lin
- Department of Operating Theatre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - John Chuo
- Department of Neonatology, Children's Hospital of Philadelphia, Pennsylvania, USA
| | - Huayan Zhang
- Department of Neonatology, Children's Hospital of Philadelphia, Pennsylvania, USA
- Department of Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xingrong Song
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Rajeev S Iyer
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Pennsylvania, USA
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Jiang Y, Zhou ZF, Shao RZ, Qiu XF, Li XY, Zhou CC. Perioperative Hypothermia in Elderly Patients During Pelvic Floor Reconstruction Surgery: An Observational Study. Int Urogynecol J 2024; 35:1163-1170. [PMID: 38695902 DOI: 10.1007/s00192-024-05781-9] [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: 11/07/2023] [Accepted: 03/19/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The potential predictors of pelvic floor reconstruction surgery hypothermia remain unclear. This prospective cohort study was aimed at identifying these predictors and evaluating the outcomes associated with perioperative hypothermia. METHODS Elderly patients undergoing pelvic floor reconstruction surgery were consecutively enrolled from April 2023 to September 2023. Perioperative temperature was measured at preoperative (T1), every 15 min after the start of anesthesia (T2), and 15 min postoperative (T3) using a temperature probe. Perioperative hypothermia was defined as a core temperature below 36°C at any point during the procedure. Multivariate logistic regression analysis was conducted to determine factors associated with perioperative hypothermia. RESULTS A total of 229 patients were included in the study, with 50.7% experiencing hypothermia. Multivariate analysis revealed that the surgical method involving pelvic floor combined with laparoscopy, preoperative temperature < 36.5°C, anesthesia duration ≥ 120 min, and the high levels of anxiety were significantly associated with perioperative hypothermia. The predictive value of the multivariate model was 0.767 (95% CI, 0.706 to 0.828). CONCLUSIONS This observational prospective study identified several predictive factors for perioperative hypothermia in elderly patients during pelvic floor reconstruction surgery. Strategies aimed at preventing perioperative hypothermia should target these factors. Further studies are required to assess the effectiveness of these strategies, specifically in elderly patients undergoing pelvic floor reconstruction surgery.
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Affiliation(s)
- Yang Jiang
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, 310008, China
| | - Zhen-Feng Zhou
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, 310008, China
| | - Ri-Zhi Shao
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, 310008, China
| | - Xiao-Fei Qiu
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, 310008, China
| | - Xiao-Yan Li
- Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, 310008, China
| | - Chun-Cong Zhou
- Department of Urolithiasis and Anorectal Surgery, Ningbo No. 2 Hospital, 41 Xibei Street, Ningbo, 315010, Zhejiang Province, China.
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Woretaw AW, Yimer Mekonnen B, Tsegaye N, Dellie E. Knowledge and practice of nurses with respect to perioperative hypothermia prevention in the Northwest Amhara Regional State Referral Hospitals, Ethiopia: a cross-sectional study. BMJ Open 2023; 13:e068131. [PMID: 38097235 PMCID: PMC10729143 DOI: 10.1136/bmjopen-2022-068131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES It has been reported that maintaining a normal body temperature among surgical patients can reduce the length of hospitalisation by up to 40%, decrease the risk of surgical site infection by 64% and reduce mortality by fourfold. Nurses are primarily responsible for preventing the occurrence of hypothermia among surgical patients. This study assessed nurses' knowledge and practices with respect to perioperative hypothermia prevention in Northwest Ethiopia, and investigated the factors associated with good knowledge and practice. DESIGN Cross-sectional study. SETTING Northwest Amhara Regional State Referral Hospitals, Northwest Ethiopia, 25 March-20 May 2021. PARTICIPANTS 413 nurses working in the perioperative units of five referral hospitals. OUTCOME MEASURES Perioperative hypothermia prevention knowledge and practice among nurses. RESULTS Nearly three-fifths (59.1%; 95% CI: 54.7% to 63.7%) of respondents had good knowledge and about half (50.4%; 95% CI: 45.5% to 55.0%) had good practice with respect to perioperative hypothermia prevention. Factors associated with nurses' knowledge of prevention of perioperative hypothermia included male sex (adjusted OR (AOR): 1.61, 95% CI: 1.02 to 2.53), having a bachelor's degree (AOR: 2.50, 95% CI: 1.25 to 5.00), having a master's degree (AOR: 4.39, 95% CI: 1.45 to 13.20) and training participation (AOR: 3.68, 95% CI: 2.14 to 6.33). Factors associated with nurses' practice of prevention of perioperative hypothermia included working in recovery (AOR: 2.87, 95% CI: 1.08 to 7.58) and intensive care units (AOR: 2.39, 95% CI: 1.09 to 5.22), training participation (AOR: 2.64, 95% CI: 1.53 to 4.57), being satisfied with their job (AOR: 2.15, 95% CI: 1.34 to 3.43) and having good knowledge (AOR: 2.64, 95% CI: 1.63 to 4.27). CONCLUSION Nurses' knowledge and practice of the prevention of perioperative hypothermia were inadequate. Hospital managers need to design and strengthen training programmes and work to enhance job satisfaction.
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Affiliation(s)
- Ashenafi Worku Woretaw
- Department of Surgical Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bezenaw Yimer Mekonnen
- Department of Emergency and Critical Care Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Netsanet Tsegaye
- Department of Emergency and Critical Care Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Endalkachew Dellie
- Departmeny of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Facchin F, Pagani A, Perozzo FAG, Scarpa C, Bassetto F, Vindigni V. Litigation Cases After Post-Bariatric Surgery: Lesson from the Past. Aesthetic Plast Surg 2023; 47:2479-2485. [PMID: 36820862 PMCID: PMC10784373 DOI: 10.1007/s00266-023-03287-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/29/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Due to the high demand of post-bariatric surgeries, the number of litigation cases is rapidly growing. Even if surgical mistakes still represent one of the main causes of medico-legal issues, many disputes depend on what happens in the post-operative course. In this article we analyzed the litigation cases that occurred in our Plastic Surgery Department, the current literature about medico-legal disputes and the importance of the doctor-patient relationship. PATIENTS AND METHODS The medical records of 788 post-bariatric surgeries, the post-operative complications and the related litigation cases from January 2015 to December 2019 were collected, analyzed and compared. RESULTS We performed 380 abdominoplasties, 28 torsoplasties, 65 breast reductions, 99 mastopexies, 94 brachioplasties, 52 thighplasties, 65 liposuctions and 5 facelifts between 2015 and 2019. Eight patients complained of medical issues and claimed for litigation. Despite in all cases the judges highlighted the risk of consent misinterpretation, the payout was granted only in one case. CONCLUSION Post-bariatric patients often mistake their preoperative condition and consider body contouring procedures as an aesthetic surgery treatment. Patients should be therefore clearly informed about the complexity of body contouring procedures after massive weight loss, which should never be compared to aesthetic surgery. Surgeons should always promote the communication with their patients and build a strong and trustworthy relationship. This attitude will allow to deal more easily with complications and, in the worst situations, with medico-legal litigations. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Federico Facchin
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
- Plastic Surgery Unit, San Bortolo Hospital, 36100, Vicenza, Italy.
| | - Andrea Pagani
- Clinic and Polyclinic of Plastic and Hand Surgery, Technical University of Munich, 81675, Munich, Germany
| | - Filippo Andrea Giovanni Perozzo
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Carlotta Scarpa
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Franco Bassetto
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Vincenzo Vindigni
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
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Ceresoli M, Braga M, Zanini N, Abu-Zidan FM, Parini D, Langer T, Sartelli M, Damaskos D, Biffl WL, Amico F, Ansaloni L, Balogh ZJ, Bonavina L, Civil I, Cicuttin E, Chirica M, Cui Y, De Simone B, Di Carlo I, Fette A, Foti G, Fogliata M, Fraga GP, Fugazzola P, Galante JM, Beka SG, Hecker A, Jeekel J, Kirkpatrick AW, Koike K, Leppäniemi A, Marzi I, Moore EE, Picetti E, Pikoulis E, Pisano M, Podda M, Sakakushev BE, Shelat VG, Tan E, Tebala GD, Velmahos G, Weber DG, Agnoletti V, Kluger Y, Baiocchi G, Catena F, Coccolini F. Enhanced perioperative care in emergency general surgery: the WSES position paper. World J Emerg Surg 2023; 18:47. [PMID: 37803362 PMCID: PMC10559594 DOI: 10.1186/s13017-023-00519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023] Open
Abstract
Enhanced perioperative care protocols become the standard of care in elective surgery with a significant improvement in patients' outcome. The key element of the enhanced perioperative care protocol is the multimodal and interdisciplinary approach targeted to the patient, focused on a holistic approach to reduce surgical stress and improve perioperative recovery. Enhanced perioperative care in emergency general surgery is still a debated topic with little evidence available. The present position paper illustrates the existing evidence about perioperative care in emergency surgery patients with a focus on each perioperative intervention in the preoperative, intraoperative and postoperative phase. For each item was proposed and approved a statement by the WSES collaborative group.
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Affiliation(s)
- Marco Ceresoli
- School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy.
- General and Emergency Surgery Department, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, Italy.
| | - Marco Braga
- School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- General and Emergency Surgery Department, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, Italy
| | - Nicola Zanini
- General Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Dario Parini
- General Surgery Department - Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Thomas Langer
- School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- Department of Anesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Dimitrios Damaskos
- Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Francesco Amico
- John Hunter Hospital Trauma Service and School of Medicine and Public Health, The University of Newcastle, Newcastle, AU, Australia
| | - Luca Ansaloni
- General Surgery, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Luigi Bonavina
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Ian Civil
- University of Auckland, Auckland, New Zealand
| | | | - Mircea Chirica
- Department of Digestive Surgery, CHU Grenoble Alpes, Grenoble, France
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Belinda De Simone
- Unit of Emergency and Trauma Surgery, Villeneuve St Georges Academic Hospital, Villeneuve St Georges, France
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | | | - Giuseppe Foti
- School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- Department of Critical Care and Anesthesia, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Michele Fogliata
- School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- General and Emergency Surgery Department, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, Italy
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences (FCM), University of Campinas (Unicamp), Campinas, Brazil
| | | | | | | | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Gießen, Germany
| | | | - Andrew W Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada
| | - Kaoru Koike
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ari Leppäniemi
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Andrei Litvin, CEO AI Medica Hospital Center, Kaliningrad, Russia
| | - Ingo Marzi
- Department of Trauma, Hand, and Reconstructive Surgery, Goethe University, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Ernest E Moore
- Director of Surgery Research, Ernest E. Moore Shock Trauma Center, Distinguished Professor of Surgery, University of Colorado, Denver, CO, USA
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Emmanouil Pikoulis
- Third Department of Surgery, Attikon University Hospital, Athene, Greece
| | - Michele Pisano
- General Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | | | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Edward Tan
- Former Chair Department of Emergency Medicine, HEMS Physician, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Giovanni D Tebala
- Digestive and Emergency Surgery Department, Azienda Ospedaliera S.Maria, Terni, Italy
| | - George Velmahos
- Harvard Medical School - Massachusetts General Hospital, Boston, USA
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, Head of Service and Director of Trauma, Royal Perth Hospital, The University of Western Australia, Perth, Australia
| | - Vanni Agnoletti
- Anesthesia and Critical Care Department, Bufalini Hospital, Cesena, Italy
| | - Yoram Kluger
- Department of General Surgery, The Rambam Academic Hospital, Haifa, Israel
| | - Gianluca Baiocchi
- General Surgery, University of Brescia, ASST Cremona, Cremona, Italy
| | - Fausto Catena
- General Surgery Department, Bufalini Hospital, Cesena, Italy
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7
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Huang J, Qi H, Lv K, Zhu Y, Wang Y, Jin L. Development and Psychometric Properties of a Scale Measuring Barriers to Perioperative Hypothermia Prevention for Anesthesiologists and Nurses. J Perianesth Nurs 2023; 38:703-709. [PMID: 37227366 DOI: 10.1016/j.jopan.2022.11.004] [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: 05/26/2022] [Revised: 09/27/2022] [Accepted: 11/06/2022] [Indexed: 05/26/2023]
Abstract
PURPOSE To develop a scale that measures barriers to perioperative hypothermia prevention (BPHP) as perceived by anesthesiologists and nurses. DESIGN A methodological and prospective psychometric study. METHODS Based on the theoretical domains framework, the item pool was created through a literature review, qualitative interviews, and expert consultation. The scale was pretested with a sample of 154 key stakeholders in perioperative temperature management and then field tested with 416 anesthesiologists and nurses working at three hospitals in Southeast China. Item analysis, and reliability and validity analysis were performed. FINDINGS The average content validity index was 0.94. According to exploratory factor analysis, seven factors were obtained that could explain 70.283% of the total variance. Confirmatory factor analysis showed excellent or acceptable goodness-of-fit indices. The reliability analysis demonstrated that the scale had high internal consistency and temporal stability, with Cronbach's α, split-half coefficient and test-retest values of 0.926, 0.878 and 0.835, respectively. CONCLUSIONS The BPHP scale meets the psychometric criteria for reliability and validity and promises to be a useful quality measure for IPH management during the perioperative period. Further investigations on educational or resource needs and the development of an optimal perioperative hypothermia prevention protocol to narrow the gap between research evidence and clinical practice should be performed.
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Affiliation(s)
- Jingying Huang
- Postanesthesia Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haiou Qi
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Kai Lv
- Postanesthesia Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiting Zhu
- Postanesthesia Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuting Wang
- Department of Anesthesiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ling Jin
- Operating Room, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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8
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Güven B, İbrahimoğlu Ö, Kuş İ. Inadvertent Perioperative Hypothermia in Ambulatory Surgery Patients: Incidence, Risk Factors, and Prevention Initiatives. J Perianesth Nurs 2023; 38:792-798. [PMID: 37269277 DOI: 10.1016/j.jopan.2023.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Although the number and complexity of ambulatory surgical interventions has grown considerably over the years, it has not been fully established whether hypothermia still poses a risk for these interventions. In this study, we aimed to determine the incidence, risk factors, and methods applied to prevent perioperative hypothermia in ambulatory surgery patients. DESIGN A descriptive research design was used. METHODS The study was conducted with 175 patients between May 2021 and March 2022 in the outpatient units of a training and research hospital in Mersin, Turkey. Data were collected using the Patient Information and Follow-up Form. FINDINGS The incidence of perioperative hypothermia was 20% in ambulatory surgery patients. Hypothermia developed in 13.7% of the patients at the 0th minute at the PACU, and 96.6% of the patients were not warmed intraoperatively. We noted a statistically significant relationship between perioperative hypothermia and advanced age (≥60 years), high American Society of Anesthesiologists' (ASA) class, and low hematocrit values. In addition, we determined that the female gender, presence of chronic diseases, general anesthesia, and a long operation time were other risk factors for hypothermia in the perioperative period. CONCLUSIONS The incidence of hypothermia during ambulatory surgeries is lower than that in inpatient surgeries. The warming rate of ambulatory surgery patients, which is quite low, can be improved by increasing the awareness of the perioperative team and following the guidelines.
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Affiliation(s)
- Betül Güven
- Faculty of Health Sciences-Nursing, Bezmialem Vakıf University, Istanbul, Turkey.
| | - Özlem İbrahimoğlu
- Faculty of Health Science-Nursing, Istanbul Medeniyet University, İstanbul, Turkey
| | - İlknur Kuş
- Mersin City Training and Research Hospital, Mersin, Turkey
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Silvasti-Lundell M, Makkonen O, Kivisaari R, Luostarinen T, Pesonen E, Mäkinen MT. Zero-heat-flux thermometry over the carotid artery in assessment of core temperature in craniotomy patients. J Clin Monit Comput 2023; 37:1153-1159. [PMID: 36879085 PMCID: PMC10520089 DOI: 10.1007/s10877-023-00984-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/08/2023] [Indexed: 03/08/2023]
Abstract
Zero-heat-flux core temperature measurements on the forehead (ZHF-forehead) show acceptable agreement with invasive core temperature measurements but are not always possible in general anesthesia. However, ZHF measurements over the carotid artery (ZHF-neck) have been shown reliable in cardiac surgery. We investigated these in non-cardiac surgery. In 99 craniotomy patients, we assessed agreement of ZHF-forehead and ZHF-neck (3M™ Bair Hugger™) with esophageal temperatures. We applied Bland-Altman analysis and calculated mean absolute differences (difference index) and proportion of differences within ± 0.5 °C (percentage index) during entire anesthesia and before and after esophageal temperature nadir. In Bland-Altman analysis [mean (limits of agreement)], agreement with esophageal temperature during entire anesthesia was 0.1 (-0.7 to +0.8) °C (ZHF-neck) and 0.0 (-0.8 to +0.8) °C (ZHF-forehead), and, after core temperature nadir, 0.1 (-0.5 to +0.7) °C and 0.1 (-0.6 to +0.8) °C, respectively. In difference index [median (interquartile range)], ZHF-neck and ZHF-forehead performed equally during entire anesthesia [ZHF-neck: 0.2 (0.1-0.3) °C vs ZHF-forehead: 0.2 (0.2-0.4) °C], and after core temperature nadir [0.2 (0.1-0.3) °C vs 0.2 (0.1-0.3) °C, respectively; all p > 0.017 after Bonferroni correction]. In percentage index [median (interquartile range)], both ZHF-neck [100 (92-100) %] and ZHF-forehead [100 (92-100) %] scored almost 100% after esophageal nadir. ZHF-neck measures core temperature as reliably as ZHF-forehead in non-cardiac surgery. ZHF-neck is an alternative to ZHF-forehead if the latter cannot be applied.
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Affiliation(s)
- Marja Silvasti-Lundell
- Anaesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
| | - Otto Makkonen
- Anaesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teemu Luostarinen
- Anaesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Eero Pesonen
- Anaesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Marja-Tellervo Mäkinen
- Anaesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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10
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Gao Y, Fan J, Zhao J, Hu Y. Risk factors for intraoperative hypothermia in infants during general anesthesia: A retrospective study. Medicine (Baltimore) 2023; 102:e34935. [PMID: 37653751 PMCID: PMC10470769 DOI: 10.1097/md.0000000000034935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/29/2023] [Accepted: 08/04/2023] [Indexed: 09/02/2023] Open
Abstract
This study aimed to determine the incidence and evaluate the risk factors and outcomes of intraoperative hypothermia (IH) during general anesthesia in infants. Retrospective analysis of prospectively collected data. A total of 754 infants younger than 1 year old who underwent surgery under general anesthesia were included. Intraoperative body temperature fluctuations, surgical and anesthetic data, postoperative complications, and infant outcomes were recorded. Logistic regression algorithms were used to evaluate potential risk factors. Among the 754 infants, 47.88% developed IH (<36 °C) and 15.4% of them experienced severe hypothermia (<35 °C). The average lowest temperature in hypothermia patients was 35.06 ± 0.69°C with a duration of 82.23 ± 50.59 minutes. Neonates tended to experience hypothermia (37.7% vs 7.6%, P < .001) and prematurity was more common in patients with IH (29.4% vs 16.8%, P < .001). Infants with hypothermia experienced a longer length of stay in the post anesthesia care units and intensive care units, postoperative hospitalizations, and tracheal extubation as well as a higher rate of postoperative hemorrhage than those with normothermia (all P < .05). Several factors were proved to be associated with an increased risk of IH after multivariate analysis: neonate (odds ratio [OR] = 3.685, 95% CI 1.839-7.382), weight (OR = 0.599, 95% CI 0.525-0.683), American society of anesthesiologists (OR = 3.418, 95% CI 2.259-5.170), fluid > 20 mL/kg (OR = 2.380, 95% CI 1.389-4.076), surgery time >60 minutes (OR = 1.785, 95% CI 1.030-3.093), and pre-warming (OR = 0.027, 95% CI 0.014-0.052). This retrospective study found that neonates, lower weight, longer surgery times, more fluid received, higher American society of anesthesiologists stage, and no pre-warming were all significant risk factors for IH during general anesthesia in infants.
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Affiliation(s)
- Yi Gao
- Department of Anesthesiology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Jiabin Fan
- Department of Anesthesiology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Jialian Zhao
- Department of Anesthesiology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Yaoqin Hu
- Department of Anesthesiology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
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11
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Qiao L, Wang Y, Liang Y, Xia T, Li L, Xiong W, Liu B, Feng Y, Liu Y, Jin X, Zhang J. Perioperative active warming strategies in children: a protocol for a multicentre, prospective, randomized controlled trial. Front Pediatr 2023; 11:1155666. [PMID: 37404557 PMCID: PMC10315579 DOI: 10.3389/fped.2023.1155666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/22/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction Inadvertent perioperative hypothermia (IPH) refers to a core body temperature lower than 36.0 °C, which can contribute to many adverse events. The special physiological characteristics in children further increase the incidence of IPH. Therefore, it is very important to perform effective perioperative warming measures for children. Traditional passive warming measures with additional layers have limited thermal insulation effects. Active warming measures might be the better choice, and most measures have achieved good effects in adults. This study combines a variety of active warming measures to propose perioperative active warming strategies and aims to verify the feasibility and thermal insulation effects of perioperative active warming strategies in children. Methods This study is a multicentre, prospective, randomized controlled trial. From August 2022 to July 2024, 400 paediatric patients undergoing elective surgery will be recruited in four centres and randomly divided into the active warming strategies group and control group at a ratio of 1:1. The primary outcome is the perioperative cumulative hypothermia effect value (Σ ΔTi × Δti, i = 1…, n). Multiple complications covering the anaesthesia recovery period and postoperative hospitalization will be considered as secondary outcomes to comprehensively analyse the prognosis. Trial registration ClinicalTrials.gov identifier: ChiCTR2200062168. Registered on July 26th, 2022. Registered with the name of "Perioperative Active Warming Strategies in Children: A multicenter, prospective, randomized controlled trial". URL:http://www.chictr.org.cn/showproj.aspx?proj=172778.
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Affiliation(s)
- Lanxin Qiao
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yaxin Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Liang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tian Xia
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ling Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Xiong
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bin Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yifan Feng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu Jin
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianmin Zhang
- Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, Beijing, China
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12
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Al-dardery NM, Abdelwahab OA, El-Samahy M, Seif AM, Mouffokes A, Khaity A. Self-warming blankets versus active warming by forced-air devices for preventing hypothermia: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33579. [PMID: 37145005 PMCID: PMC10158888 DOI: 10.1097/md.0000000000033579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/30/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Unintended perioperative hypothermia is a significant complication for patients undergoing anesthesia. Different measures are routinely undertaken to prevent hypothermia and its consequences. The evidence comparing the impact of self-warming blankets and forced-air warming is scarce. Therefore, this meta-analysis aimed to evaluate the efficacy of self-warming blankets compared to forced-air devices regarding the incidence of perioperative hypothermia. METHODS We searched the Web of Science, Cochrane Central Register of Controlled Trials, PubMed, and Scopus for relevant studies from inception until December 2022. We included comparative studies with patients allocated to undergo warming using a self-warming blanket or forced air warming. All concerned outcomes were pooled as odds ratios or mean differences (MDs) in the meta-analysis models using Review Manager (RevMan version 5.4). RESULTS Our results from 8 studies (597 patients) favored self-warming blankets over forced-air devices in terms of core temperature at 120 and 180 minutes after induction of general anesthesia (MD = 0.33, 95% confidence interval [CI] [0.14-0.51], P = .0006), (MD = 0.62, 95% CI [0.09-1.14], P = .02), respectively. However, the overall effect did not favor either of the 2 groups for the incidence of hypothermia (odds ratio = 0.69, 95% CI [0.18-2.62]). CONCLUSION Ultimately, self-warming blankets have a more significant effect than forced-air warming systems in terms of maintaining normothermia of core temperature after induction anesthesia. However, the present evidence is not enough to verify the efficacy of the 2 warming techniques in the incidence of hypothermia. Further studies with large sample sizes are recommended.
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Affiliation(s)
- Nada Mostafa Al-dardery
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Omar A. Abdelwahab
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed El-Samahy
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Adel Mouffokes
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, University of Oran 1 Ahmed Ben Bella, Oran, Algeria
| | - Abdulrhman Khaity
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, Elrazi University, Khartoum, Sudan
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13
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Liu S, Shen Y, Xiang J, Zhou F, Liu J, Zhou N, Cai L. Accelerated Perioperative Rehabilitation for Breast Cancer Patients Undergoing Radical Mastectomy: A Systematic Review. J Perianesth Nurs 2023; 38:339-348. [PMID: 36464572 DOI: 10.1016/j.jopan.2022.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/29/2022] [Accepted: 06/05/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE To summarize and analyze available evidence on perioperative accelerated rehabilitation programs for patients diagnosed with breast cancer that have had a radical mastectomy. DESIGN This article is a systematic review of literature based on evidence-based methodology. METHODS The '6S' evidence resource pyramid model was used to systematically search a range of databases. FINDINGS A total of 19 articles were extracted from the literature and used in this study, including 9 clinical decisions, 4 systematic evaluations, 4 expert consensuses, and 2 guidelines. We summarized a total of 47 lines of evidence with regard to various aspects, including preoperative, intraoperative, and postoperative nursing measures. CONCLUSIONS In this systematic review, an evidence-based methodology was used to summarize and analyze the best suggestions for perioperative accelerated rehabilitation nursing programs for breast cancer inpatients undergoing radical mastectomy. We aimed to provide a good reference value and evidence-based guidelines for the continuous improvement and development of nursing practice for the breast cancer patient population.
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Affiliation(s)
- Su Liu
- Department of Breast Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yiwei Shen
- Department of Breast Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China; School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Jialian Xiang
- Department of Breast Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Fang Zhou
- Department of Breast Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jian Liu
- Department of Breast Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ningning Zhou
- Operating Room, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Lingzhi Cai
- Department of Breast Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
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14
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Hara K, Kaneko S, Ishioka T, Tobinaga S, Urabe S, Nakao A, Hamada K, Nagaoka K, Taniguchi M, Yamaguchi M, Takeshita H, Tanaka J, Kuroda H, Matsuura E, Ishimatsu Y, Honda S, Sawai T. Relationship between perfusion index and central temperature before and after induction of anesthesia in laparoscopic gastrointestinal surgery: A prospective cohort study. Medicine (Baltimore) 2023; 102:e33169. [PMID: 36862881 PMCID: PMC9981403 DOI: 10.1097/md.0000000000033169] [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: 03/04/2023] Open
Abstract
The perfusion index (PI) cutoff value before anesthesia induction and the ratio of PI variation after anesthesia induction remain unclear. This study aimed to clarify the relationship between PI and central temperature during anesthesia induction, and the potential of PI in individualized and effective control of redistribution hypothermia. This prospective observational single center study analyzed 100 gastrointestinal surgeries performed under general anesthesia from August 2021 to February 2022. The PI was measured as peripheral perfusion, and the relationship between central and peripheral temperature values was investigated. Receiver operating characteristic curve analysis was performed to identify baseline PI before anesthesia, which predicts a decrease in central temperature 30 minutes after anesthesia induction, and the rate of change in PI that predicts the decrease in central temperature 60 minutes after anesthesia induction. In cases with a central temperature decrease of ≥ 0.6°C after 30 minutes, the area under the curve was 0.744, Youden index was 0.456, and the cutoff value of baseline PI was 2.30. In cases with a central temperature decrease of ≥ 0.6°C after 60 minutes, the area under curve was 0.857, Youden index was 0.693, and the cutoff value of the PI ratio of variation after 30 minutes of anesthesia induction was 1.58. If the baseline PI is ≤ 2.30 and the PI 30 minutes after anesthesia induction is at least 1.58-fold the PI ratio of variation, there is a high probability of a central temperature decrease of at least 0.6°C within 30 minutes after 2 time points.
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Affiliation(s)
- Kentaro Hara
- Department of Operation Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- * Correspondence: Kentaro Hara, Department of Operation Center, National Hospital Organization Nagasaki Medical Center, Kubara 2-1001-1, Omura, Nagasaki 856-8562, Japan (e-mail: )
| | - Shohei Kaneko
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Taichi Ishioka
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Shohei Tobinaga
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shigehiko Urabe
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Akiha Nakao
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Kozue Hamada
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Kyoko Nagaoka
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Miwa Taniguchi
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Michiko Yamaguchi
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Hiroaki Takeshita
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Junichi Tanaka
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiromi Kuroda
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Emi Matsuura
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuji Ishimatsu
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Sumihisa Honda
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Terumitsu Sawai
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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15
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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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16
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Oodit R, Biccard BM, Panieri E, Alvarez AO, Sioson MRS, Maswime S, Thomas V, Kluyts HL, Peden CJ, de Boer HD, Brindle M, Francis NK, Nelson G, Gustafsson UO, Ljungqvist O. Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low-Middle-Income Countries (LMIC's): Enhanced Recovery After Surgery (ERAS) Society Recommendation. World J Surg 2022; 46:1826-1843. [PMID: 35641574 PMCID: PMC9154207 DOI: 10.1007/s00268-022-06587-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND This is the first Enhanced Recovery After Surgery (ERAS®) Society guideline for primary and secondary hospitals in low-middle-income countries (LMIC's) for elective abdominal and gynecologic care. METHODS The ERAS LMIC Guidelines group was established by the ERAS® Society in collaboration with different representatives of perioperative care from LMIC's. The group consisted of seven members from the ERAS® Society and eight members from LMIC's. An updated systematic literature search and evaluation of evidence from previous ERAS® guidelines was performed by the leading authors of the Colorectal (2018) and Gynecologic (2019) surgery guidelines (Gustafsson et al in World J Surg 43:6592-695, Nelson et al in Int J Gynecol Cancer 29(4):651-668). Meta-analyses randomized controlled trials (RCTs), prospective and retrospective cohort studies from both HIC's and LMIC's were considered for each perioperative item. The members in the LMIC group then applied the current evidence and adapted the recommendations for each intervention as well as identifying possible new items relevant to LMIC's. The Grading of Recommendations, Assessment, Development and Evaluation system (GRADE) methodology was used to determine the quality of the published evidence. The strength of the recommendations was based on importance of the problem, quality of evidence, balance between desirable and undesirable effects, acceptability to key stakeholders, cost of implementation and specifically the feasibility of implementing in LMIC's and determined through discussions and consensus. RESULTS In addition to previously described ERAS® Society interventions, the following items were included, revised or discussed: the Surgical Safety Checklist (SSC), preoperative routine human immunodeficiency virus (HIV) testing in countries with a high prevalence of HIV/AIDS (CD4 and viral load for those patients that are HIV positive), delirium screening and prevention, COVID 19 screening, VTE prophylaxis, immuno-nutrition, prehabilitation, minimally invasive surgery (MIS) and a standardized postoperative monitoring guideline. CONCLUSIONS These guidelines are seen as a starting point to address the urgent need to improve perioperative care and to effect data-driven, evidence-based care in LMIC's.
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Affiliation(s)
- Ravi Oodit
- Division of Global Surgery, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape South Africa
| | - Bruce M. Biccard
- Department of Anesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape South Africa
| | - Eugenio Panieri
- Division of General Surgery, Groote Schuur Hospital, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape South Africa
| | - Adrian O. Alvarez
- Anesthesia Department, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Peron, 4190, C1199ABB Beunos Aires, Argentina
| | - Marianna R. S. Sioson
- Head Section of Medical Nutrition, Department of Medicine and ERAS Team, The Medical City, Ortigas Avenue, Manila, Metro Manila Philippines
| | - Salome Maswime
- Division of Global Surgery, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape South Africa
| | - Viju Thomas
- Department of Obstetrics and Gynaecology, Tygerberg Hospital and University of Stellenbosch, Francie Van Zyl Drive, Parow, Cape Town, Western Cape South Africa
| | - Hyla-Louise Kluyts
- Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Medunsa, Molotlegi Street, P.O. Box 60, Ga-Rankuwa, Pretoria, 0204 Gauteng South Africa
| | - Carol J. Peden
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033 USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Hans D. de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, Van Swietenplein 1, 9728 NT Groningen, The Netherlands
| | - Mary Brindle
- Cumming School of Medicine, University of Calgary, London, Canada
- Alberta Children’s Hospital, Calgary, Canada
- Safe Systems, Ariadne Labs, Stockholm, USA
- EQuIS Research Platform, Orebro, Canada
| | - Nader K. Francis
- Division of Surgery and Interventional Science- UCL, Gower Street, London, WC1E 6BT UK
| | - Gregg Nelson
- Department of Obstetrics & Gynecology, University of Calgary, 1331 29 St NW, Calgary, AB T2N 4N2 Canada
| | - Ulf O. Gustafsson
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, Entrevägen 2, 19257 Stockholm, Danderyd Sweden
| | - Olle Ljungqvist
- School of Medical Sciences, Department of Surgery, Örebro University, 701 85 Örebro, Sweden
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17
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Mroczek TJ, Prodromidis AD, Pearce A, Malik RA, Charalambous CP. Perioperative Hypothermia Is Associated With Increased 30-Day Mortality in Hip Fracture Patients in the United Kingdom: Α Systematic Review and Meta-analysis. J Orthop Trauma 2022; 36:343-348. [PMID: 34941601 DOI: 10.1097/bot.0000000000002332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To undertake a systematic review and meta-analysis to determine the relationship between perioperative hypothermia and mortality after surgery for hip fracture. DATA SOURCES A systematic literature search of Medline, EMBASE, CINAHL, and Cochrane CENTRAL databases was performed using the Cochrane methodology for systematic reviews with no publication year limit. Only studies available in the English language were included. STUDY SELECTION Predetermined inclusion criteria were patients of any age with a hip fracture, exposure was their body temperature and outcome was mortality rate. Any comparative study design was eligible. DATA EXTRACTION The quality of selected studies was assessed according to each study design with the Methodological Index for Non-Randomised Studies (MINORS) used for all the retrospective comparative studies. The GRADE approach was used to assess the quality of evidence. DATA SYNTHESIS A meta-analysis was conducted using a random-effects model. RESULTS The literature search identified 1016 records. After removing duplicates and those not meeting inclusion criteria, 3 studies measuring 30-day mortality were included. All included studies were carried out in the United Kingdom. The mortality rate was higher in the hypothermic groups as compared with the normothermic group in all the studies, with the difference being significant in 2 of the studies (P < 0.0001). The meta-analysis showed that low body temperature was associated with an increased mortality risk (estimated odds ratio: 2.660; 95% confidence interval: 1.948-3.632; P < 0.001) in patients undergoing surgery for hip fracture. CONCLUSIONS This study shows that low body temperature in hip fracture patients is associated with an increased 30-day mortality risk in the United Kingdom. Randomized control trials are required to determine whether the association between perioperative hypothermia in hip fracture patients and mortality is causal. Nevertheless, based on this analysis, we urge the maintenance of normal body temperature in the perioperative period to be included in national hip fracture guidelines. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Thomas J Mroczek
- Blackpool Teaching Hospitals NHS Foundation Trust, Trauma & Orthopaedics, Blackpool, United Kingdom
| | | | - Adrian Pearce
- Salford Royal NHS Foundation Trust, Trauma & Orthopaedics, Salford, United Kingdom
| | - Rayaz A Malik
- Weill Cornell Medicine, Doha, Qatar
- University of Manchester, Manchester, United Kingdom; and
| | - Charalambos P Charalambous
- Blackpool Teaching Hospitals NHS Foundation Trust, Trauma & Orthopaedics, Blackpool, United Kingdom
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
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Risk Nomogram Does Not Predict Anastomotic Leakage After Colon Surgery Accurately: Results of the Multi-center LekCheck Study. J Gastrointest Surg 2022; 26:900-910. [PMID: 34997466 DOI: 10.1007/s11605-021-05119-6] [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: 03/21/2021] [Accepted: 07/10/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE Anastomotic leakage (AL) is a dreaded complication after colorectal surgery. Preoperatively identifying high-risk patients can help to reduce the incidence of this complication. For this reason, AL risk nomograms have been developed. The objective of this study was to test the AL risk nomogram developed by Frasson, et al. for validity and to identify risk-factors for AL. METHODS From the international multi-center LekCheck study database, patients who underwent colonic surgery with the formation of an anastomosis were included. Data were prospectively collected between 2016 and 2019 at 14 hospitals. Univariate and multivariable regression analyses, and area under receiver operating characteristic curve analysis (AUROC) were performed. RESULTS A total of 643 patients were included. The median age was 70 years and 51% were male. The majority underwent surgery for malignancies (80.7%). The overall AL rate was 9.2%. The risk nomogram was not predictive for AL in the population tested (AUROC 0.572). Low preoperative haemoglobin (p = 0.006), intraoperative hypothermia (p = 0.02), contamination of the operative field (p = 0.004), and use of epidural analgesia (p = 0.02) were independent risk-factors for AL. CONCLUSION The AL risk nomogram could not be validated using the international LekCheck study database. In the future, intraoperative predictive factors for AL, as identified in this study, should also be included in AL risk predictors.
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Huec JL, AlEissa S, Bowey A, Debono B, El-Shawarbi A, Fernández-Baillo N, Han K, Martin-Benlloch A, Pflugmacher R, Sabatier P, Vanni D, Walker I, Warren T, Litrico S. Hemostats in Spine Surgery: Literature Review and Expert Panel Recommendations. Neurospine 2022; 19:1-12. [PMID: 35378578 PMCID: PMC8987560 DOI: 10.14245/ns.2143196.598] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/10/2022] [Indexed: 01/05/2023] Open
Abstract
Bleeding in spine surgery is a common occurrence but when bleeding is uncontrolled the consequences can be severe due to the potential for spinal cord compression and damage to the central nervous system. There are many factors that influence bleeding during spine surgery including patient factors and those related to the type of surgery and the surgical approach to bleeding. There are a range of methods that can be employed to both reduce the risk of bleeding and achieve hemostasis, one of which is the adjunct use of hemostatic agents. Hemostatic agents are available in a variety of forms and materials and with considerable variation in cost, but specific evidence to support their use in spine surgery is sparse. A literature review was conducted to identify the pre-, peri-, and postsurgical considerations around bleeding in spine surgery. The review generated a set of recommendations that were discussed and ratified by a wider expert group of spine surgeons. The results are intended to provide a practical guide to the selection of hemostats for specific bleeding situations that may be encountered in spine surgery.
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Affiliation(s)
- J.C. Le Huec
- Spine Unit, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France,Corresponding Author J.C. Le Huec https://orcid.org/0000-0002-0463-6706 Spine Unit, Polyclinique Bordeaux Nord Aquitaine, Université Bordeaux, 33000, Bordeaux, France
| | - S. AlEissa
- King Saud bin Abdulaziz University for Health Sciences Riyadh, Riyadh, Saudi Arabia
| | - A.J. Bowey
- Department of Orthopaedic Spinal Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - B. Debono
- Paris-Versailles Spine Center (Centre Francilien du Dos), Ramsay Santé - Hôpital Privé de Versailles, Versailles, France
| | | | - N. Fernández-Baillo
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - K.S. Han
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A. Martin-Benlloch
- Department of Orthopaedic Surgery, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - R. Pflugmacher
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - P. Sabatier
- Department of Neurosurgery, Clinique des Cèdres, Cornebarrieu, France
| | - D. Vanni
- G-spine 4, Spine Surgery Division, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - I. Walker
- Triducive Partners Limited, Hertfordshire, UK
| | - T. Warren
- Triducive Partners Limited, Hertfordshire, UK
| | - S. Litrico
- Department of Spine Surgery, Pasteur II Hospital, Centre Hospitalo-Universitaire de Nice, Nice, France
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20
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Dai Z, Zhang Y, Yi J, Huang Y. Validation of a Prediction Model for Intraoperative Hypothermia in Patients Receiving General Anesthesia. Int J Clin Pract 2022; 2022:6806225. [PMID: 36187909 PMCID: PMC9509213 DOI: 10.1155/2022/6806225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES There have been no fully validated tools for the rapid identification of surgical patients at risk of intraoperative hypothermia. The objective of this study was to validate the performance of a previously established prediction model in estimating the risk of intraoperative hypothermia in a prospective cohort. METHODS In this observational study, consecutive adults scheduled for elective surgery under general anesthesia were enrolled prospectively at a tertiary hospital between September 4, 2020, and December 28, 2020. An intraoperative hypothermia risk score was calculated by a mobile application of the prediction model. A wireless axillary thermometer was used to continuously measure perioperative core temperature as the reference standard. The discrimination and calibration of the model were assessed, using the area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow goodness-of-fit test, and Brier score. RESULTS Among 227 participants, 99 (43.6%) developed intraoperative hypothermia, and 10 (4.6%) received intraoperative active warming with forced-air warming. The model had an AUC of 0.700 (95% confidence interval [CI], 0.632-0.768) in the overall cohort with adequate calibration (Hosmer-Lemeshow χ 2 = 13.8, P=0.087; Brier score = 0.33 [95% CI, 0.29-0.37]). We categorized the risk scores into low-risk, moderate-risk, and high-risk groups, in which the incidence of intraoperative hypothermia was 23.0% (95% CI, 12.4-33.5), 43.4% (95% CI, 33.7-53.2), and 62.7% (95% CI, 51.5-74.3), respectively (P for trend <0.001). CONCLUSIONS The intraoperative hypothermia prediction model demonstrated possibly helpful discrimination and adequate calibration in our prospective validation. These findings suggest that the risk screening model could facilitate future perioperative temperature management.
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Affiliation(s)
- Ziyi Dai
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jie Yi
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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21
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Marin L, Höcker J, Esser A, Terhorst R, Sauerwald A, Schröder S. Forced-air warming and continuous core temperature monitoring with zero-heat-flux thermometry during cesarean section: a retrospective observational cohort study. Braz J Anesthesiol 2021; 72:484-492. [PMID: 34848308 PMCID: PMC9373610 DOI: 10.1016/j.bjane.2021.10.007] [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] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 10/22/2021] [Accepted: 10/30/2021] [Indexed: 11/30/2022] Open
Abstract
Background Over 30% of parturients undergoing spinal anesthesia for cesarean section become intraoperatively hypothermic. This study assessed the magnitude of hypothermic insult in parturients and newborns using continuous, high-resolution thermometry and evaluated the efficiency of intraoperative forced-air warming for prevention of hypothermia. Methods One hundred and eleven parturients admitted for elective or emergency cesarean section under spinal anesthesia with newborn bonding over a 5-month period were included in this retrospective observational cohort study. Patients were divided into two groups: the passive insulation group, who received no active warming, and the active warming group, who received convective warming through an underbody blanket. Core body temperature was continuously monitored by zero-heat-flux thermometry and automatically recorded by data-loggers. The primary outcome was the incidence of hypothermia in the operating and recovery room. Neonatal outcomes were also analyzed. Results The patients in the passive insulation group had significantly lower temperatures in the operating room compared to the actively warmed group (36.4°C vs. 36.6°C, p = 0.005), including temperature at skin closure (36.5°C vs. 36.7°C, p = 0.017). The temperature of the newborns after discharge from the postanesthetic care unit was lower in the passive insulation group (36.7°C vs. 37.0°C, p = 0.002); thirteen (15%) of the newborns were hypothermic, compared to three (4%) in the active warming group (p < 0.01). Conclusion Forced-air warming decreases perioperative hypothermia in parturients undergoing cesarean section but does not entirely prevent hypothermia in newborns while bonding. Therefore, it can be effectively used for cesarean section, but special attention should be given to neonates.
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Affiliation(s)
- Laurentiu Marin
- St. Marien-Hospital, Department of Anesthesiology and Intensive Care Medicine, Düren, Germany.
| | - Jan Höcker
- Friedrich-Ebert-Hospital, Department of Anesthesiology and Intensive Care Medicine, Neumünster, Germany
| | - André Esser
- RWTH Aachen University, Medical Faculty, Department of Occupational, Social and Environmental Medicine, Aachen, Germany
| | - Rainer Terhorst
- St. Marien-Hospital, Department of Anesthesiology and Intensive Care Medicine, Düren, Germany
| | - Axel Sauerwald
- St. Marien-Hospital, Department of Gynecology and Obstetrics, Düren, Germany
| | - Stefan Schröder
- Krankenhaus Düren, Department of Anesthesiology and Intensive Care Medicine, Düren, Germany
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22
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Postoperative hypothermia following non-cardiac high-risk surgery: A prospective study of temporal patterns and risk factors. PLoS One 2021; 16:e0259789. [PMID: 34780517 PMCID: PMC8592479 DOI: 10.1371/journal.pone.0259789] [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: 04/13/2021] [Accepted: 10/26/2021] [Indexed: 12/16/2022] Open
Abstract
Background and objectives Hypothermia occurs commonly during surgery and can cause postoperative complications. We aimed to describe the characteristics and outcomes of hypothermia in patients undergoing major surgeries. Methods This prospective, observational, multicenter study of a nationally representative sample included all patients over 18 years of age admitted to an intensive care unit (ICU). Thirty ICUs were selected randomly at national level. The main outcome measure was the proportion of patients who developed postoperative hypothermia in the first 24 hours of ICU admission. Patients were divided into three groups based on temperature: <35°C, <36°C, and ≥36°C (no hypothermia). Patients’ characteristics, postoperative complications, and risk factors were evaluated in all groups. To verify whether hypothermia was a strong risk factor for postoperative complications, a Kaplan–Meier curve was generated and adjusted using a Cox regression model. Results In total, 738 patients had their temperatures measured. The percentage of patients with temperature <35°C (median [Q1-Q3], 34.7°C [34.3–34.9°C]) was 19.1% (95% confidence interval [CI] = 16.1–22.5) and that of patients with temperature <36°C (median [Q1-Q3], 35.4°C [35.0–35.8°C]) was 64% (95% CI = 58.3–70.0). The percentage of surgical complications was 38.9%. Patients with hypothermia were older, had undergone abdominal surgeries, had undergone procedures of longer duration, and had more comorbidities. A postoperative temperature ≤35°C was an independent risk for composite postoperative complications (hazard ratio = 1.523, 95% CI = 1.15–2.0), especially coagulation and infection. Conclusions Inadvertent hypothermia was frequent among patients admitted to the ICU and occurred more likely after abdominal surgery, after a long procedure, in elderly patients, and in patients with a higher number of comorbidities. Low postoperative temperature was associated with postoperative complications.
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Thapa D, Valente JDS, Barrett B, Smith MJ, Argunhan F, Lee SY, Nikitochkina S, Kodji X, Brain SD. Dysfunctional TRPM8 signalling in the vascular response to environmental cold in ageing. eLife 2021; 10:70153. [PMID: 34726597 PMCID: PMC8592571 DOI: 10.7554/elife.70153] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/02/2021] [Indexed: 12/16/2022] Open
Abstract
Ageing is associated with increased vulnerability to environmental cold exposure. Previously, we identified the role of the cold-sensitive transient receptor potential (TRP) A1, M8 receptors as vascular cold sensors in mouse skin. We hypothesised that this dynamic cold-sensor system may become dysfunctional in ageing. We show that behavioural and vascular responses to skin local environmental cooling are impaired with even moderate ageing, with reduced TRPM8 gene/protein expression especially. Pharmacological blockade of the residual TRPA1/TRPM8 component substantially diminished the response in aged, compared with young mice. This implies the reliance of the already reduced cold-induced vascular response in ageing mice on remaining TRP receptor activity. Moreover, sympathetic-induced vasoconstriction was reduced with downregulation of the α2c adrenoceptor expression in ageing. The cold-induced vascular response is important for sensing cold and retaining body heat and health. These findings reveal that cold sensors, essential for this neurovascular pathway, decline as ageing onsets.
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Affiliation(s)
- Dibesh Thapa
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom
| | - Joäo de Sousa Valente
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom
| | - Brentton Barrett
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom
| | - Matthew John Smith
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom
| | - Fulye Argunhan
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom
| | - Sheng Y Lee
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom.,Cancer Research UK, Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Sofya Nikitochkina
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom
| | - Xenia Kodji
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom.,Skin Research Institute, Agency of Science, Technology, and Research (A*STAR), Singapore, Singapore
| | - Susan D Brain
- Section of Vascular Biology and Inflammation, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, London, United Kingdom
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Value of Active Warming Devices for Intraoperative Hypothermia Prevention-A Meta-Analysis and Cost-Benefit Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111360. [PMID: 34769877 PMCID: PMC8582721 DOI: 10.3390/ijerph182111360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 11/22/2022]
Abstract
Purpose: Historically, studies suggested that intraoperative hypothermia (IH) could result in significant resource consumption, but more recent studies have found the opposite. The purpose of this study is to estimate the value of active warming devices for IH prevention based on synthesized evidence. Methods: A cost-benefit analysis was conducted using the effect of active warming versus passive warming devices for intraoperative hypothermia from a meta-analysis. The item-based aggregated treatment cost approach was adopted to estimate the cost of each adverse event, which was then weighted to calculate the total cost of IH. Results: IH was associated with higher risks of bleeding, surgical site infection, and shivering compared with normothermia. The cost of one case of IH was $363.80, and the use of active warming devices might save $152.80. Extra investment in active warming (e.g., $291.00) might only be cost-beneficial when the minimum willingness-to-pay is $150.00. Conclusions: Synthesized evidence showed that the cost of IH might be overestimated. Furthermore, the value of using active warming devices remains uncertain because the willingness to pay may vary between decision-makers. As not enough awareness of hypothermia prevention in some countries, further research into the clinical use of active warming devices during major surgeries is warranted.
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25
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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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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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Zhang J, Deng L, Wang X, Song F, Hou H, Qiu Y. Effect of Forced-Air Warming Blanket on Perioperative Hypothermia in Elderly Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer. Ther Hypothermia Temp Manag 2021; 12:68-73. [PMID: 34232804 DOI: 10.1089/ther.2021.0010] [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: 11/13/2022] Open
Abstract
The study aimed to evaluate the effect of forced-air warming blanket combined with conventional thermal insulation measures on inadvertent perioperative hypothermia (IPH) in elderly patients undergoing laparoscopic radical resection of colorectal cancer. A total of 70 elderly patients undergoing laparoscopic radical resection of colorectal cancer with general anesthesia were included, and divided into conventional warming treatment (CT) group or forced-air warming treatment (FT) group. In the FT group, based on the conventional warming strategy, patients received prewarming with the forced-air warming blanket (38°C) for ≥20 minutes before induction of anesthesia, and received this treatment continuously during operation. The core body temperature, recovery time from anesthesia, extubating time, and length of stay in the postanesthesia care unit were recorded. The incidence of IPH and postoperative shivering was observed. The incidence of IPH was significantly lower, and average minimum body temperature during the operation was significantly higher in the FT group than that in the CT group (5.7% vs. 22.8% and 36.23°C vs. 35.89°C, respectively). The intraoperative body temperature decreased less (0.32°C vs. 0.69°C), the recovery time from anesthesia was faster (12.8 minutes vs. 17.1 minutes), and the incidence of postoperative shivering was less (2.8% vs. 28.6%) in the FT group than the CT group. In elderly patients undergoing laparoscopic radical resection of colorectal cancer, use of forced-air warming blankets combined with conventional warming measures is more effective to maintain normal body temperature during the perioperative period and reduce the incidence of IPH.
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Affiliation(s)
- Junxia Zhang
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Liqin Deng
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xiaomei Wang
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Fengxiang Song
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Haitao Hou
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yuxue Qiu
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
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Urfalioglu A, Urfalioglu S, Oksuz G, Doganer A, Teksen S, Guler O, Calisir F. The effects of active warming on perioperative inadvertent hypothermia in patients undergoing vitreoretinal surgery under local anesthesia. Indian J Ophthalmol 2021; 69:308-313. [PMID: 33463580 PMCID: PMC7933865 DOI: 10.4103/ijo.ijo_227_20] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose: Perioperative inadvertent hypothermia (PIH) is the decrease in core temperature below 36°C. We aimed to assess whether PIH develops in patients operated under local anesthesia (ULA) for vitreoretinal surgery in the operating room and investigate active warming efficacy. Methods: Seventy-two patients were divided into two groups: Group 1 contained unwarmed patients (n = 36), and Group 2, warmed patients (n = 36). The core temperatures, heart rate (HR), and mean arterial pressure (MAP) of the patients were measured at the beginning of surgery, after 20 min, 40 min, 1 h, at the end of the operation, and during the postoperative period. Results: PIH incidence was 44.6% in Group 1, whereas no hypothermia was observed in Group 2. Patient temperatures at 20 min (P = 0.001), 40 min (P < 0.001), 1 h (P < 0.001), the end of the operation (P < 0.001), and the postoperative period (P < 0.001) were significantly higher in Group 2 than in Group 1. Patient HRs at the end of the operation and during the postoperative period were significantly lower in Group 2 (P = 0.005) than in Group 1 (P < 0.001). The intraoperative 40th (P = 0.044) and 60th (P < 0.001) minutes, end of operation (P < 0.001), and postoperative MAP (P < 0.001) values of Group 1 were significantly higher than those of Group 2. Conclusion: PIH may develop in patients operated ULA, especially with a low ambient temperature. Actively warming may help prevent the harmful effects of PIH.
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Affiliation(s)
- Aykut Urfalioglu
- Department of Anesthesiology and Reanimation, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Turkey
| | - Selma Urfalioglu
- Department of Ophthalmology, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Turkey
| | - Gozen Oksuz
- Department of Anesthesiology and Reanimation, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Turkey
| | - Adem Doganer
- Department of Biostatistics and Medical Informatics, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Turkey
| | - Seyma Teksen
- Department of Anesthesiology and Reanimation, Afşin State Hospital, Kahramanmaras, Turkey
| | - Ozlem Guler
- Department of Emergency Medicine, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Turkey
| | - Feyza Calisir
- Department of Anesthesiology and Reanimation, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Turkey
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Kim H, Kim TK, Yoo S, Kim JT. Influence of flow rate, fluid temperature, and extension line on Hotline and S-line heating capability: an in vitro study. BMC Anesthesiol 2021; 21:1. [PMID: 33397294 PMCID: PMC7780655 DOI: 10.1186/s12871-020-01225-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background A fluid warmer can prevent hypothermia during the perioperative period. This study evaluated the heating capabilities of Hotline and Barkey S-line under different flow rates and initial fluid temperatures, as well as after the extension line installation. Methods We measured the temperature of a 0.9% sodium chloride solution at the fluid warmer outlet (TProx) and the extension line end (TDistal) with three different initial fluid temperatures (room, warm, and cold) and two flow rates (250 ml/hr and 100 mL/hr). Results At a 250 ml/hr flow rate, the TProx and TDistal values were observed to be higher in Hotline than in S-line when using room-temperature or cold fluid. Administering of the warm fluid at the same flow rate significantly increased the TProx and TDistal values in S-line more than the cold and room-temperature fluids. At flow rates of 100 ml/hr, TDistal values were significantly lower than TProx values in both devices regardless of the initial fluid temperature. Conclusions Hotline outperformed S-line for warming fluids at a high flow rate with cold or room-temperature fluids. Administering warm fluid in S-line prevented a decrease in the fluid temperature at a high flow rate. However, at a low flow rate, the fluid temperature significantly decreased in both devices after passing through an extension line.
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Affiliation(s)
- Hosu Kim
- College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Tae Kyong Kim
- College of Medicine, Seoul National University, Seoul, Republic of Korea.,Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Sukha Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 03080, Seoul, Republic of Korea
| | - Jin-Tae Kim
- College of Medicine, Seoul National University, Seoul, Republic of Korea. .,Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 03080, Seoul, Republic of Korea.
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Bräuer A, Fazliu A, Perl T, Heise D, Meissner K, Brandes IF. Accuracy of zero-heat-flux thermometry and bladder temperature measurement in critically ill patients. Sci Rep 2020; 10:21746. [PMID: 33303884 PMCID: PMC7730188 DOI: 10.1038/s41598-020-78753-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022] Open
Abstract
Core temperature (TCore) monitoring is essential in intensive care medicine. Bladder temperature is the standard of care in many institutions, but not possible in all patients. We therefore compared core temperature measured with a zero-heat flux thermometer (TZHF) and with a bladder catheter (TBladder) against blood temperature (TBlood) as a gold standard in 50 critically ill patients in a prospective, observational study. Every 30 min TBlood, TBladder and TZHF were documented simultaneously. Bland–Altman statistics were used for interpretation. 7018 pairs of measurements for the comparison of TBlood with TZHF and 7265 pairs of measurements for the comparison of TBlood with TBladder could be used. TBladder represented TBlood more accurate than TZHF. In the Bland Altman analyses the bias was smaller (0.05 °C vs. − 0.12 °C) and limits of agreement were narrower (0.64 °C to − 0.54 °C vs. 0.51 °C to – 0.76 °C), but not in clinically meaningful amounts. In conclusion the results for zero-heat-flux and bladder temperatures were virtually identical within about a tenth of a degree, although TZHF tended to underestimate TBlood. Therefore, either is suitable for clinical use. German Clinical Trials Register, DRKS00015482, Registered on 20th September 2018, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00015482.
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Affiliation(s)
- Anselm Bräuer
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch Strasse 40, 37099, Göttingen, Germany.
| | - Albulena Fazliu
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch Strasse 40, 37099, Göttingen, Germany
| | - Thorsten Perl
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Daniel Heise
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch Strasse 40, 37099, Göttingen, Germany
| | - Konrad Meissner
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch Strasse 40, 37099, Göttingen, Germany
| | - Ivo Florian Brandes
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch Strasse 40, 37099, Göttingen, Germany
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Okamura M, Saito W, Miyagi M, Shirasawa E, Imura T, Nakazawa T, Mimura Y, Yokozeki Y, Kuroda A, Kawakubo A, Uchida K, Akazawa T, Takaso M, Inoue G. Incidence of Unintentional Intraoperative Hypothermia in Pediatric Scoliosis Surgery and Associated Preoperative Risk Factors. Spine Surg Relat Res 2020; 5:154-159. [PMID: 34179551 PMCID: PMC8208945 DOI: 10.22603/ssrr.2020-0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/23/2020] [Indexed: 11/08/2022] Open
Abstract
Introduction Intraoperative hypothermia is associated with perioperative complications such as blood loss and wound infection. Thus, perioperative heat retention methods to prevent perioperative hypothermia such as providing a warmed blanket and active patients' warming are important. Although major surgery and pediatric patient age are noted as risk factors, only a few studies focus on hypothermia as an intraoperative complication in pediatric scoliosis surgery. The aim of this study is to investigate the incidence of intraoperative hypothermia in pediatric scoliosis surgery and the associated preoperative risk factors. Methods We retrospectively reviewed the records of pediatric patients who underwent posterior spinal fusion at a single institution between 2015 and 2019. We recorded the background data, perioperative data, lowest recorded core temperature, and perioperative complications. Patients were divided into those whose temperature decreased below 36°C (Group H) and those who maintained a temperature of 36°C or greater (Group N) during surgery. We compared the two groups and performed multivariate analysis to identify preoperative risk factors for intraoperative hypothermia. Results A total of 103 patients underwent posterior spinal fusion; 56 for adolescent idiopathic scoliosis and 47 for neuromuscular scoliosis. Hypothermia was observed in 40 patients (38.8%). Group H had more non-adolescent idiopathic scoliosis (AIS) patients, lower mean body mass index, greater mean blood loss, greater number of fused vertebrae, larger preoperative Cobb angle, and lower initial core body temperature (immediately after induction of anesthesia). On multivariate analysis, a diagnosis of neuromuscular scoliosis, a lower body mass index, and a lower initial core body temperature were identified as independent risk factors for intraoperative hypothermia. Conclusions The incidence of hypothermia in pediatric posterior scoliosis surgery is 38.8%. Diagnosis of non-AIS, lower body mass index, and lower core body temperature at the time of anesthesia induction are preoperative risk factors for intraoperative hypothermia.
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Affiliation(s)
- Maho Okamura
- Department of Nursing, Kitasato University Hospital, Sagamihara, Japan
| | - Wataru Saito
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masayuki Miyagi
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Eiki Shirasawa
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takayuki Imura
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Toshiyuki Nakazawa
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yusuke Mimura
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuji Yokozeki
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Akiyoshi Kuroda
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Ayumu Kawakubo
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kentaro Uchida
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masashi Takaso
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Gen Inoue
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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32
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Gopan G, Kumar L, Babu AR, Sudhakar A, George R, Menon VP. Intraoperative factors contributory to myocardial injury in high-risk patients undergoing abdominal surgery in a South Indian population. Indian J Anaesth 2020; 64:743-749. [PMID: 33162567 PMCID: PMC7641085 DOI: 10.4103/ija.ija_436_20] [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: 04/30/2020] [Revised: 05/16/2020] [Accepted: 05/28/2020] [Indexed: 12/15/2022] Open
Abstract
Background and Aims: Myocardial injury after non-cardiac surgery (MINS) is associated with high postoperative mortality. We sought to examine the intraoperative variables associated with MINS among high-risk patients undergoing abdominal surgery at a South Indian Centre. Methods: A retrospective analysis of patients who underwent abdominal surgery, aged >45 years with one of five factors: hypertension, diabetes mellitus, previous coronary artery disease (CAD), stroke, or peripheral vascular disease or all patients >65 years of age was undertaken. Forty-six patients with raised troponin Group P (Trop I > 0.03 ng/d) were compared with 125 troponin-negative patients Group N (Trop I < 0.012 ng/dL) as well as 51 with intermediate levels Group I (Trop I > 0.012 and < 0.03 ng/dL). We evaluated the association of pre and intraoperative factors on MINS using logistic regression to identify the explanatory variables. Results: Demographics were similar among the three groups. In-hospital mortality was significantly higher in group P (P = 0.005).The use of vasopressors (OR 2.6; 95% CI 1.2–5.5), female gender, (OR 2.3; 95%CI 1.1–4.7), associated CAD (OR 2.8;95% CI 1.1–7.4), and fresh frozen plasma (FFP) transfusion (OR 12.1;95% CI 1.3–11.7) were associated with MINS in regression analysis between group P versus group N. Female gender (OR2.3; 95% CI 1.2–4.5), postoperative mechanical ventilation (OR 3.5; 95% CI 1.2–10.4), and perioperative hypothermia (OR 4.5; 95% CI 1.3–14.9) were significant between Group P and Group I with Group N. Conclusions: Female patients with CAD undergoing abdominal surgery, needing vasopressors and transfusion of plasma are at high risk for MINS with higher hospital mortality and merit vigilant monitoring postoperatively.
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Affiliation(s)
- G Gopan
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Lakshmi Kumar
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Anjana Rajan Babu
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Abish Sudhakar
- Department of Paediatric Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Rubin George
- Department of Internal Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Vidya P Menon
- Department of Internal Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Safety of intraoperative hypothermia for patients: meta-analyses of randomized controlled trials and observational studies. BMC Anesthesiol 2020; 20:202. [PMID: 32799802 PMCID: PMC7429823 DOI: 10.1186/s12871-020-01065-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have shown that intraoperative hypothermia was associated with higher risks of clinical adverse events, but we found otherwise from recent evidences. This study aims to synthesize the existing evidence evaluating safety of intraoperative hypothermia. METHODS Articles, reviews, ongoing trials and grey literatures were retrieved from PubMed, The Cochrane Library, Clinical Trails and CNKI (a Chinese national database) till February 2nd, 2019. Both randomized controlled trials and observational studies compared incidences of all sorts of intra- and post-operative consequences between hypothermia and normothermia were included. Researches comparing different warming systems were excluded. We also examined risks of hypothermia using lowered standards (35.5 °C and 35 °C) from a Chinese trial (ChiCTR-IPR-17011099). RESULTS A total of 9 RCT studies and 11 observational studies were included. RCT-synthesized results showed that intraoperative hypothermia was associated with higher risks of bleeding (MD = 131.90, 95%CI: 117.42, 146.38), surgical site infection (RD = 0.14, 95%CI: 0.06, 0.21) and shivering (RD = 0.32, 95%CI: 0.06, 0.58) but with no significant differences in duration of surgery, hospital stay or mortality. Observational study-synthesized evidences showed that intraoperative hypothermia did not result in higher risks in any of these adverse events. Results didn't change even if the standard of hypothermia was lowered by 0.5-1.0 °C. CONCLUSIONS The study indicates that the synthesized risks resulted by intra-operative hypothermia might be overestimated and the eligibility of 36 °C to define hypothermia is not sensitive enough. Given body-temperature protection has not been popularized in China, it is still critical to normalize the hypothermia prevention at this stage.
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Akers JL, Dupnick AC, Hillman EL, Bauer AG, Kinker LM, Hagedorn Wonder A. Inadvertent Perioperative Hypothermia Risks and Postoperative Complications: A Retrospective Study. AORN J 2020; 109:741-747. [PMID: 31135987 DOI: 10.1002/aorn.12696] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Inadvertent perioperative hypothermia is a widely known patient condition that is associated with postoperative complications. This retrospective comparative study of 298 surgical patients was conducted at a single hospital site in the midwestern United States. Our aims were to describe risk factors and outcomes associated with perioperative hypothermia. We compared the type and frequency of patient factors, clinical factors, and postoperative complications during the inpatient stay of the sample patients to determine whether there were factors or complications associated with perioperative hypothermia. Significant factors associated with the occurrence of perioperative hypothermia included older age and type of surgery. Hypothermia in patients was associated with a higher rate of postoperative complications when compared with normothermic patients. Nurses and perioperative leaders should understand the risk factors and complications associated with perioperative hypothermia to collaboratively develop and test evidence-based initiatives, improve care, and promote optimal patient outcomes.
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Sorber R, Crawford TC, Wolfgang CL, Rizkalla N, Frank SM, Atallah C. Hypothermia prevention in hepatopancreatobiliary surgery through a multidisciplinary perioperative protocol: A case-control, propensity-matched study. J Clin Anesth 2020; 65:109858. [PMID: 32361549 DOI: 10.1016/j.jclinane.2020.109858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/08/2020] [Accepted: 04/24/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Rebecca Sorber
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Todd C Crawford
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher L Wolfgang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Surgical Oncology and Hepatobiliary Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nicole Rizkalla
- Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven M Frank
- Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chady Atallah
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Özsaban A, Acaroğlu R. The Effect of Active Warming on Postoperative Hypothermia on Body Temperature and Thermal Comfort: A Randomized Controlled Trial. J Perianesth Nurs 2020; 35:423-429. [PMID: 32360129 DOI: 10.1016/j.jopan.2019.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 12/16/2019] [Accepted: 12/27/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to determine the effect of active warming method in temperature control and thermal comfort in hypothermia after surgery. DESIGN A randomized controlled trial. METHODS The study sample consisted of 64 male and female postanesthesia care unit and intensive care unit neurosurgery postoperative inpatients. The experimental group was warmed using the active warming method, and the control group's routine care was continued via a cotton blanket. Patients were warmed until their tympanic body temperature reached 37°C. FINDINGS The time needed to adequately warm patients was approximately twice as short in those who received active warming as compared with the control group. The perception of thermal comfort was significantly higher in the first hour in patients who received the active warming method (P < .05). CONCLUSIONS The active warming method resulted in a shorter time to warming in hypothermia after surgery and an increase in the perception of thermal comfort and body temperature.
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Affiliation(s)
- Aysel Özsaban
- Department of Nursing, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey.
| | - Rengin Acaroğlu
- Department of Fundamentals of Nursing, Florence Nightingale Faculty of Nursing, İstanbul University-Cerrahpaşa, Istanbul, Turkey
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Lakha S, Levin MA, Leibowitz AB, Lin HM, Gal JS. Intraoperative Electronic Alerts Improve Compliance With National Quality Program Measure for Perioperative Temperature Management. Anesth Analg 2020; 130:1167-1175. [PMID: 32287124 DOI: 10.1213/ane.0000000000004546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Reimbursement for anesthesia services has been shifting from a fee-for-service model to a value-based model that ties payment to quality metrics. The Centers for Medicare & Medicaid Service's (CMS) value-based payment program includes a quality measure for perioperative temperature management (Measure #424, Perioperative Temperature Management). Compliance may impose new challenges in clinical practice, data collection, and reporting. We investigated the impact of an electronic decision-support tool on adherence to this emerging standard. METHODS In this retrospective observational study, perioperative temperature data were collected from cases eligible for reporting this measure to CMS from a single academic medical center before and after the implementation of an electronic decision-support tool that prompted temperature measurement and maintenance of normothermia. Proportions of measure compliance were assessed using segmented regression analysis. Proportions of intraoperative temperature measurement were also assessed, and multivariable logistic regression was performed to assess the association between patient and surgical factors and measure compliance. RESULTS A total of 24,755 cases eligible for reporting in 2017 were assessed, and 25,274 cases from 2016 were included as an extended baseline. Segmented time-series regression did not show a significant baseline trend in measure compliance. Introduction of the alerts was associated with an increase in overall compliance from 84.4% (95% confidence interval [CI], 83.6%-85.2%) to 92.4% (91.4%-93.4%), and an increase in intraoperative compliance from 26.8% (25.8%-27.8%) to 71.0% (69.6%-72.4%). The association between the alerts and overall compliance was also present on multivariable analysis. CONCLUSIONS Implementation of an intraoperative decision-support tool was associated with statistically significant improvement in the maintenance of normothermia in cases eligible for reporting to CMS. This led to improved compliance with Measure #424 and suggests that electronic alerts can help practices improve their performance and payment bonus eligibility.
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Affiliation(s)
- Sameer Lakha
- From the Departments of Anesthesiology, Perioperative and Pain Medicine
| | - Matthew A Levin
- From the Departments of Anesthesiology, Perioperative and Pain Medicine.,Genetics and Genomic Sciences
| | | | - Hung-Mo Lin
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jonathan S Gal
- From the Departments of Anesthesiology, Perioperative and Pain Medicine
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Matilda E, Westergaard-Nielsen E, Henricson M. Preoperative peripheral and core temperature: an observational study at a day-surgery unit. ACTA ACUST UNITED AC 2020; 29:160-164. [PMID: 32053433 DOI: 10.12968/bjon.2020.29.3.160] [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: 11/11/2022]
Abstract
BACKGROUND Hypothermia is a common problem in the surgical context and can lead to serious consequences for the patient and increased costs for society. AIMS To study day-surgery patients' peripheral and core temperatures during the preoperative phase. METHODS In total, 50 day-surgery patients participated in the study. Two sets of measurements of temperatures were made: core temperature and peripheral temperatures (two measuring points on the upper body and lower extremities respectively) were measured on arrival at the day-surgery unit, as well as on arrival at the operating theatre. The data were normally distributed and a paired t-test was used for statistical analysis. FINDINGS Peripheral temperatures had significant changes, with measuring points on the upper body decreasing and measuring points on the lower extremities increasing in temperature. The results show no significant change in core temperature. CONCLUSION The measurements show that 28% of the patients were below recommended preoperative temperature on arrival at the operating theatre. Further research is needed to study the development of body temperature perioperatively as well as at what point reheating interventions should be introduced.
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Affiliation(s)
- Ek Matilda
- Operating Theatre Nurse, Department of Operations and Intensive Care, Ryhov County Hospital, Region Jönköping County, Sweden
| | - Emma Westergaard-Nielsen
- Operating Theatre Nurse, Department of Operations and Intensive Care, Eksjö County Hospital, Region Jönköping County, Sweden
| | - Maria Henricson
- Associate Professor, IMPROVE-research Group, Department of Nursing Science, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Smith N, Abernethy C, Allgar V, Foster L, Martinson V, Stones E. An open-label, randomised controlled trial on the effectiveness of the Orve + wrap ® versus Forced Air Warming in restoring normothermia in the postanaesthetic care unit. J Clin Nurs 2020; 29:1085-1093. [PMID: 31889367 DOI: 10.1111/jocn.15159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/29/2019] [Accepted: 12/20/2019] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To determine the clinical effectiveness and safety of the Orve + wrap® thermal blanket. BACKGROUND Inadvertent perioperative hypothermia is a common problem in postanaesthetic care units and can have significant effects on patients' postoperative morbidity. Despite its commercial availability, there is no clinical evidence on the effectiveness of Orve + wrap®. DESIGN A single centre prospective, open-label, noninferiority randomised controlled trial. METHODS Postoperative hypothermic (35.0-35.9°C) patients who had undergone elective surgery were randomised to receive either Orve + wrap® or Forced Air Warming during their PACU stay. Patient temperatures were recorded every 10 min using zero-heat-flux thermometry. This study is reported using CONSORT Extension checklist for noninferiority and equivalence trials. RESULTS Between December 2016-October 2018, 129 patients were randomised to receive either Orve + wrap® blanket (n = 65, 50.3%) or Forced Air Warming (n = 64, 49.7%). The mean 60-min postoperative temperature of patients receiving Orve + wrap® blanket was 36.2 and 36.3°C for the patients receiving Forced Air Warming. The predefined noninferiority margin of a mean difference in temperature of 0.3°C was not reached between the groups at 60 min. Additionally, there were no statistical differences between adverse event rates across these groups. CONCLUSIONS In the context of this study, warming patients with the Orve + wrap® was noninferior to Forced Air Warming. There were comparable rates of associated postoperative consequences of warming (shivering, hypotension, arrhythmias or surgical site infections), between the groups. RELEVANCE TO CLINICAL PRACTICE The Orve + wrap® potentially provides an alternative warming method to Forced Air Warming for patients requiring short-term postoperative warming. However, there are still a number of unknowns regarding the Orve + wrap® performance and further exploration is required.
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Affiliation(s)
- Neil Smith
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | | | - Louise Foster
- Hull University Teaching Hospitals NHS Trust, Hull, UK
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Perioperative measurement of core body temperature using an unobtrusive passive heat flow sensor. J Clin Monit Comput 2020; 34:1351-1359. [PMID: 31902094 DOI: 10.1007/s10877-019-00446-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/13/2019] [Indexed: 01/15/2023]
Abstract
Clinicians strive to maintain normothermia, which requires measurement of core-body temperature and may necessitate active warming of patients. Monitoring temperature currently requires invasive probes. This work investigates a novel foam-based flexible sensor worn behind the ear for the measurement of core body temperature. This observational study uses the device prototype and clinical data to compare three methods for calculating the temperature from this sensor: a basic heat-flow model, a new dynamic model that addresses changing surrounding temperatures and one that combines the dynamic model with a correction for adhesive quality. Clinical validation was performed with 21 surgical patients (average length of surgery 4.4 h) using an esophageal temperature probe as reference. The operative period was divided into four segments: normal periods (with stable surrounding temperatures), surrounding temperatures increasing due to the use of the Bair Hugger™, stable periods during Bair Hugger™ use and surrounding temperatures decreasing due to its removal. The error bias and limits of agreement over these segments were on average of - 0.05 ± 0.28 °C (95% limits of agreement) overall. The dynamic model outperformed the simple heat-flow model for periods of surrounding temperature changes (12.7% of total time) while it had a similar, high, performance for the temperature-stable periods. The results suggest that our proposed topical sensor can replace invasive core temp sensors and provide a means of consistently measuring core body temperature despite surrounding temperature shifts.
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Mikhail C, Pennington Z, Arnold PM, Brodke DS, Chapman JR, Chutkan N, Daubs MD, DeVine JG, Fehlings MG, Gelb DE, Ghobrial GM, Harrop JS, Hoelscher C, Jiang F, Knightly JJ, Kwon BK, Mroz TE, Nassr A, Riew KD, Sekhon LH, Smith JS, Traynelis VC, Wang JC, Weber MH, Wilson JR, Witiw CD, Sciubba DM, Cho SK. Minimizing Blood Loss in Spine Surgery. Global Spine J 2020; 10:71S-83S. [PMID: 31934525 PMCID: PMC6947684 DOI: 10.1177/2192568219868475] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
STUDY DESIGN Broad narrative review. OBJECTIVE To review and summarize the current literature on guidelines, outcomes, techniques and indications surrounding multiple modalities of minimizing blood loss in spine surgery. METHODS A thorough review of peer-reviewed literature was performed on the guidelines, outcomes, techniques, and indications for multiple modalities of minimizing blood loss in spine surgery. RESULTS There is a large body of literature that provides a consensus on guidelines regarding the appropriate timing of discontinuation of anticoagulation, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and herbal supplements prior to surgery. Additionally, there is a more heterogenous discussion the utility of preoperative autologous blood donation facilitated by erythropoietin and iron supplementation for healthy patients slated for procedures with high anticipated blood loss and for whom allogeneic transfusion is likely. Intraoperative maneuvers available to minimize blood loss include positioning and maintaining normothermia. Tranexamic acid (TXA), bipolar sealer electrocautery, and topical hemostatic agents, and hypotensive anesthesia (mean arterial pressure (MAP) <65 mm Hg) should be strongly considered in cases with larger exposures and higher anticipated blood loss. There is strong level 1 evidence for the use of TXA in spine surgery as it reduces the overall blood loss and transfusion requirements. CONCLUSION As the volume and complexity of spinal procedures rise, intraoperative blood loss management has become a pivotal topic of research within the field. There are many tools for minimizing blood loss in patients undergoing spine surgery. The current literature supports combining techniques to use a cost- effective multimodal approach to minimize blood loss in the perioperative period.
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Affiliation(s)
| | | | - Paul M. Arnold
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Norman Chutkan
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - John G. DeVine
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Daniel E. Gelb
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Fan Jiang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Brian K. Kwon
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas E. Mroz
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ahmad Nassr
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - K. Daniel Riew
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lali H. Sekhon
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | | | | | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,Samuel K. Cho, Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York, NY 10029, USA.
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Morettini E, Turchini F, Tofani L, Villa G, Ricci Z, Romagnoli S. Intraoperative core temperature monitoring: accuracy and precision of zero-heat flux heated controlled servo sensor compared with esophageal temperature during major surgery; the ESOSPOT study. J Clin Monit Comput 2019; 34:1111-1119. [PMID: 31673946 DOI: 10.1007/s10877-019-00410-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022]
Abstract
Monitoring of intraoperative core temperature is strongly recommended to reduce the risk of perioperative thermic imbalance and related complications. The zero-heat-flux sensor (3M Bair Hugger Temperature monitoring system, ZHF), measures core temperature in a non-invasive manner. This study was aimed at comparing accuracy and precision of the ZHF sensor compared to the esophageal thermometer. Patients scheduled for major elective abdominal or urologic surgery were considered eligible for enrollment. Core body temperature was measured using both an esophageal probe (TESO) and a ZHF sensor (TZHF) every 15 min from induction until the end of general anaesthesia. A Bland-Altman plot for repeated measures was performed. The proportion of measurements within ± 0.5 °C was estimated; from a clinical point of view, a proportion greater than 90% was considered sufficiently accurate. Lin's concordance correlation coefficient (CCC) for repeated measures were calculated. To evaluate association between the two methods, a generalized estimating equation (GEE) simple linear regression model, was elaborated. A GEE multiple regression model was also performed in order to adjust the estimate of the association between measurements from surgical and patient's features. Ninety-nine patients were enrolled. Bland-Altman plot bias was 0.005 °C with upper and lower limits of agreement for repeated measures of 0.50 °C and - 0.49 °C. The percentage of measurements within 0.5 °C of the reference value was 97.98% (95% confidence interval 92.89-99.75%), indicating a clinically sufficient agreement between the two methods. This was also confirmed by a CCC for repeated measures of 0.89 (95% CI 0.80 to 0.94). The GEE simple regression model (slope value of 0.77) was not significantly influenced by any patient or surgical variables. According to GEE multiple regression model results, the explored patient- and surgery-related variables did not influence the association between methods. ZHF sensor has shown a clinically acceptable accuracy and precision for body core temperature monitoring during elective major surgery. CLINICAL TRIALS: Clinical trial number: NCT03820232.
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Affiliation(s)
- Elena Morettini
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy.
| | - Francesca Turchini
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Lorenzo Tofani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Gianluca Villa
- Section of Anesthesia, Intensive Care and Pain Medicine, Department of Health Sciences, University of Florence, Florence, Italy
| | - Zaccaria Ricci
- Pediatric Cardiac Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, Rome, Italy
| | - Stefano Romagnoli
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy.,Section of Anesthesia, Intensive Care and Pain Medicine, Department of Health Sciences, University of Florence, Florence, Italy
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Xu X, Lian C, Liu Y, Ding H, Lu Y, ShangGuan W. Warming efficacy of Ranger™ and FT2800 fluid warmer under different room temperatures and flow rates. J Clin Monit Comput 2019; 34:1105-1110. [PMID: 31624997 DOI: 10.1007/s10877-019-00400-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022]
Abstract
The comparison of the heating capabilities with different warming system between 3M™ Ranger™ warmer (3M) and FT2800 fluid warmer (FT) under different room temperatures and infusion rates, has been rarely reported previously. The study was then aimed to compare the warming efficacies of dry heat technology (3M) and coaxial warming system (FT) under different room temperatures and infusion rates, the advantages and disadvantages of both infusion systems would be compared to provide reference for clinical infusion practice. In the study, both target warming temperatures of 3M and FT warmer were set at 41 °C, fluid was administrated under 20, 22 and 24 °C room temperatures and drip rates of 60, 80, 100, 120, 140, 160, 200, 350 drops min-1. The fluid temperature at the outlet of the infusion tube (Toutlet) was measured and compared. The Toutlet of FT was higher than that of 3 M (P < 0.001) under different room temperatures. The Toutlet of FT increased with the room temperature raised (P < 0.05). As for 3M, Toutlet was lowest at 20 °C (P < 0.001) and no statistical difference of Toutlet was found between 22 and 24 °C (P = 0.667). Linear regression showed that the Toutlet of 3M increased with the speed up of drip rate, while the Toutlet of FT was decreased. The relationship between Toutlet & room temperature & drip rate for both 3M and FT warmers was calculated by a formula. 3M Ranger™ and FT2800 show different heating capabilities under different room temperatures and drip rates. 3M is more efficient at high flow rate while FT is more efficient at low flow rate. There is a formula relationship between Toutlet & room temperature & drip rate for both 3M and FT warmers.
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Affiliation(s)
- Ximou Xu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China
| | - Chaohui Lian
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China
| | - Yao Liu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China.,Department of Anesthesiology, Xingsha Branch of Hunan Provincial People's Hospital (People's Hospital of Changsha County), Changsha, China
| | - Hehe Ding
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China
| | - Yi Lu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China
| | - Wangning ShangGuan
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China.
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Brodshaug I, Tettum B, Raeder J. Thermal Suit or Forced Air Warming in Prevention of Perioperative Hypothermia: A Randomized Controlled Trial. J Perianesth Nurs 2019; 34:1006-1015. [DOI: 10.1016/j.jopan.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/28/2019] [Accepted: 03/03/2019] [Indexed: 10/26/2022]
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Meng-Meng T, Xue-Jun X, Xiao-Hong B. Clinical effects of warmed humidified carbon dioxide insufflation in infants undergoing major laparoscopic surgery. Medicine (Baltimore) 2019; 98:e16151. [PMID: 31277116 PMCID: PMC6635157 DOI: 10.1097/md.0000000000016151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Some studies have reported that warmed humidified carbon dioxide (CO2) insufflation in adult laparoscopic surgery could reduce pain and improve the core body temperature (CBT). However, similar studies are lacking in infants. Thus, this study aimed to investigate the clinical effects of warmed, humidified CO2 insufflation in pediatric patients undergoing major laparoscopic surgeries. METHODS From January 2015 to December 2017, infants who underwent major laparoscopic surgeries in Ningbo Women and Children's Hospital were randomized to Group A (standard CO2 insufflation) or Group B (warmed humidified CO2 insufflation, 35°C, 95% relative humidity). Change in CBT at the end of surgery was the primary outcome. Secondary outcomes included surgery time, intraoperative blood loss, oxygen saturation (SO2), and Face, Legs, Activity, Cry and Consolability (FLACC) scale. These variables were compared between the 2 groups. RESULTS Sixty-three infants (38 females, 25 males) were included; 30 patients were in Group A and 33 in Group B. The diseases treated with the laparoscopic approach included congenital megacolon, congenital diaphragmatic hernia, and intestinal malrotation. No deaths were noted. CBT was significantly higher in Group B at the end of surgery (P = .021). The occurrence of postoperative shivering (P = .02), hypothermia (P = .032), bowel movement (P = .044), and hospital stay (P = .038) was significantly different between the 2 groups; Group B had less shivering and hypothermia occurrence after surgery. Moreover, Group B demonstrated a more rapid postoperative recovery of bowel movement and shortened hospital stay than Group A. There was no statistical difference in operative time (P = .162), intraoperative blood loss (P = .541), SO2 (P = .59), and FLACC scale (P = .65) between the 2 groups. CONCLUSION The use of warmed humidified CO2 insufflation in infants undergoing major laparoscopic surgery was helpful for maintaining normothermia and was associated with several positive postoperative outcomes, including less shivering and hypothermia, faster recovery of bowel movement, and shortened hospital stay.
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Affiliation(s)
| | - Xu Xue-Jun
- Department of Pediatric Surgery, Ningbo Women and Children's Hospital, Ningbo, China
| | - Bao Xiao-Hong
- Department of Pediatric Surgery, Ningbo Women and Children's Hospital, Ningbo, China
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Bräuer A, Müller MM, Wetz AJ, Quintel M, Brandes IF. Influence of oral premedication and prewarming on core temperature of cardiac surgical patients: a prospective, randomized, controlled trial. BMC Anesthesiol 2019; 19:55. [PMID: 30987594 PMCID: PMC6466686 DOI: 10.1186/s12871-019-0725-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 04/02/2019] [Indexed: 12/21/2022] Open
Abstract
Background Perioperative hypothermia is still very common and associated with numerous adverse effects. The effects of benzodiazepines, administered as premedication, on thermoregulation have been studied with conflicting results. We investigated the hypotheses that premedication with flunitrazepam would lower the preoperative core temperature and that prewarming could attenuate this effect. Methods After approval by the local research ethics committee 50 adult cardiac surgical patients were included in this prospective, randomized, controlled, single-centre study with two parallel groups in a university hospital setting. Core temperature was measured using a continuous, non-invasive zero-heat flux thermometer from 30 min before administration of the oral premedication until beginning of surgery. An equal number of patients was randomly allocated via a computer-generated list assigning them to either prewarming or control group using the sealed envelope method for blinding. The intervention itself could not be blinded. In the prewarming group patients received active prewarming using an underbody forced-air warming blanket. The data were analysed using Student’s t-test, Mann-Whitney U-test and Fisher’s exact test. Results Of the randomized 25 patients per group 24 patients per group could be analysed. Initial core temperature was 36.7 ± 0.2 °C and dropped significantly after oral premedication to 36.5 ± 0.3 °C when the patients were leaving the ward and to 36.4 ± 0.3 °C before induction of anaesthesia. The patients of the prewarming group had a significantly higher core temperature at the beginning of surgery (35.8 ± 0.4 °C vs. 35.5 ± 0.5 °C, p = 0.027), although core temperature at induction of anaesthesia was comparable. Despite prewarming, core temperature did not reach baseline level prior to premedication (36.7 ± 0.2 °C). Conclusions Oral premedication with benzodiazepines on the ward lowered core temperature significantly at arrival in the operating room. This drop in core temperature cannot be offset by a short period of active prewarming. Trial registration This trial was prospectively registered with the German registry of clinical trials under the trial number DRKS00005790 on 20th February 2014.
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Affiliation(s)
- Anselm Bräuer
- Department of Anaesthesiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Michaela Maria Müller
- Department of Anaesthesiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Anna Julienne Wetz
- Department of Anaesthesiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Michael Quintel
- Department of Anaesthesiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Ivo Florian Brandes
- Department of Anaesthesiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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Kanazawa M, Watanabe M, Suzuki T. Protein malnutrition prevents heat conservation induced by amino acid infusion during general anesthesia in rats. Nutr Res 2019; 65:79-88. [PMID: 30967292 DOI: 10.1016/j.nutres.2019.02.007] [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: 03/04/2018] [Revised: 11/16/2018] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
The intravenous administration of an amino acid (AA) mixture during general anesthesia reduces anesthesia-induced hypothermia. AA-induced skeletal muscle protein synthesis and thermogenesis play important roles in the antihypothermic effects of AAs. We hypothesized that a preanesthetic dietary protein deficiency impairs the antihypothermic effects of AAs during general anesthesia due to a reduction in thermogenesis caused by a decrease in muscle protein synthesis. Sprague-Dawley rats were divided into 4 groups: fed a control diet plus saline (CON-SAL) or the AA mixture (CON-AA), and fed a protein-free diet plus saline (PF-SAL) or the AA mixture (PF-AA). SAL solution or AA mixture solution was infused for 180 minutes during sevoflurane anesthesia, and rectal temperatures were measured. Rectal temperatures were significantly higher in the CON-AA group than in the PF-AA group 90 to 180 minutes after initiating the intravenous infusion of the test solutions. There was no significant difference between the PF-SAL and PF-AA groups. Plasma insulin concentrations were significantly higher in the CON-AA group than in the PF-AA group (P < .05). The phosphorylation states of protein kinase B, mammalian target of rapamycin, and eukaryotic initiation factor 4E-binding protein 1 were significantly greater in the CON-AA group than in the PF-AA group (P < .05, P < .05, and P < .01, respectively). Our results indicated that a dietary protein deficiency before general anesthesia impaired the antihypothermic effects of an AA mixture infusion during general anesthesia by decreasing muscle protein synthesis through the insulin-stimulated phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin complex 1 signaling pathway followed by metabolic heat production.
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Affiliation(s)
- Masahiro Kanazawa
- Division of Anesthesia, Subaru Health Insurance Society Ota Memorial Hospital, 455-1, Oshima-cho, Ota, Gunma 373-8585, Japan.
| | - Mariko Watanabe
- Department of Anesthesiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1143, Japan
| | - Toshiyasu Suzuki
- Department of Anesthesiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1143, Japan
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Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadok TM, Hill AG, Soop M, de Boer HD, Urman RD, Chang GJ, Fichera A, Kessler H, Grass F, Whang EE, Fawcett WJ, Carli F, Lobo DN, Rollins KE, Balfour A, Baldini G, Riedel B, Ljungqvist O. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS ®) Society Recommendations: 2018. World J Surg 2019; 43:659-695. [PMID: 30426190 DOI: 10.1007/s00268-018-4844-y] [Citation(s) in RCA: 1044] [Impact Index Per Article: 208.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This is the fourth updated Enhanced Recovery After Surgery (ERAS®) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded recommendations for each ERAS item within the ERAS® protocol. METHODS A wide database search on English literature publications was performed. Studies on each item within the protocol were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts and examined, reviewed and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS All recommendations on ERAS® protocol items are based on best available evidence; good-quality trials; meta-analyses of good-quality trials; or large cohort studies. The level of evidence for the use of each item is presented accordingly. CONCLUSIONS The evidence base and recommendation for items within the multimodal perioperative care pathway are presented by the ERAS® Society in this comprehensive consensus review.
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Affiliation(s)
- U O Gustafsson
- Department of Surgery, Danderyd Hospital and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - M J Scott
- Department of Anesthesia, Virginia Commonwealth University Hospital, Richmond, VA, USA
- Department of Anesthesiology, University of Pennsylvania, Philadelphia, USA
| | - M Hubner
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - J Nygren
- Department of Surgery, Ersta Hospital and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - N Demartines
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - N Francis
- Colorectal Unit, Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, UK
- University of Bath, Wessex House Bath, BA2 7JU, UK
| | - T A Rockall
- Department of Surgery, Royal Surrey County Hospital NHS Trust, and Minimal Access Therapy Training Unit (MATTU), Guildford, UK
| | - T M Young-Fadok
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - A G Hill
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland Middlemore Hospital, Auckland, New Zealand
| | - M Soop
- Irving National Intestinal Failure Unit, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - H D de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital, Groningen, The Netherlands
| | - R D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - G J Chang
- Department of Surgical Oncology and Department of Health Services Research, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - A Fichera
- Division of Gastrointestinal Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - H Kessler
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio, USA
| | - F Grass
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - E E Whang
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - W J Fawcett
- Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust and University of Surrey, Guildford, UK
| | - F Carli
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - D N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - K E Rollins
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - A Balfour
- Department of Colorectal Surgery, Surgical Services, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - G Baldini
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - B Riedel
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - O Ljungqvist
- Department of Surgery, Örebro University and University Hospital, Örebro & Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Pesonen E, Silvasti-Lundell M, Niemi TT, Kivisaari R, Hernesniemi J, Mäkinen MT. The focus of temperature monitoring with zero-heat-flux technology (3M Bair-Hugger): a clinical study with patients undergoing craniotomy. J Clin Monit Comput 2018; 33:917-923. [PMID: 30467673 PMCID: PMC6710334 DOI: 10.1007/s10877-018-0227-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/16/2018] [Indexed: 11/29/2022]
Abstract
In the noninvasive zero-heat-flux (ZHF) method, deep body temperature is brought to the skin surface when an insulated temperature probe with servo-controlled heating on the skin creates a region of ZHF from the core to the skin. The sensor of the commercial Bair-Hugger ZHF device is placed on the forehead. According to the manufacturer, the sensor reaches a depth of 1-2 cm below the skin. In this observational study, the anatomical focus of the Bair-Hugger ZHF sensor was assessed in pre- and postoperative CT or MRI images of 29 patients undergoing elective craniotomy. Assuming the 2-cm depth from the forehead skin surface, the temperature measurement point preoperatively reached the brain cortex in all except one patient. Assuming the 1-cm depth, the preoperative temperature measurement point did not reach the brain parenchyma in any of the patients and was at the cortical surface in two patients. Corresponding results were obtained postoperatively, although either sub-arachnoid fluid or air was observed in all CT/MRI images. Craniotomy did not have a detectable effect on the course of the ZHF temperatures. In Bland-Altman analysis, the agreement of ZHF temperature with the nasopharyngeal temperature was 0.11 (95% confidence interval - 0.54 to 0.75) °C and with the bladder temperature - 0.14 (- 0.81 to 0.52) °C. As conclusions, within the reported range of the Bair-Hugger ZHF measurement depth, the anatomical focus of the sensor cannot be determined. Craniotomy did not have a detectable effect on the course of the ZHF temperatures that showed good agreement with the nasopharyngeal and bladder temperatures.
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Affiliation(s)
- Eero Pesonen
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Marja Silvasti-Lundell
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tomi T Niemi
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Hernesniemi
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marja-Tellervo Mäkinen
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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50
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Effect of preoperative warming on intraoperative hypothermia: a randomized-controlled trial. Can J Anaesth 2018; 65:1029-1040. [DOI: 10.1007/s12630-018-1161-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 10/14/2022] Open
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