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Zhou L, Cui X, Mo G, Wei J, Mo M, Zhong Y. Immediate fever during anaesthesia recovery after surgical procedure with scoliosis: A case report and literature review. Int J Surg Case Rep 2024; 121:110027. [PMID: 39003972 DOI: 10.1016/j.ijscr.2024.110027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Fever is a common clinical symptom in patients with postoperative scoliosis. However, there are rare reports of immediately fevers occurring following operative procedures. CASE PRESENTATION A 15-year-old female with a 1-year history of scoliosis was admitted to the hospital after a health examination. The patient was diagnosed with idiopathic scoliosis and underwent a posterior idiopathic scoliosis procedure and correction for pedicle fixation. The clinical symptoms, including chills, fever, increased heart rate and increased blood pressure, were observed immediately following surgery during anaesthesia recovery. The patient was discharged from the hospital 12 days post-surgery. Over the 90-day follow-up, no chills, fever (≥38 °C), deep tissue infection, or surgery-related complications were reported. This remained consistent for the subsequent 3-year follow-up. CLINICAL DISCUSSION The patient was discharged 12 days after the operation, and no chills or fever (≥38 °C) occurred during the 90-day follow-up. Furthermore, there were no instances of deep tissue infection or any other surgery-related complications throughout the subsequent 3-year follow-up duration. A literature review has performed for this subject by systematic review. We identified only three reports that specifically examined postoperative fever as an observational measure among spine surgical patients. Unfortunately, none of these reports mentioned immediate postoperative fever. CONCLUSION Based on the available clinical data and research evidence, it is recommended to exercise caution when treating patients who experience postoperative chill and fever, as it may be caused by a combination of intraoperative hypothermia and anaesthesia inhibition. While these symptoms may be self-limiting in nature, close monitoring and appropriate management should be implemented to ensure patient safety and to identify any potential complications.
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Affiliation(s)
- Limin Zhou
- Department of Operating room, Affiliated Hospital of Guangdong Medical University, No.57 South People Avenue, Zhanjiang 524001, China
| | - Xiumei Cui
- Department of Nursing, Affiliated Hospital of Guangdong Medical University, No.57 South People Avenue, Zhanjiang 524001, China.
| | - Guixi Mo
- Department of Anesthesiology, Affiliated Hospital of Guangdong Medical University, No.57 South People Avenue, Zhanjiang 524001, China
| | - Jingsong Wei
- Department of Spine Surgery, Affiliated Hospital of Guangdong Medical University, No.57 South People Avenue, Zhanjiang 524001, China
| | - Meizhen Mo
- Department of Operating room, Affiliated Hospital of Guangdong Medical University, No.57 South People Avenue, Zhanjiang 524001, China
| | - Yiyue Zhong
- Department of Operating room, Affiliated Hospital of Guangdong Medical University, No.57 South People Avenue, Zhanjiang 524001, China.
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Uçak A, Tat Çatal A, Karadağ E, Cebeci F. The Effect of Prewarming on Perioperative Hypothermia: A Systematic Review and Meta-analysis of Randomized Controlled Studies. J Perianesth Nurs 2024; 39:611-623.e2. [PMID: 38340096 DOI: 10.1016/j.jopan.2023.11.003] [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: 08/16/2023] [Accepted: 11/03/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE One of the methods for maintaining perioperative normothermia is prewarming. This study was conducted to investigate the effect of a preoperative prewarming intervention on perioperative body temperature. DESIGN Systematic review and meta-analysis. METHODS A literature review was conducted using PubMed, CINAHL, Cochrane Central, Science Direct, Springer Link, Scopus, Web of Science, and Ovid databases. Randomized controlled trials that investigate the effect of prewarming on body temperature in the prevention of perioperative hypothermia were included. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. Methodological quality was assessed using the Cochrane Collaboration "risk of bias" tool. Meta-analysis was performed with Comprehensive Meta-Analysis, version 2. Moderator analysis and publication bias assessment were performed. Funnel plots were analyzed using Orwin's fail-safe N, Trim, and Fill test method to investigate the source of heterogeneity. FINDINGS A total of 907 studies were found. The systematic review included 27 studies. Of these, 23 were included in the intraoperative meta-analysis, and 16 were included in the postoperative meta-analysis. According to the meta-analysis results, the prewarming intervention was effective in maintaining normothermia in the intraoperative (Hedge's g = 0.972, 95% confidence intervaI = 0.674 to 1.270) and postoperative (Hedge's g = 0.818, 95% confidence intervaI = 0.520 to 1.114) periods. CONCLUSIONS The findings of this systematic review and meta-analysis showed that preoperative prewarming played a significant role in providing and maintaining perioperative normothermia.
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Affiliation(s)
- Ayşe Uçak
- Faculty of Health Sciences, Department of Nursing, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| | - Arzu Tat Çatal
- Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Engin Karadağ
- Faculty of Education, Akdeniz University, Antalya, Turkey
| | - Fatma Cebeci
- Faculty of Nursing, Head of the Surgical Nursing Department, Akdeniz University, Antalya, Turkey
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3
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Dubatovka A, Nöthiger CB, Spahn DR, Buhmann JM, Roche TR, Tscholl DW. Predicting vital sign deviations during surgery from patient monitoring data: developing and validating single-stream deep learning models. Br J Anaesth 2024:S0007-0912(24)00405-7. [PMID: 39089955 DOI: 10.1016/j.bja.2024.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 05/22/2024] [Accepted: 06/17/2024] [Indexed: 08/04/2024] Open
Affiliation(s)
- Alina Dubatovka
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | - Christoph B Nöthiger
- Institute of Anaesthesiology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anaesthesiology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | | | - Tadzio R Roche
- Institute of Anaesthesiology, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
| | - David W Tscholl
- Institute of Anaesthesiology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
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Pan L, Chen F, Hu J, Zhang Y. The Effect of Temperature Chain Management Scheme During Robot-Assisted Radical Prostatectomy. Ther Hypothermia Temp Manag 2024. [PMID: 39054959 DOI: 10.1089/ther.2024.0020] [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: 07/27/2024] Open
Abstract
The study aimed to explore the effect of the temperature chain management scheme on preventing hypothermia in patients undergoing robot-assisted radical prostatectomy (RARP). The patients were randomized to receive either intraoperative warming only (control group, Group C) or the temperature chain management (experimental group, Group T). We compared the core temperature, inadvertent perioperative hypothermia (IPH) rates, the incidence of shivering, and thermal comfort between the two groups. The perioperative core temperature of the Group T was higher than that of the Group C, and the incidence of IPH, the incidence of shivering in the postanesthesia care unit (PACU), and the length of stay in PACU were lower than those of the control group. The thermal comfort of Group T scored higher than that of Group C when leaving the PACU, all above have a statistically significant difference (p < 0.05). The temperature chain management scheme could decrease the IPH rates and reduce postoperative complications in RARP patients. The Clinical Trials Registration number is 2023IIT034.
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Affiliation(s)
- Lanxia Pan
- Nursing School, Henan University of Chinese Medicine, Zhengzhou, China
| | - Fengxia Chen
- Operating Room, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Jie Hu
- Operating Room, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Yingying Zhang
- Operating Room, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
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Xia F, Li Q, Xu L, Chen X, Li G, Li L, Cheng Z, Zhang J, Deng C, Li J, Chen R. Development and validation of an intraoperative hypothermia nomograph model for patients undergoing video-assisted thoracoscopic lobectomy: a retrospective study. Sci Rep 2024; 14:15202. [PMID: 38956148 PMCID: PMC11219828 DOI: 10.1038/s41598-024-66222-7] [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: 02/19/2024] [Accepted: 06/28/2024] [Indexed: 07/04/2024] Open
Abstract
This study aimed to develop and internally validate a nomogram model for assessing the risk of intraoperative hypothermia in patients undergoing video-assisted thoracoscopic (VATS) lobectomy. This study is a retrospective study. A total of 530 patients who undergoing VATS lobectomy from January 2022 to December 2023 in a tertiary hospital in Wuhan were selected. Patients were divided into hypothermia group (n = 346) and non-hypothermia group (n = 184) according to whether hypothermia occurred during the operation. Lasso regression was used to screen the independent variables. Logistic regression was used to analyze the risk factors of hypothermia during operation, and a nomogram model was established. Bootstrap method was used to internally verify the nomogram model. Receiver operating characteristic (ROC) curve was used to evaluate the discrimination of the model. Calibration curve and Hosmer Lemeshow test were used to evaluate the accuracy of the model. Decision curve analysis (DCA) was used to evaluate the clinical utility of the model. Intraoperative hypothermia occurred in 346 of 530 patients undergoing VATS lobectomy (65.28%). Logistic regression analysis showed that age, serum total bilirubin, inhaled desflurane, anesthesia duration, intraoperative infusion volume, intraoperative blood loss and body mass index were risk factors for intraoperative hypothermia in patients undergoing VATS lobectomy (P < 0.05). The area under ROC curve was 0.757, 95% CI (0.714-0.799). The optimal cutoff value was 0.635, the sensitivity was 0.717, and the specificity was 0.658. These results suggested that the model was well discriminated. Calibration curve has shown that the actual values are generally in agreement with the predicted values. Hosmer-Lemeshow test showed that χ2 = 5.588, P = 0.693, indicating that the model has a good accuracy. The DCA results confirmed that the model had high clinical utility. The nomogram model constructed in this study showed good discrimination, accuracy and clinical utility in predicting patients with intraoperative hypothermia, which can provide reference for medical staff to screen high-risk of intraoperative hypothermia in patients undergoing VATS lobectomy.
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Affiliation(s)
- Fuhai Xia
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Qiang Li
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
| | - Liqin Xu
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Xi Chen
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Gen Li
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Li Li
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Zhineng Cheng
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Jie Zhang
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Chaoliang Deng
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Jing Li
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Rui Chen
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
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6
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Bitsa Y, Belay A, Mulaw A, Hadush Y, Teferi M. Magnitude and associated factors of intraoperative hypothermia among pediatric patients undergoing elective surgery at Ayder Comprehensive Specialized Hospital 2023: prospective observational cross-sectional study Tigray, Ethiopia. Ann Med Surg (Lond) 2024; 86:3936-3944. [PMID: 38989220 PMCID: PMC11230762 DOI: 10.1097/ms9.0000000000002202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/17/2024] [Indexed: 07/12/2024] Open
Abstract
Background Hypothermia is characterized by a drop in core body temperature of less than 36°C. It occurs frequently throughout the operating period and affects surgical patient outcomes differently in terms of morbidity and mortality. Because of coagulopathy, metabolic acidosis, multiple organ failure, hemodynamic instability, and infections, a core temperature below 34°C is strongly associated with mortality. Objective This study aimed to assess the magnitude and associated factors of intraoperative hypothermia in pediatric patients undergoing elective surgery at the Ayder Comprehensive Specialized Hospital. Method A prospective observational cross-sectional study was conducted on 399 pediatric patients undergoing elective surgery at Ayder Comprehensive Specialized Hospital in Tigray, Ethiopia, from 1 May 2023, to 30 July 2023. Participants in the study were selected by a systematic random sampling technique. The data collection procedure was chart review and intraoperative temperature measurement, and the collected data were analyzed by SPSS version 23. The independent variables were analyzed using binary and multi-logistic regression. The odds ratio, 95% CI, and p value of less than 0.05 were considered statistical significance. Result The magnitude of intraoperative hypothermia was 52.9%. Neonate and infant [adjusted odds ratio (AOR): 6, 95% CI: 3.7, 9.8], (AOR=4.5, 95% CI: 2.9, 7) respectively, volume of fluid administered greater than half-liter [AOR: 4.37, (95% CI, 3, 6.4)], patients who underwent surgery during the morning [AOR: 5.3, (95% CI: 3.8, 7.4)], and duration of surgery and anesthesia greater than 120 minutes [AOR: 2.7, (95% CI, 1.8, 4)] and (AOR=3.4, 95% CI, 2.4, 4.9], respectively, were factors significantly associated with intraoperative hypothermia. Conclusion and recommendation This study revealed a high magnitude of intraoperative hypothermia among pediatric patients. Being neonates and infants, having a cold volume of IV fluid administered greater than half a liter, entering surgery during the morning, the duration of surgery, and the anesthesia time were significantly associated with intraoperative hypothermia. The authors would like to advise anesthetists to use warm intravenous fluids, calculate IV fluids, and maintain room temperature.
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Affiliation(s)
- Yihdego Bitsa
- Department of Anesthesiology, College of Health Science, Addigrat University, Addigrat
| | | | | | | | - Molla Teferi
- Public Health, College of Health Science, Mekelle University, Mekelle, Ethiopia
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Yang M, Li S, Drzymalski D, Chen X. Intravenous Bolus of Dexmedetomidine for Treatment of Severe Shivering After Caesarean Delivery Under Combined Spinal-Epidural Anaesthesia: A Randomized Dose-Response Study. Drug Des Devel Ther 2024; 18:2393-2402. [PMID: 38911029 PMCID: PMC11193989 DOI: 10.2147/dddt.s456289] [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: 12/24/2023] [Accepted: 06/05/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose Shivering occurs frequently after caesarean delivery. The present study aimed to investigate the ED50 and ED95 of an intravenous (i.v.) bolus of dexmedetomidine for treating severe shivering after caesarean delivery under combined spinal-epidural anaesthesia. Patients and methods Seventy-five parturients with severe shivering after caesarean delivery were randomized into one of the five groups to receive an i.v. bolus of 0.2 (Group D1), 0.25 (Group D2), 0.3 (Group D3), 0.35 (Group D4) or 0.4 (Group D5) μg/kg of dexmedetomidine. Effectiveness of shivering treatment was defined as a standardized shivering score decreasing to ≤1 within 10 min of dexmedetomidine injection. The ED50 and ED95 were determined by probit regression. Adverse effects were also compared among the groups. Results The ED50 and ED95 of i.v. dexmedetomidine to treat severe shivering were 0.23 (95% CI, 0.16-0.26) μg/kg and 0.39 (95% CI, 0.34-0.52) μg/kg, respectively. No difference in the incidence of adverse effects was found between groups. Conclusion An i.v. bolus of 0.39 μg/kg of dexmedetomidine will treat 95% of parturients experiencing severe shivering after caesarean delivery.
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Affiliation(s)
- Meijuan Yang
- Department of Anaesthesia, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - ShuXi Li
- Department of Anaesthesia, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Dan Drzymalski
- Department of Anaesthesiology and Perioperative Medicine, Tufts Medical Centre, Boston, MA, USA
| | - Xinzhong Chen
- Department of Anaesthesia, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
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Pelizzo G, Destro F, Pierucci UM, Costanzo S, Camporesi A, Diotto V, Calcaterra V, Saxena AK. Minimal Access in Pediatric Surgery: An Overview on Progress towards Dedicated Instrument Developments and Anesthesiologic Advances to Enhance Safe Completion of Procedures. CHILDREN (BASEL, SWITZERLAND) 2024; 11:679. [PMID: 38929258 PMCID: PMC11201956 DOI: 10.3390/children11060679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 06/28/2024]
Abstract
Surgical techniques are evolving in Pediatric Surgery, especially in the area of minimal access surgery (MAS) where indications for applications are expanding. Miniaturization of instruments, using natural orifices, single incisions, or remotely controlled robot-assisted procedures, promises to increase the benefits of MAS procedures in pediatrics. Many pediatric pathologies are rare, and specialized surgical and anesthesiologic instruments are necessary to manage them, defined as "orphan devices", for which development and dissemination on the market are slowed down or sometimes hindered by regulatory standards and limiting financial conflicts of interest. In pediatric surgery, it is of utmost importance to work in a multidisciplinary way to offer a surgical path that is safe and supported by technological advances. For this reason, optimizing pediatric anesthesia is also a crucial factor where technological advances have made monitoring more precise, thereby enhancing safety in the operative room. The development of customized instruments and technologies should be supported by pediatric research and should be adapted to the individualities of the small patient. This overview outlines the importance of dedicated instruments developed for the safe completion of MAS procedures in pediatrics.
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Affiliation(s)
- Gloria Pelizzo
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy;
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (U.M.P.); (S.C.)
| | - Francesca Destro
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (U.M.P.); (S.C.)
| | - Ugo Maria Pierucci
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (U.M.P.); (S.C.)
| | - Sara Costanzo
- Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (U.M.P.); (S.C.)
| | - Anna Camporesi
- Pediatric Anesthesiology and Intensive Care Unit, Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (A.C.); (V.D.)
| | - Veronica Diotto
- Pediatric Anesthesiology and Intensive Care Unit, Department of Pediatric Surgery, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (A.C.); (V.D.)
| | - Valeria Calcaterra
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy;
| | - Amulya K. Saxena
- Department of Pediatric Surgery, Chelsea Children’s Hospital, Chelsea and Westminster Hospital NHS Fdn Trust, Imperial College London, London SW10 9NH, UK;
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Huniler HC, Deniz MN, Günişen İ, Yakut Özdemir Ö, Tetik A, Ulukaya S. Effects of Perioperative Hypothermia on Extubation, Recovery Time, and Postoperative Shivering in Breast Surgery. Ther Hypothermia Temp Manag 2024; 14:110-117. [PMID: 37639685 DOI: 10.1089/ther.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Women undergoing breast surgery seem to be under the risk for hypothermia (central body temperature <36°) due to the uncertainty caused by the preoperative preparation time and the variety of operations, leading to neglect of warming precautions. The study examines the perioperative hypothermia (PH) in breast surgery and the relationships between the depth of decrease in body temperature and individual or clinical variables. This prospective, cross-sectional, observational study includes 120 female patients 18-65 years of age who were given general anesthesia for breast surgery. The incidence of hypothermia was 68.1%. The given patients were discriminated as body temperature <36°, hypothermia was significantly related with lower weight, body mass index, American Society of Anesthesiology (ASA) score, baseline body temperatures, higher extubation, and recovery times. When patients' temperature decreases by >1 or 1.5°, lower age and longer durations of operation and anesthesia were also significant variables. The incidence of shivering is quite high at temperatures below 36°C or at 1 and 1.5°C reductions from baseline (72.7%, 84%, 94.1%, respectively). Body temperature changes of the patients had no effect on nausea-vomiting and pain scores. It turned out that the incidence of PH and shivering is high in women who underwent breast surgery. We think that the depth of decrease in body temperature should be taken into account when evaluating the predictors or clinical consequences of hypothermia, except for the 36°C limit for body temperature.
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Affiliation(s)
- Hatice Cansu Huniler
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
| | - Mustafa Nuri Deniz
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
| | - İlkben Günişen
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
| | - Özlem Yakut Özdemir
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
| | - Aslı Tetik
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
| | - Sezgin Ulukaya
- Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
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Liedl HJ, Lazenby KA, Arimoto RS, Singh A, Strelzow JA. Normothermia to Decrease Surgical Site Infection Risk: Silver Bullet or Fool's Gold? A Retrospective Cohort Study. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202406000-00008. [PMID: 38875451 PMCID: PMC11191004 DOI: 10.5435/jaaosglobal-d-23-00227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/08/2024] [Accepted: 04/02/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE Surgical site infection (SSI) is the leading cause of nosocomial infections among surgical patients in the United States. Currently, there is compelling evidence suggesting that temperature dysregulation in surgical patients may be a risk factor for the development of SSI. We examined the relationship between perioperative hypothermia (PH) and SSI in a population of surgical patients with diabetes mellitus (DM). METHODS This retrospective cohort review was conducted on patients with a history of DM undergoing orthopaedic surgery at our institution between May 1, 2018, and April 1, 2022. Inclusion criteria were age older than 15 years, a history of DM or recent hemoglobin A1c concentration of ≥6.5%, and operation of at least 60 minutes under general anesthesia. Perioperative hypothermia was defined as an intraoperative temperature ≤ 35.5°C. Continuous variables were compared using the t-test and Wilcoxon rank-sum test. Categorical variables were compared using the chi-squared test. We constructed a multivariable logistic regression model to estimate SSI risk while controlling for demographic variables. RESULTS A total of 236 patients were included in the final analysis. The overall incidence of SSI was 5.93%. 99 patients (42%) experienced PH. No difference was observed in the risk of SSI between the normothermic and hypothermic cohorts. Among the 99 patients who experienced PH, increasing HbA1c was associated with increasing risk of SSI (OR = 2.39, 95% CI = 1.12 to 5.32, P-value = 0.0222). The multivariable logistic regression model had good discriminatory ability (c-statistic 0.74, 95% CI: 0.61 to 0.89) and good predictive accuracy (sensitivity 64%, specificity 73%). DISCUSSION PH is not an independent risk factor of SSI. However, in the presence of elevated HbA1c, PH may more than double the risk of SSI. Perioperative hypothermia may be an additive risk factor in the setting of poor glycemic control and potentially in the setting of other known risk factors.
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Affiliation(s)
- Henry J.C. Liedl
- From the Department of Orthopaedic Surgery, University of Chicago Medicine, Chicago, IL (Dr. Liedl and Dr. Strelzow), and the Pritzker School of Medicine, University of Chicago, Chicago, IL (Dr. Liedl, Dr. Lazenby, Dr. Arimoto, and Mr. Singh)
| | - Kevin A. Lazenby
- From the Department of Orthopaedic Surgery, University of Chicago Medicine, Chicago, IL (Dr. Liedl and Dr. Strelzow), and the Pritzker School of Medicine, University of Chicago, Chicago, IL (Dr. Liedl, Dr. Lazenby, Dr. Arimoto, and Mr. Singh)
| | - Ryuji S. Arimoto
- From the Department of Orthopaedic Surgery, University of Chicago Medicine, Chicago, IL (Dr. Liedl and Dr. Strelzow), and the Pritzker School of Medicine, University of Chicago, Chicago, IL (Dr. Liedl, Dr. Lazenby, Dr. Arimoto, and Mr. Singh)
| | - Armaan Singh
- From the Department of Orthopaedic Surgery, University of Chicago Medicine, Chicago, IL (Dr. Liedl and Dr. Strelzow), and the Pritzker School of Medicine, University of Chicago, Chicago, IL (Dr. Liedl, Dr. Lazenby, Dr. Arimoto, and Mr. Singh)
| | - Jason A. Strelzow
- From the Department of Orthopaedic Surgery, University of Chicago Medicine, Chicago, IL (Dr. Liedl and Dr. Strelzow), and the Pritzker School of Medicine, University of Chicago, Chicago, IL (Dr. Liedl, Dr. Lazenby, Dr. Arimoto, and Mr. Singh)
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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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12
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Nayebi N, Tekgül ZT, Şahinkaya HH. Effect of Prewarming on Skin Temperature Changes After Spinal Anesthesia in Transurethral Resection of the Bladder. J Perianesth Nurs 2024; 39:391-396. [PMID: 38206216 DOI: 10.1016/j.jopan.2023.08.020] [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: 02/27/2023] [Revised: 07/18/2023] [Accepted: 08/24/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Monitoring of peripheral skin temperature changes is an objective and rapid method to evaluate the success of neuraxial block after spinal anesthesia. The aim of this study is to investigate the effect of prewarming on peripheral temperature changes after the administration of spinal anesthesia. DESIGN Randomized, prospective, single-blind study. METHODS In this study, patients scheduled for transurethral resection of the bladder surgery under spinal anesthesia were divided into two groups: those with active prewarming and those without active prewarming. The groups were compared in core and skin temperature changes after administration of spinal anesthesia, length of stay in the postanesthesia care unit, shivering score, and the thermal comfort scale. FINDINGS A statistically significant difference was found between the groups on time for a 1 °C increase in ankle and toe skin temperatures (P < .001). There was a statistically significant difference between the groups in core temperature measurements (P < .001). When thermal comfort was compared between the groups, a statistically significant difference was found (P < .001). Patients' shivering score (P = .704), and length of stay in the postanesthesia care unit (P = .059) between the groups were similar. CONCLUSIONS Skin temperature changes in the prewarming group were lower, and this group had a lower rate of increase than the nonprewarming group. Therefore, skin temperature changes in the lower extremity can be used to determine the success of spinal anesthesia in patients who are prewarmed, with the awareness of these differences.
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Affiliation(s)
- Negin Nayebi
- Department of Anesthesiology and Reanimation, University of Health Sciences, İzmir Bozyaka Training and Research Hospital, İzmir, Turkiye
| | - Zeki Tuncel Tekgül
- Department of Anesthesiology and Reanimation, University of Health Sciences, İzmir Bozyaka Training and Research Hospital, İzmir, Turkiye
| | - Halide H Şahinkaya
- Department of Anesthesiology and Reanimation, University of Health Sciences, İzmir Bozyaka Training and Research Hospital, İzmir, Turkiye.
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13
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Lee EK, Bang YJ, Kim J, Ahn HJ. Comparison of tracheal versus esophageal temperatures during laparoscopic surgery. Can J Anaesth 2024; 71:619-628. [PMID: 38468077 DOI: 10.1007/s12630-024-02721-5] [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: 06/22/2023] [Revised: 11/17/2023] [Accepted: 11/29/2023] [Indexed: 03/13/2024] Open
Abstract
PURPOSE Recently, endotracheal tubes with an embedded temperature sensor in the inner surface of the tube cuff (temperature tracheal tubes) have been developed. We sought to assess whether temperature tracheal tubes show a good agreement with esophageal temperature probes during surgery. METHODS We enrolled 40 patients who underwent laparoscopic surgery in an observational study. The tracheas of all patients were intubated with a temperature tracheal tube, and an esophageal temperature probe was inserted into the esophagus. Tracheal and esophageal temperatures were recorded at 15-min intervals until the end of surgery. Temperatures from both devices were analyzed using Bland-Altman analysis, four-quadrant plots, and polar plots. RESULTS We analyzed 261 data points from 36 patients. Temperatures ranges were 34.2 °C to 36.6 °C for the tracheal temperature tube and 34.7 °C to 37.2 °C for the esophageal temperature probe. Bland-Altman analysis showed an acceptable agreement between the two devices, with an overall mean bias (95% limit of agreement) of -0.3 °C (-0.8 °C to 0.1 °C) and a percentage error of 3%; the trending ability (temperature changes over time) between the two devices showed a concordance rate of 94% in four-quadrant plot (cut-off ≥ 92%), but this was higher than the acceptable mean angular bias of 177° (cut-off < ± 5°) and radial limits of agreement of 52° (cut-off < ± 30°) in the polar plot. Bronchoscopy during extubation and patient interviews at six hours postoperatively revealed no serious injuries related to the use of the temperature tracheal tube. CONCLUSION The temperature tracheal tube showed an acceptable overall mean bias of -0.3 °C and a percentage error of 3%, but incompatible trending ability with the esophageal temperature probe. STUDY REGISTRATION cris.nih.go.kr (KCT0007265); 22 April 2022.
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Affiliation(s)
- Eun Kyung Lee
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Yu Jeong Bang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeayoun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Joo Ahn
- Department of Anaesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Yoon EJ, Kwon EH, Kim JH, Delacruz J, Symons TB, Lee S, Park D. Influence of cosmetic foundation cream on skin condition during treadmill exercise. J Cosmet Dermatol 2024; 23:1884-1890. [PMID: 38444348 DOI: 10.1111/jocd.16205] [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: 11/04/2023] [Revised: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND There is a growing trend of individuals wearing cosmetics while participating in physical activities. Nonetheless, there remains a need for further understanding regarding the effects of makeup on the facial epidermis during exercise, given the existing knowledge gaps. PURPOSE This study aimed to evaluate the effects of a cosmetic foundation cream on skin conditions during physical activity. METHODS Forty-three healthy college students, 20 males (26.3 ± 1.5 years) and 23 females (23.1 ± 1.0 years), were enrolled in this study. Foundation cream was applied to participants on half of the face in two different areas (MT: makeup T zone and MU: makeup U zone). The other half of the face served as internal control (T: non-makeup T zone and U: non-makeup U zones). Skin levels of moisture, elasticity, pore, sebum, and oil were measured using a skin analysis device (Aramhuvis, Gyeonggi, Republic of Korea) before and after a 20-min treadmill exercise. Paired t-test and independent t-test were performed for skin condition measurements at pre- and postexercise. RESULTS The skin moisture levels in both the T and MT significantly increased after exercise (p < 0.05) (pre-T: 24.5 ± 1.3, post-T: 38.5 ± 3.5 and pre-MT: 18.7 ± 0.7, post-MT: 40.4 ± 4.8). Elasticity also significantly improved in both the T and MT (p < 0.05) (pre-T: 25.6 ± 1.3, post-T: 41.5 ± 3.5 and pre-MT: 20.0 ± 0.9, post-MT: 41.7 ± 3.7). The size of the pores in the T zone observed a significant increase after exercise (p < 0.05) (pre-T: 41.7 ± 2.1, post-T: 47.8 ± 2.4). The sebum levels in the T zone exhibited a reduction following physical activity, whereas there was a notable increase in sebum levels in the makeup zones (p < 0.05) (pre-MT: 2.4 ± 0.7, post-MT:4.2 ± 0.8 and pre MU 1.8 ± 0.34, post MU 4.9 ± 0.9). The oil level was increased in the non-makeup zones (pre-T: 6.1 ± 1.4, post-T: 11.8 ± 2.0 and pre-U: 7.3 ± 1.5, post-U: 11.9 ± 1.9; p < 0.05) and decreased in the makeup zones (pre-MT: 13.3 ± 1.9, post-MT: 7.4 ± 2.3 and pre-MU: 22.1 ± 2.4, post-MU: 3.2 ± 1.0; p < 0.05). CONCLUSIONS The findings suggest that using foundation cream during aerobic exercise can reduce skin oil, causing dryness. Additionally, makeup can clog pores and increase sebum production. Therefore, wearing makeup may not be recommended for people with dry skin conditions based on the results of the current study. This research offers important insights to the public, encouraging them to consider the possible consequences of using makeup while exercising.
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Affiliation(s)
- Eun-Jung Yoon
- Department of Counselling, Health, and Kinesiology, Texas A&M University-San Antonio, San Antonio, Texas, USA
- Department of Life Sports Educator, Kongju National University, Kongju, Korea
| | - Eun Hye Kwon
- Department of Counselling, Health, and Kinesiology, Texas A&M University-San Antonio, San Antonio, Texas, USA
| | - Joo Hyun Kim
- Department of Counselling, Health, and Kinesiology, Texas A&M University-San Antonio, San Antonio, Texas, USA
| | - Jesse Delacruz
- Department of Counselling, Health, and Kinesiology, Texas A&M University-San Antonio, San Antonio, Texas, USA
| | - T Brock Symons
- Department of Counselling, Health, and Kinesiology, Texas A&M University-San Antonio, San Antonio, Texas, USA
| | - Sukho Lee
- Department of Counselling, Health, and Kinesiology, Texas A&M University-San Antonio, San Antonio, Texas, USA
| | - Dongsun Park
- Department of Biology Education, Korea National University of Education, Cheongju, Korea
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15
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Yuan X, Liu Q, Zhou H, Ni L, Yin X, Zhang X, Du M, Du X. Development and Validation of a Predictive Model for Intraoperative Hypothermia in Elderly Patients Undergoing Craniocerebral Tumor Resection: A Retrospective Cohort Study. World Neurosurg 2024; 184:e593-e602. [PMID: 38325704 DOI: 10.1016/j.wneu.2024.01.174] [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: 01/14/2024] [Accepted: 01/31/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Timely identification of elderly patients who are at risk of developing intraoperative hypothermia (IH) is imperative to enable appropriate interventions. This study aimed to develop a nomogram for predicting the risk of IH in elderly patients undergoing resection of craniocerebral tumor, and to validate its effectiveness. METHODS Elderly patients who underwent craniocerebral tumor resection at a large tertiary hospital in eastern China between January 2019 and December 2022 were included (n = 988). The study population was divided into a training set and a validation set by time period. Risk factors identified through the Least Absolute Shrinkage and Selection Operator method and logistic regression analysis were used to establish the nomogram. The model was validated internally by Bootstrap method and externally by validation set through receiver operating characteristic curve analysis, Hosmer-Lemeshow test, and decision curve analysis. RESULTS A total of 273 (27.6%) patients developed IH. Duration of anesthesia (P < 0.001), blood loss (P < 0.001), preoperative temperature (P < 0.001), tumor location (P < 0.001), age (P < 0.05), and mean arterial pressure (P < 0.05) were identified as independent risk factors for IH. A nomogram integrating these 6 factors was constructed. The area under the curve was 0.773 (95% confidence interval: 0.735-0.811) (70.5% specificity and 75.0% sensitivity), indicating good predictive performance. The decision curve analysis demonstrated the clinical benefit of using the nomogram. CONCLUSIONS Our model showed good performance in identifying elderly patients who are at high risk of developing IH during craniocerebral tumor resection. The nomogram can help inform timely preventive interventions.
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Affiliation(s)
- Xi Yuan
- Department of Anesthesiology and Surgery, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Qing Liu
- Department of Anesthesiology and Surgery, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Huixian Zhou
- Department of Anesthesiology and Surgery, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Liangyan Ni
- Department of Anesthesiology and Surgery, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Xuequn Yin
- Department of Anesthesiology and Surgery, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Xinmei Zhang
- Department of Anesthesiology and Surgery, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Meilan Du
- Department of Anesthesiology and Surgery, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Xiaohong Du
- Department of Anesthesiology and Surgery, the First Affiliated Hospital of Soochow University, Soochow, China.
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16
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Zhong Y, Zhu Y, Li J, Yang X, Feng Z, Liu H, Liang Z, Lin B, Liu Z, Wang X, Luo W, Zhu J, Li B, Lai S, Jiang W, Wu J, Li D, Zhang L, Huang B, Tang J. Efficacy and safety of radiofrequency ablation versus surgical sympathectomy in palmar hyperhidrosis. Sci Rep 2024; 14:7620. [PMID: 38556580 PMCID: PMC10982298 DOI: 10.1038/s41598-024-57834-0] [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: 01/09/2024] [Accepted: 03/22/2024] [Indexed: 04/02/2024] Open
Abstract
Radiofrequency ablation (RFA) comparative efficacy of treatments using video-assisted thoracoscopic sympathectomy (VATS) in the long term remains uncertain in patients with palmar hyperhidrosis (PHH). This study aimed to compare the efficacy and safety of RFA and VATS in patients with PHH. We recruited patients aged ≥ 14 years with diagnosed PHH from 14 centres in China. The treatment options of RFA or VATS were assigned to two cohort in patients with PHH. The primary outcome was the efficacy at 1-year. A total of 807 patients were enrolled. After propensity score matching, the rate of complete remission was lower in RFA group than VATS group (95% CI 0.21-0.57; p < 0.001). However, the rates of palmar dryness (95% CI 0.38-0.92; p = 0.020), postoperative pain (95% CI 0.13-0.33; p < 0.001), and surgery-related complications (95% CI 0.19-0.85; p = 0.020) were lower in RFA group than in VATS group, but skin temperature rise was more common in RFA group (95% CI 1.84-3.58; p < 0.001). RFA had a lower success rate than VATS for the complete remission of PHH. However, the symptom burden and cost are lower in patients undergoing RFA compared to those undergoing VATS.Trial Registration: ChiCTR2000039576, URL: http://www.chictr.org.cn/index.aspx .
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Affiliation(s)
- Yiyue Zhong
- Department of Anaesthesiology and Pain Medicine, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, Guangdong, China
| | - Yanwen Zhu
- Department of Anaesthesiology and Pain Medicine, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, Guangdong, China
| | - Jiayan Li
- Department of Thoracic Cardiovascular Surgery, Gaozhou People's Hospital, No. 89 Xiguan Road, Gaozhou, 525200, Guangdong, China
| | - Xiaowei Yang
- Department of Thoracic Cardiovascular Surgery, The First Hospital of Wuhan, No. 215 Zhongshan Road, Qiaokou District, Wuhan, 430070, China
| | - Zhiying Feng
- Department of Pain Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, 310003, China
| | - Haipeng Liu
- Department of Pain Medicine, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou, 730000, Gansu, China
| | - Zhu Liang
- Department of Thoracic Cardiovascular Surgery, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, Guangdong, China
| | - Baoquan Lin
- Department of Thoracic Cardiovascular Surgery, The 900Th Hospital of Joint Logistic Support Force, No. 156 West Second Ring North Road, Fuzhou, 350000, Fujian, China
| | - Zhifeng Liu
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, China
| | - Xin Wang
- Department of Pain Medicine, The Third People's Hospital of Huizhou, No. 1, Qiaodong Xuexiu Street, Huicheng District, Huizhou, 516000, Guangdong, China
| | - Weibin Luo
- Department of Thoracic Cardiovascular Surgery, The Second People's Hospital of Shenzhen, No. 3002 Sungang West Road, Futian District, Shenzhen, 518000, Guangdong, China
| | - Jian Zhu
- Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of the People's Liberation Army, 627#, Wuluo Road, Wuchang District, Wuhan, 430070, Hubei, China
| | - Bin Li
- Department of Thoracic Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 310000, China
| | - Shangdao Lai
- Department of Pain Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-Sen University, No. 63 Huangtang Road, Meijiang District, Meizhou, 514031, China
| | - Weize Jiang
- Department of Pain Medicine, China Railway Fuyang Central Hospital, No. 161 Xingfu Road, Yingdong District, Fuyang, 236000, Anhui, China
| | - Jiayuan Wu
- Department of Clinical Research, Affiliated Hospital of Guangdong Medical University, No. 57, South of People Avenue, Zhanjiang, 524001, Guangdong, China
| | - Daheng Li
- Department of Anaesthesiology and Pain Medicine, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, Guangdong, China
| | - Liangqing Zhang
- Department of Anaesthesiology and Pain Medicine, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, Guangdong, China
| | - Bing Huang
- Department of Anaesthesiology and Pain Center, The Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Jing Tang
- Department of Anaesthesiology and Pain Medicine, Affiliated Hospital of Guangdong Medical University, No. 57 People Avenue South, Zhanjiang, 524001, Guangdong, China.
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Shim JW, Kwon H, Moon HW, Chae MS. Clinical Efficacy of 10 Min of Active Prewarming for Preserving Patient Body Temperature during Percutaneous Nephrolithotomy: A Prospective Randomized Controlled Trial. J Clin Med 2024; 13:1843. [PMID: 38610608 PMCID: PMC11012836 DOI: 10.3390/jcm13071843] [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: 02/07/2024] [Revised: 03/02/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Percutaneous nephrolithotomy (PNL) poses a risk of hypothermia. Additionally, general anesthesia lowers the thresholds for shivering and vasoconstriction, which leads to dysfunction of central thermoregulation. Perioperative hypothermia is associated with adverse outcomes after surgery. In this study, we aimed to demonstrate that prewarming for 10 min can effectively prevent early hypothermia during PNL. Methods: A total of 68 patients scheduled for elective PNL were recruited to this study from January to June 2022, but two patients were excluded because of a change in the surgical plan. After randomization, patients in the prewarming group (n = 32) received warming using a forced-air warming device for 10 min in the preoperative area before being transferred to the operating room, while the controls (n = 34) did not. The incidence of hypothermia within the first hour after inducing general anesthesia was the primary outcome. Perioperative body temperatures and postoperative recovery findings were also evaluated. Results: Early intraoperative hypothermia decreased significantly more in the prewarming group than in the control group (9.4% vs. 41.2%, p = 0.003). Moreover, the net decrease in core body temperature during surgery was smaller in the prewarming group than in the control group (0.2 °C, vs. 0.5 °C, p = 0.003). In addition, the prewarmed patients had a lower incidence of postoperative shivering and a shorter post-anesthesia-care unit (PACU) stay (12.5% vs. 35.3%, p = 0.031; and 46 vs. 50 min, p = 0.038, respectively). Conclusions: Prewarming for 10 min decreased early hypothermia, preserved intraoperative body temperature, and improved postoperative recovery in the PACU.
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Affiliation(s)
- Jung-Woo Shim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hyejin Kwon
- Department of Anesthesiology and Pain Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hyong Woo Moon
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Min Suk Chae
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Oden TN, Celikturk Doruker N, Demir Korkmaz F. Perioperative Health Care Professionals' Knowledge of Evidence-Based Inadvertent Perioperative Hypothermia Management. J Perianesth Nurs 2024:S1089-9472(23)01097-3. [PMID: 38520469 DOI: 10.1016/j.jopan.2023.12.009] [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: 04/05/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 03/25/2024]
Abstract
PURPOSE To evaluate the perioperative health care professionals' knowledge of evidence-based inadvertent perioperative hypothermia management. DESIGN A descriptive, cross-sectional study. METHODS The research sample consisted of 219 perioperative nurses and anesthesia technicians working in the university hospital and participating in perioperative care. Data were collected by the researchers using a questionnaire that included descriptive characteristics of health care professionals and inadvertent perioperative hypothermia management between March and April 2021. Descriptive statistics, Shapiro-Wilk normality, Kruskal Wallis, Mann Whitney U, and Spearman correlation test were used to analyze the data. FINDINGS In this study, only 29.2% of the health care professionals knew that the threshold value for inadvertent perioperative hypothermia was <36 °C. The mean knowledge score of health care professionals on the management of inadvertent perioperative hypothermia was 13.78 ± 3.47. The knowledge score of 79.5% of health care professionals was moderate level. A significant correlation was determined between inadvertent perioperative hypothermia management knowledge score and education status (P = .032), task (P < .001), and mean years in the profession (P = .02). CONCLUSIONS The knowledge of the health care professionals working in the perioperative process about evidence-based practices related to inadvertent perioperative hypothermia management was determined to be moderate. We recommend increasing the level of knowledge of health care professionals by providing education on guidelines regarding inadvertent perioperative hypothermia management.
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Affiliation(s)
- Tugba N Oden
- Department of Organ Transplantation Center, Ege University Hospital, Izmir, Turkey.
| | | | - Fatma Demir Korkmaz
- Department of Surgical Nursing, Ege University Faculty of Nursing, Izmir, Turkey
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Zhang Y, Bai Y, Zhang Y, Du Y, Liu M, Zhu J, Wang G. Effect of Aggressive Warming versus Routine Thermal Management on the Incidence of Perioperative Hypothermia in Patients Undergoing Thyroid Surgery: A Prospective, Randomized, Double-Blind Controlled Trial. Ther Clin Risk Manag 2024; 20:207-216. [PMID: 38524686 PMCID: PMC10960539 DOI: 10.2147/tcrm.s454272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/04/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose Despite the implementation of various insulation measures, the incidence of hypothermia during thyroid surgery remains high. This randomized controlled study aimed to evaluate the effects of aggressive thermal management combined with resistive heating mattresses to prevent perioperative hypothermia in patients undergoing thyroid surgery. Patients and Methods 142 consecutive patients scheduled for elective thyroid surgery were enrolled in the study. They were randomly and equally allocated to the aggressive warming or routine care groups (n = 71). The patients' body temperature was monitored before the induction of anesthesia until they returned to the ward. The primary outcome was the incidence of perioperative hypothermia. Secondary outcomes included postoperative complications, such as mortality, cardiovascular complications, wound infection, shivering, postoperative nausea and vomiting (PONV), visual analog scale (VAS) pain scores, fever, headache and hospital length of stay (LOS). Results In our study, the results showed that a significantly higher rate of hypothermia was observed in the routine care group compared with the aggressive warming group. The incidence of perioperative hypothermia was 19.72% (14/71) in the aggressive warming group and 35.21% (25/71) in the routine care group (P < 0.05). The incidence of shivering in the aggressive warming group (1.41%) was significantly lower than that in the routine care group (11.27%) (P < 0.05), and a one-day reduction in hospital length of stay was observed in the aggressive warming group (P < 0.05). There was no significant difference in mortality or other postoperative complications, such as cardiovascular complications, wound infection, PONV, pain, fever or headache, between the two groups (P > 0.05). Conclusion Our results suggest that aggressive thermal management combined with resistive heating mattresses provided improved perioperative body temperature and reduced the incidence of perioperative hypothermia and shivering compared to routine thermal management.
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Affiliation(s)
- Yue Zhang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yafan Bai
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yi Zhang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yingjie Du
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Min Liu
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jiayu Zhu
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Guyan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
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Bozkurt Z, Şahin Akboğa Ö. The Relationship of Perioperative Inadvertent Hypothermia with Anxiety and Comfort. Ther Hypothermia Temp Manag 2024. [PMID: 38394137 DOI: 10.1089/ther.2023.0089] [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: 02/25/2024] Open
Abstract
The study aimed to investigate the relationship of perioperative inadvertent hypothermia with anxiety and thermal and general comfort in surgical patients. Inadvertent perioperative hypothermia occurs after surgery and affects many patient outcomes. However, the relationship between hypothermia and anxiety has been given little attention. The research is of descriptive type. A total of 117 surgical patients who met the inclusion criteria were sampled and divided into two groups: hypothermic (n = 54) and normothermic (n = 63). Patients undergoing surgery were monitored for body temperature, systolic and diastolic blood pressure, heart rate, pain intensity, anxiety (Numeric Rating Scale [NRS] and State Anxiety Scale [SAI]), and comfort (Perianesthesia Comfort Questionnaire) levels. The groups were similar in terms of descriptive characteristics (p > 0.05). Among the patients undergoing surgical intervention, 46.1% were hypothermic. Compared with the normothermic group, the hypothermic group had significantly lower body temperature until the second postoperative hour, lower thermal comfort score until the third postoperative hour, and higher heart rate and anxiety (NRS) score until the first postoperative day. Furthermore, there was a significant difference between the groups in terms of pain intensity up to the first 30 minutes after surgery (p < 0.05). Moreover, there was no significant difference between the groups in terms of pre and postoperative day one anxiety (SAI) and Periantesthesia Comfort Scale mean scores (p > 0.05). The study findings showed that hypothermia affected thermal comfort up to the first 3 hours after surgery, pain intensity up to the first 30 minutes, and heart rate and anxiety (NRS) levels up to the first day.
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Affiliation(s)
- Zehra Bozkurt
- Department of Nursing, Faculty of Health Sciences, University of Yozgat Bozok, Yozgat, Turkey
| | - Özlem Şahin Akboğa
- Department of Nursing, Faculty of Health Sciences, University of Yozgat Bozok, Yozgat, Turkey
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21
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Stobbe AY, Mertens MJ, Nolte PA, van Stralen KJ. A Warm Air Blanket is Superior to a Heated Mattress in Preventing Perioperative Hypothermia in Orthopedic Arthroplasties, a Time-Series Analyses. J Arthroplasty 2024; 39:326-331.e2. [PMID: 37597820 DOI: 10.1016/j.arth.2023.08.039] [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: 03/21/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Hypothermia is a common perioperative problem that can lead to severe complications. We evaluated whether a heated mattress (HM) is superior to a warm air blanket (WA) in preventing perioperative hypothermia in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHODS A retrospective cohort study was performed in a teaching hospital and data were collected for all patients undergoing THA or TKA between January 1, 2015 and May 1, 2022. We used logistic and linear regressions to analyze hypothermia occurrence and important complications. Results were adjusted for confounders and time, and was present in all subgroups and after imputation of missing data. RESULTS In total, 4,683 of 5,497 patients had information on type of heating. We found more perioperative hypothermia in patients treated with an HM compared to a WA for both THA (odds ratio-adjusted 1.42 [1.0 to 1.6] P = .06) and TKA (odds ratio-adjusted 2.10 [1.5 to 3.0] P < .01). There was no difference in postoperative infections between groups (all between 0.5% and 1.3%). Patients who had an HM significantly stayed longer in the postoperative ward (a mean difference of 4 [TKA] to 6 [THA] minutes, P < .01), but there was no difference in hospital stay. CONCLUSION A WA is superior compared to an HM in preventing perioperative hypothermia, with no increased risk of complications. Patients who have an HM stayed longer at the postoperative ward, potentially because of higher hypothermia rates. Therefore, it is suggested to use a WA instead of an HM.
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Affiliation(s)
- Ayla Y Stobbe
- Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands; Department of Anesthesiology, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands
| | - Martijn J Mertens
- Department of Anesthesiology, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands
| | - Peter A Nolte
- Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands; Department of Orthopedic surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands; Department Oral Cell Biology, Academic Center for Dentistry (ACTA), Vrije Universiteit Amsterdam (VU), Amsterdam, The Netherlands
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22
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Brodshaug I, Reine E, Raeder J. Maternal hypothermia during elective caesarean delivery: A prospective observational study. Acta Anaesthesiol Scand 2024; 68:247-253. [PMID: 37876139 DOI: 10.1111/aas.14340] [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: 03/16/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Patients undergoing caesarean delivery are at risk of developing unintended perioperative hypothermia, defined as a core temperature <36.0°C. Most previous studies of core temperature in caesarean delivery patients have not been conducted with accurate measurements for the complete perioperative period. Therefore, we conducted a prospective observational study to identify the incidence and duration of pre- and post-operative maternal hypothermia with a high accuracy continuous temperature monitoring system. METHODS Women ≥18 years old presenting for elective caesarean delivery under spinal anaesthesia were invited to participate in the study. The primary outcomes were the incidence and duration of perioperative maternal hypothermia (<36.0°C). Maternal core temperatures were measured with the non-invasive zero-heat-flux thermometer (Bair Hugger Temperature Monitoring System, 3M) throughout the perioperative course. RESULTS A total of 40 participants were recruited to the study. The incidence of perioperative hypothermia was 32.5%, with a duration of 77 ± 40 min (mean ± standard deviation). The hypothermic patients had similar core temperature as the normothermic patients at baseline preoperatively, but significantly lower temperature at operating room arrival and during the remaining study period. Forty percent of all patients reported thermal discomfort and felt cold on admission to post anaesthesia care unit, whereas 33% had shivering. Neither thermal discomfort nor shivering were associated with hypothermia. CONCLUSION In the present study almost a third of the women undergoing elective caesarean delivery developed perioperative hypothermia with a core temperature <36.0°C. The mean duration of maternal hypothermia was 77 min, lasting well into the postoperative period for many patients. These data should remind healthcare professionals of the importance of measuring core temperature in all phases of the perioperative setting and to consider optimal warming measures to avoid and treat hypothermia.
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Affiliation(s)
- Irene Brodshaug
- Department of Nurse Anaesthesia, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Elizabeth Reine
- Department of Nurse Anaesthesia, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Johan Raeder
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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23
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Liang H, Wang JY, Liang Y, Shao XF, Ding YL, Jia HQ. Agreement of zero-heat-flux thermometry with the oesophageal and tympanic core temperature measurement in patient receiving major surgery. J Clin Monit Comput 2024; 38:197-203. [PMID: 37792140 PMCID: PMC10879315 DOI: 10.1007/s10877-023-01078-2] [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: 06/25/2023] [Accepted: 09/12/2023] [Indexed: 10/05/2023]
Abstract
To identify and prevent perioperative hypothermia, most surgical patients require a non-invasive, accurate, convenient, and continuous core temperature method, especially for patients undergoing major surgery. This study validated the precision and accuracy of a cutaneous zero-heat-flux thermometer and its performance in detecting intraoperative hypothermia. Adults undergoing major non-cardiac surgeries with general anaesthesia were enrolled in the study. Core temperatures were measured with a zero-heat-flux thermometer, infrared tympanic membrane thermometer, and oesophagal monitoring at 15-minute intervals. Taking the average value of temperature measured in the tympanic membrane and oesophagus as a reference, we assessed the agreement using the Bland-Altman analysis and linear regression methods. Sensitivity, specificity, and predictive values of detecting hypothermia were estimated. 103 patients and one thousand sixty-eight sets of paired temperatures were analyzed. The mean difference between zero-heat-flux and the referenced measurements was -0.03 ± 0.25 °C, with 95% limits of agreement (-0.52 °C, 0.47 °C) was narrow, with 94.5% of the differences within 0.5 °C. Lin's concordance correlation coefficient was 0.90 (95%CI 0.89-0.92). The zero-heat-flux thermometry detected hypothermia with a sensitivity of 82% and a specificity of 90%. The zero-heat-flux thermometer is in good agreement with the reference core temperature based on tympanic and oesophagal temperature monitoring in patients undergoing major surgeries, and appears high performance in detecting hypothermia.
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Affiliation(s)
- Hao Liang
- Department of Anesthesiology, The Fourth Hospital Of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jing-Yan Wang
- Department of ENT, Affiliated Hospital Of Hebei University, Baoding, Hebei, China
| | - Yan Liang
- Department of Obstetrics, The NO.1 Central Hospital Of Baoding City, Baoding, Hebei, China
| | - Xin-Feng Shao
- Department of Anesthesiology, The NO.1 Central Hospital Of Baoding City, Baoding, Hebei, China
| | - Yan-Ling Ding
- Department of Anesthesiology, The NO.1 Central Hospital Of Baoding City, Baoding, Hebei, China
| | - Hui-Qun Jia
- Department of Anesthesiology, The Fourth Hospital Of Hebei Medical University, Shijiazhuang, Hebei, China.
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24
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Chang G, Moiteiro Manteigas H, Strutton PH, Mullington CJ. An evaluation of a healthy participant laboratory model of epidural hyperthermia: a physiological study. Int J Obstet Anesth 2024; 57:103961. [PMID: 38199895 DOI: 10.1016/j.ijoa.2023.103961] [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: 02/11/2023] [Revised: 11/01/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Hyperthermia complicates 21% of cases of intrapartum epidural analgesia, but the mechanism is unclear. One hypothesis is that blockade of cholinergic sympathetic nerves prevents active vasodilation and sweating, thus limiting heat loss. Because labour increases heat production, this could create a situation in which heat production exceeds loss, causing body temperature to rise. This physiological study tested a novel laboratory model of epidural-related hyperthermia, using exercise to simulate the increased heat production of labour and surface insulation to simulate the effect of epidural analgesia. METHODS Twelve healthy non-pregnant participants (six female) cycled an ergometer for two hours at 20 Watts (W) on two occasions: once with surface insulation (intervention) and once without (control). Core temperature, skin temperature (eight sites), and heat loss (eight sites) were recorded. Mean body temperature and heat production were calculated. Values are mean (SD). RESULTS Exercise increased heat production on both visits (intervention 38 (18) W; control 37 (31) W; P = 0.94). Total heat loss was less on the intervention visit (intervention 115 (19) W; control 129 (23) W; P = 0.002). Core temperature increased on both visits (intervention 0.21 (0.37)°C; control 0.19 (0.27)°C; P < 0.001). The increase in mean body temperature was greater on the intervention visit (intervention 0.47 (0.41)°C; control 0.25 (0.19)°C; P = 0.007). CONCLUSIONS This laboratory model predicts that labour epidural analgesia limits heat loss by >14 W. Once the model is validated, it could be used to test the efficacy of potential interventions to prevent and treat epidural-related maternal hyperthermia.
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Affiliation(s)
- G Chang
- MSk Lab, Imperial College London, London, UK
| | - H Moiteiro Manteigas
- MSk Lab, Imperial College London, London, UK; Theatres and Anaesthetics, Imperial College Healthcare NHS Trust, London, UK
| | | | - C J Mullington
- MSk Lab, Imperial College London, London, UK; Theatres and Anaesthetics, Imperial College Healthcare NHS Trust, London, UK.
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25
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Heo H, Kim YY, Lee JH, Kim G, Kwon D. Comparison of the incidence of inadvertent perioperative hypothermia between general anesthesia and interscalene brachial plexus block in shoulder arthroscopy: A randomized prospective study. Medicine (Baltimore) 2024; 103:e36855. [PMID: 38215085 PMCID: PMC10783373 DOI: 10.1097/md.0000000000036855] [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: 11/14/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION Inadvertent perioperative hypothermia (IPH), defined as core body temperature below 36°C, is associated with various complications. Shoulder arthroscopy is a risk factor of IPH. This study aimed to compare the incidence of IPH between general anesthesia (GA) and interscalene brachial plexus block (ISBPB) for shoulder arthroscopy. METHOD Patients scheduled for shoulder arthroscopy were prospectively enrolled and randomly assigned to GA or ISBPB groups. The body temperature of the patients was measured from baseline to the end of anesthesia and in the post-anesthetic care unit to compare the incidence of IPH. RESULTS Of the 114 patients initially identified, 80 were included in the study (GA = 40, ISBPB = 40). The incidence of IPH differed significantly between the groups, with GA at 52.5% and ISBPB at 30.0% (P = .04). Profound IPH (defined as < 35.0°C) occurred in 2 patients with GA. Upon arrival at the post-anesthesia care unit, the GA group exhibited a significantly lower mean body temperature (35.9 ± 0.6°C) than the ISBPB group (36.1 ± 0.2°C, P = .04). CONCLUSION The incidence of IPH in the GA group was higher than that in the ISBPB group during shoulder arthroscopy, suggesting that ISBPB may be a preferable anesthetic technique for reducing risk of IPH in such procedures.
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Affiliation(s)
- Hyunjoo Heo
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Jeollabuk-Do, Korea
| | - Yu Yil Kim
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Jeollabuk-Do, Korea
| | - Ji Hye Lee
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Jeollabuk-Do, Korea
| | - Gwanbeom Kim
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Jeollabuk-Do, Korea
| | - Dohun Kwon
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Jeollabuk-Do, Korea
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26
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Van Wicklin SA. Intraoperative Management of Older Adult Patients Undergoing Plastic Surgical Procedures. PLASTIC AND AESTHETIC NURSING 2024; 44:20-27. [PMID: 38166304 DOI: 10.1097/psn.0000000000000540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Affiliation(s)
- Sharon Ann Van Wicklin
- Sharon Ann Van Wicklin, PhD, RN, CNOR, CRNFA(E), CPSN-R, PLNC, ISPAN-F, FAORN, FAAN, is the Editor-in-Chief, Plastic and Aesthetic Nursing, and a Perioperative and Legal Nurse Consultant, Aurora, CO
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27
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Xu R, Nair SK, Kilgore CB, Xie ME, Jackson CM, Hui F, Gailloud P, McDougall CG, Gonzalez LF, Huang J, Tamargo RJ, Caplan J. Hypothermia is Associated with Improved Neurological Outcomes After Mechanical Thrombectomy. World Neurosurg 2024; 181:e126-e132. [PMID: 37690581 PMCID: PMC11060169 DOI: 10.1016/j.wneu.2023.09.010] [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: 04/12/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Acute ischemic stroke (AIS) is the second leading cause of death globally. Mechanical thrombectomy (MT) has improved patient prognosis but expedient treatment is still necessary to minimize anoxic injury. Lower intraoperative body temperature decreases cerebral oxygen demand, but the role of hypothermia in treatment of AIS with MT is unclear. METHODS We retrospectively reviewed patients undergoing MT for AIS from 2014 to 2020 at our institution. Patient demographics, comorbidities, intraoperative parameters, and outcomes were collected. Maximum body temperature was extracted from minute-by-minute anesthesia readings, and patients with maximal temperature below 36°C were considered hypothermic. Risk factors were assessed by χ2 and multivariate ordinal regression. RESULTS Of 68 patients, 27 (40%) were hypothermic. There was no significant association of hypothermia with patient age, comorbidities, time since last known well, number of passes intraoperatively, favorable revascularization, tissue plasminogen activator use, and immediate postoperative complications. Hypothermic patients exhibited better neurologic outcome at 3-month follow-up (P = 0.02). On multivariate ordinal regression, lower maximum intraoperative body temperature was associated with improved 3-month outcomes (P < 0.001), when adjusting for other factors influencing neurological outcomes. Other significant protective factors included younger age (P = 0.03), better revascularization (P = 0.03), and conscious sedation (P = 0.02). CONCLUSIONS Lower intraoperative body temperature during MT was independently associated with improved neurological outcome in this single center retrospective series. These results may help guide clinicians in employing therapeutic hypothermia during MT to improve long-term neurologic outcomes from AIS, although larger studies are needed.
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Affiliation(s)
- Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sumil K Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Collin B Kilgore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael E Xie
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ferdinand Hui
- Division of Neurointerventional Surgery, Queen's Medical Center, Honolulu, Hawaii, USA
| | - Phillipe Gailloud
- Department of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - L Fernando Gonzalez
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Justin Caplan
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Kim H, Jung H. Considerations regarding anesthesia for renal transplantation. Anesth Pain Med (Seoul) 2024; 19:5-11. [PMID: 38311350 PMCID: PMC10847005 DOI: 10.17085/apm.23153] [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: 12/01/2023] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 02/08/2024] Open
Abstract
Renal transplantation is a complex surgical procedure requiring meticulous anesthetic planning to ensure patient safety and optimal graft function. In this comprehensive review, we examined various aspects of anesthesia management during renal transplantation, including preoperative, intraoperative, and postoperative care. Preoperative optimization involves the identification and management of risks to mitigate perioperative complications. Treatment with erythropoiesis-stimulating agents is recommended to correct anemia in transplant recipients with hemoglobin levels below 9-10 g/dl. Intraoperative management focuses on hemodynamic monitoring, maintenance of intravascular volume, and careful selection of anesthetic techniques. Neuromuscular monitoring and the appropriate use of neuromuscular blocking and reversal agents are considered essential. Further, hemodynamic goals include maintaining the mean arterial pressure within the range of 80-110 mmHg. In addition, attention should be paid to perioperative glycemic control, temperature management, and diuretic use. In postoperative management, multimodal analgesia and the prevention of postoperative delirium contribute to optimal recovery. The implementation of enhanced recovery after surgery principles can further improve outcomes. Collaborative efforts among surgical teams, anesthesiologists, and healthcare professionals are crucial for achieving successful renal transplantation outcomes.
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Affiliation(s)
- Hyunjee Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hoon Jung
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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29
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Sakata H, Clark-Price SC, Johnson AK, Elrod SM, Hofmeister EH. Effect of a single intravenous injection of branched chain amino acids on body temperature of cats undergoing general anesthesia. Vet Anaesth Analg 2024; 51:44-51. [PMID: 38042672 DOI: 10.1016/j.vaa.2023.11.003] [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: 03/11/2023] [Revised: 11/05/2023] [Accepted: 11/05/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVE To evaluate the effect of a single intravenous injection of branched chain amino acids (BCAAs) on body temperature in cats undergoing general anesthesia. STUDY DESIGN Prospective, blinded, randomized, crossover, experimental study. ANIMALS A total of 10 healthy adult cats (five female and five male). METHODS Cats were anesthetized three times with three different treatments in a random order: 3 mL kg-1 lactated Ringer's solution (LRS), 100 mg kg-1 BCAAs (B100) or 200 mg kg-1 BCAAs (B200) solution immediately before induction of anesthesia. After induction, rectal temperature was measured every 5 minutes. Blood samples were collected for the measurement of blood glucose (BG) just before induction, at the end of the 90 minute period of anesthesia, and 24 hours after anesthesia induction. The differences between baseline and each subsequent rectal temperature, and BG measurements were analyzed. Areas under the curve (AUCs) for temperature differences were calculated for each animal for the anesthetic period (AUCT0-90). Parametric or nonparametric data were analyzed by one-way repeated measures anova or Friedman test. A value of p < 0.05 was considered significant. RESULTS There were no significant differences in AUCT0-90 between groups: 41.6 ± 7.7 for LRS, 43.4 ± 6.9 for B100 and 42.9 ± 7.5 for B200 (p = 0.368). No significant differences were observed in BG between groups at 90 minutes and 24 hours after anesthesia induction (p = 0.283 and p = 0.089, respectively). The incidence of hypoglycemia [BG ≤ 3.17 mmol L-1 (57 mg dL-1)] after anesthesia tended to be higher in both B100 (4/10 cats) and B200 groups (3/10 cats) than in LRS group (1/10 cats). CONCLUSIONS AND CLINICAL RELEVANCE A single, preanesthetic intravenous injection of BCAAs did not attenuate heat loss during anesthesia. More cats were hypoglycemic in the BCAA groups than in the LRS group.
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Affiliation(s)
- Hisashi Sakata
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA; Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA.
| | - Stuart C Clark-Price
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Aime K Johnson
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Susan M Elrod
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Erik H Hofmeister
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
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30
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Carella M, Beck F, Piette N, Lecoq JP, Bonhomme VL. Effect of preoperative warming on intraoperative hypothermia and postoperative functional recovery in total hip arthroplasty: a randomized clinical trial. Minerva Anestesiol 2024; 90:41-50. [PMID: 37878246 DOI: 10.23736/s0375-9393.23.17555-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND Intraoperative hypothermia is associated with increased morbidity and impaired postoperative recovery. Direct anterior-approached total hip arthroplasty (ATHA) may lead to significant thermal loss. We aimed to assess whether preoperative warming had an impact on intraoperative hypothermia and postoperative functional recovery after ATHA. METHODS In this prospective randomized controlled clinical trial 40 patients scheduled for ATHA were randomly divided into two groups of 20 patients each. Group W received, prior to the induction of general anesthesia, a 30 minutes 43 °C forced-air preoperative warming. Group C did not receive any preoperative warming. A blinded observer noted the core body temperature at the time of induction and at fixed time points, i.e. every five minutes during the first hour of surgery. The evolution of postoperative patient perceived thermal comfort (TC) and functional recovery (QoR-15) was assessed 24, 48 and 72 hours after surgery. Length of stay in the post-anesthesia care unit (PACU) was noted. RESULTS The temperature drop was significantly faster and of higher amplitude in group C than in group W, during first hour of surgery (P<0.001). Evolution of QoR-15 and TC was significantly better in group W than in group C (P<0.001 for QoR-15 and P<0.001 for thermal comfort), with shorter length of stay (median [IQR]) in the PACU (minutes; 73 [61-79] for group C and 98 [83-129] for group W, P<0.001). CONCLUSIONS In ATHA, pre-warming delays and reduces intraoperative heat loss, impacting patient comfort and postoperative functional recovery.
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Affiliation(s)
- Michele Carella
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Liege, Liege, Belgium -
- Inflammation and Enhanced Rehabilitation Laboratory (Regional Anesthesia and Analgesia), GIGA-I3 Thematic Unit, GIGA-Research, Liege University, Liege, Belgium -
| | - Florian Beck
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Liege, Liege, Belgium
- Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
| | - Nicolas Piette
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Liege, Liege, Belgium
- Inflammation and Enhanced Rehabilitation Laboratory (Regional Anesthesia and Analgesia), GIGA-I3 Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
| | - Jean-Pierre Lecoq
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Liege, Liege, Belgium
- Inflammation and Enhanced Rehabilitation Laboratory (Regional Anesthesia and Analgesia), GIGA-I3 Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
| | - Vincent L Bonhomme
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Liege, Liege, Belgium
- Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
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Ma Z, Ma P, Huang N, Li C, Cao Y, Chen J. Incidence of Unintentional Intraoperative Hypothermia and Its Risk Factors in Oral and Maxillofacial Surgery: A Prospective Study. J Perianesth Nurs 2023; 38:876-880. [PMID: 37565936 DOI: 10.1016/j.jopan.2023.01.019] [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: 06/08/2022] [Revised: 11/04/2022] [Accepted: 01/21/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Unintentional intraoperative hypothermia is a common complication in patients who undergo open surgery, increasing the risk of adverse outcomes. However, few studies have focused on intraoperative hypothermia during oral and maxillofacial surgery. Our study aimed to analyze the prevalence and risk factors of hypothermia in patients who underwent oral and maxillofacial surgery. DESIGN A prospective cohort study was conducted on 128 patients who underwent oral and maxillofacial surgery. METHODS This prospective study was conducted at West China Hospital of Stomatology between December 2020 and May 2021, and each patient was followed for at least 1-month postoperatively. Patients who underwent oral and maxillofacial surgery under general anesthesia, with at least 1-month follow-up were analyzed. The primary variable was intraoperative hypothermia, defined as core body temperature less than 36°C, measured using a tympanic thermometer during the surgery. We performed univariate and multivariate logistic regression analyses to identify the risk factors of unintentional intraoperative hypothermia. FINDINGS The mean age of the 128 patients was 31.0 ± 20.9 years, and there was a male predominance (53.1%), with male to female ratio of 1.13:1. Thirty-one patients (24.2%) developed hypothermia intraoperatively. Older age (OR = 1.068, 95% CI: 1.028-1.110, P = .001), lower weight (OR = 0.878, 95% CI: 0.807-0.955, P = .002), greater blood loss (OR = 1.003, 95% CI: 1.000-1.006, P = .034), and undergoing cancer surgery (OR = 0.210, 95% CI: 0.067-0.656, P = .007) were associated with intraoperative hypothermia. CONCLUSIONS Unintentional intraoperative hypothermia is common in patients who undergo surgery for oral cancer. Warming interventions to prevent intraoperative hypothermia for high-risk patients (older, lower weight, or more intraoperative bleeding) should be considered. Meanwhile, with careful nursing and rehabilitation instructions, intraoperative hypothermia does not lead to serious perioperative complications.
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Affiliation(s)
- Zhongkai Ma
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, PR China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Pingchuan Ma
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, PR China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Nengwen Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, PR China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Chunjie Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, PR China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Yubin Cao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, PR China; Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Jing Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, PR China; Department of Operating Room, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China.
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Recio-Pérez J, Miró Murillo M, Martin Mesa M, Silva García J, Santonocito C, Sanfilippo F, Asúnsolo A. Effect of Prewarming on Perioperative Hypothermia in Patients Undergoing Loco-Regional or General Anesthesia: A Randomized Clinical Trial. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2082. [PMID: 38138185 PMCID: PMC10744774 DOI: 10.3390/medicina59122082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Redistribution hypothermia occurs during anesthesia despite active intraoperative warming. Prewarming increases the heat absorption by peripheral tissue, reducing the central to peripheral heat gradient. Therefore, the addition of prewarming may offer a greater preservation of intraoperative normothermia as compared to intraoperative warming only. Materials and Methods: A single-center clinical trial of adults scheduled for non-cardiac surgery. Patients were randomized to receive or not a prewarming period (at least 10 min) with convective air devices. Intraoperative temperature management was identical in both groups and performed according to a local protocol. The primary endpoint was the incidence, the magnitude and the duration of hypothermia (according to surgical time) between anesthetic induction and arrival at the recovery room. Secondary outcomes were core temperature on arrival in operating room, surgical site infections, blood losses, transfusions, patient discomfort (i.e., shivering), reintervention and hospital stay. Results: In total, 197 patients were analyzed: 104 in the control group and 93 in the prewarming group. Core temperature during the intra-operative period was similar between groups (p = 0.45). Median prewarming lasted 27 (17-38) min. Regarding hypothermia, we found no differences in incidence (controls: 33.7%, prewarming: 39.8%; p = 0.37), duration (controls: 41.6% (17.8-78.1), prewarming: 45.2% (20.6-71.1); p = 0.83) and magnitude (controls: 0.19 °C · h-1 (0.09-0.54), prewarming: 0.20 °C · h-1 (0.05-0.70); p = 0.91). Preoperative thermal discomfort was more frequent in the prewarming group (15.1% vs. 0%; p < 0.01). The interruption of intraoperative warming was more common in the prewarming group (16.1% vs. 6.7%; p = 0.03), but no differences were seen in other secondary endpoints. Conclusions: A preoperative prewarming period does not reduce the incidence, duration and magnitude of intraoperative hypothermia. These results should be interpreted considering a strict protocol for perioperative temperature management and the low incidence of hypothermia in controls.
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Affiliation(s)
- Jesus Recio-Pérez
- Department of Anesthesia, Torrejon University Hospital, 28850 Torrejón de Ardoz, Spain; (M.M.M.)
| | - Miguel Miró Murillo
- Department of Anesthesia, Torrejon University Hospital, 28850 Torrejón de Ardoz, Spain; (M.M.M.)
| | - Marta Martin Mesa
- Department of Anesthesia, Torrejon University Hospital, 28850 Torrejón de Ardoz, Spain; (M.M.M.)
| | | | - Cristina Santonocito
- Department of Anesthesia and Intensive Care, University Hospital “Policlinico-San Marco”, 95124 Catania, Italy;
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, University Hospital “Policlinico-San Marco”, 95124 Catania, Italy;
- Department of Surgery and Medical-Surgical Specialties, University of Catania, 95124 Catania, Italy
| | - Angel Asúnsolo
- Department of Public Health, Alcala University, 28801 Alcala de Henares, Spain
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Şahin Akboğa Ö, Gürkan A. Effects of Active Heating Methods on Body Temperature, Shivering, Thermal Comfort, Pain, Nausea and Vomiting During General Anesthesia: A Randomized Controlled Trial. Ther Hypothermia Temp Manag 2023. [PMID: 38011688 DOI: 10.1089/ther.2023.0049] [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: 11/29/2023] Open
Abstract
To investigate the effect of forced-air warming and heated intravenous (IV) and irrigation fluids alone and in combination on body temperature, shivering, thermal comfort, pain, nausea and vomiting in adult patients undergoing surgery under general anesthesia in a prospective, four-group, randomized controlled trial. After induction of anesthesia, 120 patients were divided into the following groups: patients warmed with forced-air warming (n = 30), patients receiving warmed IV and irrigation fluid (n = 30), patients receiving warmed IV and irrigation fluid with forced-air warming (n = 30), and the control group without any intervention (n = 30). Body temperature, shivering, thermal comfort, pain, nausea and vomiting were monitored in the first 24 hours after surgery. The general characteristics of the groups, mean body temperature, length of stay, ambient temperature, and duration of surgery in the preoperative waiting unit were similar (p > 0.05). Compared with the other groups, patients in the control group had a significant decrease in body temperature from the 30th minute during surgery (p < 0.001), lower body temperature in the first 2 hours and thermal comfort in the first three hours after surgery (p < 0.01), and higher shivering levels in the first hour after surgery (p < 0.01). There was no significant difference between the groups in terms of postoperative pain, nausea and vomiting (p > 0.05). The study findings showed that normothermia was maintained in all three intervention groups during the surgery and in the first 24 hours after surgery. Moreover, postoperative thermal comfort increased and shivering levels decreased compared with the control group, but pain, nausea and vomiting levels were not affected. The study was registered on ClinicalTrials.gov (NCT04907617).
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Affiliation(s)
| | - Aysel Gürkan
- Faculty of Health Sciences, University of Marmara, Istanbul, Turkey
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Song S, Pei L, Chen H, Zhang Y, Sun C, Yi J, Huang Y. Analysis of hospital and payer costs of care: aggressive warming versus routine warming in abdominal major surgery. Front Public Health 2023; 11:1256254. [PMID: 38026375 PMCID: PMC10652782 DOI: 10.3389/fpubh.2023.1256254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Background Hypothermia is common and active warming is recommended in major surgery. The potential effect on hospitals and payer costs of aggressive warming to a core temperature target of 37°C is poorly understood. Methods In this sub-analysis of the PROTECT trial (clinicaltrials.gov, NCT03111875), we included patients who underwent radical procedures of colorectal cancer and were randomly assigned to aggressive warming or routine warming. Perioperative outcomes, operation room (OR) scheduling process, internal cost accounting data from the China Statistical yearbook (2022), and price lists of medical and health institutions in Beijing were examined. A discrete event simulation (DES) model was established to compare OR efficiency using aggressive warming or routine warming in 3 months. We report base-case net costs and sensitivity analyses of intraoperative aggressive warming compared with routine warming. Costs were calculated in 2022 using US dollars (USD). Results Data from 309 patients were analyzed. The aggressive warming group comprised 161 patients and the routine warming group comprised 148 patients. Compared to routine warming, there were no differences in the incidence of postoperative complications and total hospitalization costs of patients with aggressive warming. The potential benefit of aggressive warming was in the reduced extubation time (7.96 ± 4.33 min vs. 10.33 ± 5.87 min, p < 0.001), lower incidence of prolonged extubation (5.6% vs. 13.9%, p = 0.017), and decreased staff costs. In the DES model, there is no add-on or cancelation of operations performed within 3 months. The net hospital costs related to aggressive warming were higher than those related to routine warming in one operation (138.11 USD vs. 72.34 USD). Aggressive warming will have an economic benefit when the OR staff cost is higher than 2.37 USD/min/person, or the cost of disposable forced-air warming (FAW) is less than 12.88 USD/piece. Conclusion Despite improving OR efficiency, the economic benefits of aggressive warming are influenced by staff costs and the cost of FAW, which vary from different regions and countries. Clinical trial registration clinicaltrials.gov, identifier (NCT03111875).
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Affiliation(s)
- Shujia Song
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lijian Pei
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongda Chen
- Institute for Clinical Medical Research, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuelun Zhang
- Institute for Clinical Medical Research, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Sun
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Yi
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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de Jonge SW, Hulskes RH, Zokaei Nikoo M, Weenink RP, Meyhoff CS, Leslie K, Myles P, Forbes A, Greif R, Akca O, Kurz A, Sessler DI, Martin J, Dijkgraaf MG, Pryor K, Belda FJ, Ferrando C, Gurman GM, Scifres CM, McKenna DS, Chan MT, Thibon P, Mellin-Olsen J, Allegranzi B, Boermeester M, Hollmann MW. Benefits and harms of perioperative high fraction inspired oxygen for surgical site infection prevention: a protocol for a systematic review and meta-analysis of individual patient data of randomised controlled trials. BMJ Open 2023; 13:e067243. [PMID: 37899157 PMCID: PMC10619062 DOI: 10.1136/bmjopen-2022-067243] [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: 08/15/2022] [Accepted: 07/27/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION The use of high fraction of inspired oxygen (FiO2) intraoperatively for the prevention of surgical site infection (SSI) remains controversial. Promising results of early randomised controlled trials (RCT) have been replicated with varying success and subsequent meta-analysis are equivocal. Recent advancements in perioperative care, including the increased use of laparoscopic surgery and pneumoperitoneum and shifts in fluid and temperature management, can affect peripheral oxygen delivery and may explain the inconsistency in reproducibility. However, the published data provides insufficient detail on the participant level to test these hypotheses. The purpose of this individual participant data meta-analysis is to assess the described benefits and harms of intraoperative high FiO2compared with regular (0.21-0.40) FiO2 and its potential effect modifiers. METHODS AND ANALYSIS Two reviewers will search medical databases and online trial registries, including MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov and WHO regional databases, for randomised and quasi-RCT comparing the effect of intraoperative high FiO2 (0.60-1.00) to regular FiO2 (0.21-0.40) on SSI within 90 days after surgery in adult patients. Secondary outcome will be all-cause mortality within the longest available follow-up. Investigators of the identified trials will be invited to collaborate. Data will be analysed with the one-step approach using the generalised linear mixed model framework and the statistical model appropriate for the type of outcome being analysed (logistic and cox regression, respectively), with a random treatment effect term to account for the clustering of patients within studies. The bias will be assessed using the Cochrane risk-of-bias tool for randomised trials V.2 and the certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation methodology. Prespecified subgroup analyses include use of mechanical ventilation, nitrous oxide, preoperative antibiotic prophylaxis, temperature (<35°C), fluid supplementation (<15 mL/kg/hour) and procedure duration (>2.5 hour). ETHICS AND DISSEMINATION Ethics approval is not required. Investigators will deidentify individual participant data before it is shared. The results will be submitted to a peer-review journal. PROSPERO REGISTRATION NUMBER CRD42018090261.
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Affiliation(s)
- Stijn W de Jonge
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Rick H Hulskes
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Robert P Weenink
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kate Leslie
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ozan Akca
- Department of Anaesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrea Kurz
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
- Department of General Anaesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
- Department of General Anaesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Janet Martin
- Department of Anaesthesiology and Perioperative Medicine, and Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Marcel Gw Dijkgraaf
- Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Kane Pryor
- Department of Anaesthesiology, Weil Medical College of Cornell University, New York City, New York, USA
| | - F Javier Belda
- Department of Surgery, Hospital Clinico Universitario de Valencia, Valencia, Valenciana, Spain
- Department of Anaesthesia and Critical Care, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Carlos Ferrando
- Department of Anaesthesiology and Critical Care, Hospital Clínic de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Gabriel M Gurman
- Department of Anaesthesiology and Critical Care Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Christina M Scifres
- Department of Obstetrics and Gynaecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David S McKenna
- Department of Obstetrics and Gynaecology, Wright State University and Miami Valley Hospital, Dayton, Ohio, USA
| | - Matthew Tv Chan
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Pascal Thibon
- Centre d'appui pour la Prévention des Infections Associées aux Soins, CPias Normandie, Centre Hospitalo-Universitaire, Caen, Normandy, France
| | | | | | - Marja Boermeester
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
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Park C, Kim T, Oh S, Bang YS. Prospective comparative analysis of zero-heat-flux thermometer (SpotOn®) compared with tympanic thermometer and bladder thermometer in extremely aged patients undergoing lower extremity orthopedic surgery. Medicine (Baltimore) 2023; 102:e35593. [PMID: 37861486 PMCID: PMC10589526 DOI: 10.1097/md.0000000000035593] [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: 07/12/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023] Open
Abstract
Thermoregulation is important for maintaining homeostasis in the body. It can be easily broken under anesthesia. An appropriate method for measuring core body temperature is needed, especially for elderly patients, because the efficiency of thermoregulation gradually decreases with age. Zero-heat-flux (ZHF) thermometry (SpotOn) is an alternative, noninvasive method for continuous temperature monitoring at the skin surface. The aim of this study was to examine the accuracy and feasibility of using the SpotOn sensor in lower extremity orthopedic surgery in elderly patients aged over 80 years by comparing a SpotOn sensor with 2 other reliable minimally invasive methods: a tympanic membrane thermometer and a bladder thermometer. This study enrolled 45 patients aged over 80 years who were scheduled to undergo lower extremity surgery. Body temperature was measured using a SpotOn sensor, a tympanic membrane thermometer and a bladder thermometer. Agreements between the SpotOn sensor and the other 2 methods were assessed using Bland and Altman plots for repeated measures adjusted for unequal numbers of measurements per patient. Compared with bladder temperature, bias and limits of agreement for SpotOn temperature were 0.07°C ± 0.58°C. Compared with tympanic membrane temperature, bias and limits of agreement for SpotOn temperature were -0.28°C ± 0.61°C. The 3M SpotOn sensor using the ZHF method for patients aged over 80 years undergoing lower extremity surgery showed feasible measurement value and sensitivity.
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Affiliation(s)
- Chunghyun Park
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Taeyeon Kim
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Soojeong Oh
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Yun-Sic Bang
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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Wang G, He S, Yu M, Zhang Y, Mu D, Wang D. Intraoperative body temperature and emergence delirium in elderly patients after non-cardiac surgery: A secondary analysis of a prospective observational study. Chin Med J (Engl) 2023; 136:2330-2339. [PMID: 36939236 PMCID: PMC10538877 DOI: 10.1097/cm9.0000000000002375] [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: 10/15/2022] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Emergence delirium (ED) is a kind of delirium that occured in the immediate post-anesthesia period. Lower body temperature on post-anesthesia care unit (PACU) admission was an independent risk factor of ED. The present study was designed to investigate the association between intraoperative body temperature and ED in elderly patients undergoing non-cardiac surgery. METHODS This study was a secondary analysis of a prospective observational study. Taking baseline body temperature as a reference, intraoperative absolute and relative temperature changes were calculated. The relative change was defined as the amplitude between intraoperative lowest/highest temperature and baseline reference. ED was assessed with the confusion assessment method for intensive care unit at 10 and 30 min after PACU admission and before PACU discharge. RESULTS A total of 874 patients were analyzed with a mean age of 71.8 ± 5.3 years. The incidence of ED was 38.4% (336/874). When taking 36.0°C, 35.5°C, and 35.0°C as thresholds, the incidences of absolute hypothermia were 76.7% (670/874), 38.4% (336/874), and 17.5% (153/874), respectively. In multivariable logistic regression analysis, absolute hypothermia (lowest value <35.5°C) and its cumulative duration were respectively associated with an increased risk of ED after adjusting for confounders including age, education, preoperative mild cognitive impairment, American Society of Anesthesiologists grade, duration of surgery, site of surgery, and pain intensity. Relative hypothermia (decrement >1.0°C from baseline) and its cumulative duration were also associated with an increased risk of ED, respectively. When taking the relative increment >0.5°C as a threshold, the incidence of relative hyperthermia was 21.7% (190/874) and it was associated with a decreased risk of ED after adjusting above confounders. CONCLUSIONS In the present study, we found that intraoperative hypothermia, defined as either absolute or relative hypothermia, was associated with an increased risk of ED in elderly patients after non-cardiac surgery. Relative hyperthermia, but not absolute hyperthermia, was associated with a decreased risk of ED. REGISTRATION Chinese Clinical Trial Registry (No. ChiCTR-OOC-17012734).
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Affiliation(s)
- Guojun Wang
- Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China
| | - Shuting He
- Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China
| | - Mengyao Yu
- Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China
| | - Yan Zhang
- Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China
- Department of Anesthesiology, Peking University Cancer Hospital, Beijing 100142, China
| | - Dongliang Mu
- Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China
| | - Dongxin Wang
- Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China
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Zhao B, Zhu Z, Qi W, Liu Q, Zhang Q, Jiang L, Wang C, Weng X. Construction and validation of a risk prediction model for intraoperative hypothermia in elderly patients undergoing total hip arthroplasty. Aging Clin Exp Res 2023; 35:2127-2136. [PMID: 37490260 PMCID: PMC10520156 DOI: 10.1007/s40520-023-02500-0] [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: 04/01/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
AIMS To construct and validate an intraoperative hypothermia risk prediction model for elderly patients undergoing total hip arthroplasty (THA). METHODS We collected data from 718 patients undergoing THA in a tertiary hospital from January 2021 to December 2022. Of these patients, 512 were assigned to the modeling group from January 2021 to April 2022, and 206 participants were assigned to the validation group from May 2022 to December 2022. A logistic regression analysis was performed to construct the model. The area under the curve (AUC) was used to test the model's predictive ability. RESULTS The incidence rate of intraoperative hypothermia was 51.67%. The risk factors entered into the risk prediction model were age, preoperative hemoglobin level, intraoperative blood loss, postoperative hemoglobin level, and postoperative systolic blood pressure. The model was constructed as follows: logit (P) = - 10.118 + 0.174 × age + 1.366 × 1 (preoperative hemoglobin level) + 0.555 × 1 (postoperative hemoglobin level) + 0.009 × 1 (intraoperative blood loss) + 0.066 × 1 (postoperative systolic blood pressure). Using the Hosmer-Lemeshow test, the P value was 0.676 (AUC, 0.867). The Youden index, sensitivity, and specificity were 0.602, 0.790, and 0.812, respectively. The incidence rates of intraoperative hypothermia in the modeling and validation groups were 53.15% and 48.06%, respectively. The correct practical application rate was 89.81%. This model had good application potential. CONCLUSIONS This risk prediction model has good predictive value and can accurately predict the occurrence of intraoperative hypothermia in patients who undergo THA, which provides reliable guidance for clinical work and has good clinical application value.
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Affiliation(s)
- Bin Zhao
- Department of Anesthesiology and SICU, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China
| | - Zhe Zhu
- Department of Anesthesiology and SICU, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China
| | - Wenwen Qi
- Department of Psychogeriatric, School of Medicine, Shanghai Mental Health Center, Shanghai Jiao Tong University, South Wanping Road 600, Shanghai, 200030, China
| | - Qiuli Liu
- Department of Anesthesiology and SICU, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China
| | - Qi Zhang
- Department of Emergency, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China
| | - Liping Jiang
- Department of Nursing, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China.
| | - Chenglong Wang
- Department of Orthopaedic Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China.
| | - Xiaojian Weng
- Department of Anesthesiology and SICU, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China.
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Ito Y, Ishii T, Yamazaki S, Yoshida A, Nagaya K, Saijo Y. Evaluation of temperature-dependent fluctuations in skin microcirculation flow using a light-emitting diode based photoacoustic imaging device. J Clin Monit Comput 2023; 37:1361-1367. [PMID: 37166692 DOI: 10.1007/s10877-023-01026-0] [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: 10/24/2022] [Accepted: 04/24/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Skin microvessels maintain temperature homeostasis by contracting and dilating upon exposure to changes in temperature. Under general anesthesia, surgical invasiveness, including incisions and coagulation, and the effects of anesthetics may cause variations in the threshold temperature, leading to the constriction and dilation of cutaneous blood vessels. Therefore, studies on skin microvascular circulation are necessary to develop appropriate interventions for complications during surgery. METHODS We visualized and quantified skin microcirculatory fluctuations associated with temperature variations using a light-emitting diode photoacoustic imaging (LED-PAI) device. The hands of ten healthy volunteers were stressed with four different water temperatures [25℃ (Control), 15℃ (Cold1), 40℃ (Warm), and 15℃ (Cold2)]. The photoacoustic images of the fingers were taken under each condition, and the microvascular flow owing to temperature stress was quantified as the area of photoacoustic signal (S) in each image. The S values were compared with the variations in blood flow (Q) measured by laser Doppler flowmetry (LDF). RESULTS The correlation between Q and S according to the 40 measurements was r = 0.45 (p<0.01). In addition, the values of S under each stress condition were as follows: Scontrol = 10,826 ± 3364 pixels, Scold1 = 8825 ± 2484 pixels, Swarm = 13,369 ± 3001 pixels, and Scold2 = 8838 ± 1892 pixels; the differences were significant. The LDF blood flow (Q) showed similar changes among conditions. CONCLUSION These findings suggest that the LED-PAI device could be an option for evaluating microcirculation in association with changes in temperature.
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Affiliation(s)
- Yosuke Ito
- Graduate School of Medicine, Tohoku University, Sendai, Miyagi, 980-8575, Japan.
- Department of Anesthesia, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, 983-8512, Japan.
| | - Takuro Ishii
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, 980-8579, Japan
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai, Miyagi, 980-8578, Japan
| | - Shin Yamazaki
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, 980-8579, Japan
| | - Akiko Yoshida
- Department of Anesthesia, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, 983-8512, Japan
| | - Kei Nagaya
- Department of Anesthesia, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, 983-8512, Japan
| | - Yoshifumi Saijo
- Graduate School of Medicine, Tohoku University, Sendai, Miyagi, 980-8575, Japan
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, 980-8579, Japan
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Luca E, Schipa C, Cambise C, Sollazzi L, Aceto P. Implication of age-related changes on anesthesia management. Saudi J Anaesth 2023; 17:474-481. [PMID: 37779561 PMCID: PMC10540993 DOI: 10.4103/sja.sja_579_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 10/03/2023] Open
Abstract
Elderly patients have a high risk of perioperative morbidity and mortality. Pluri-morbidities, polypharmacy, and functional dependence may have a great impact on intraoperative management and request specific cautions. In addition to surgical stress, several perioperative noxious stimuli such as fasting, blood loss, postoperative pain, nausea and vomiting, drug adverse reactions, and immobility may trigger a derangement leading to perioperative complications. Older patients have a high risk of major hemodynamic derangement due to aging of the cardiovascular system and associated comorbidities. The hemodynamic monitoring as well as fluid therapy should be the most accurate as possible. Aging is accompanied by decreased renal function, which is related to a reduction in renal blood flow, renal mass, and the number and size of functioning nephrons. Drugs eliminated predominantly by the renal route need dosage adjustments based on residual renal function. Liver mass, hepatic blood flow, and intrinsic metabolic activity are decreased in the elderly, and all drugs metabolized by the liver have a variable half-life, thus requiring dose reduction. Decreased neural plasticity contributes to a high risk for postoperative delirium. Monitoring of anesthesia depth should be mandatory to avoid overdosage of hypnotic drugs. Prevention of postoperative pulmonary complications requires both protective ventilation strategies and adequate recovery of neuromuscular function at the end of surgery. Avoidance of hypothermia cannot be missed. The aim of this review is to describe comprehensive strategies for intraoperative management plans tailored to meet the unique needs of elderly surgical patients, thus improving outcomes in this vulnerable population.
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Affiliation(s)
- Ersilia Luca
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Schipa
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Cambise
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Liliana Sollazzi
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paola Aceto
- Dipartimento di Scienze dell’emergenza, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
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Tian YN, Gao WY, Tian XR, Wang ZW. Comparative Efficacy of Six Active Warming Systems for Intraoperative Warming in Adult Patients Undergoing Laparoscopic Surgery: A Systematic Review and Network Meta-Analysis. Ther Hypothermia Temp Manag 2023; 13:92-101. [PMID: 36449377 DOI: 10.1089/ther.2022.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Intraoperative hypothermia is very common and harmful in adult patients undergoing laparoscopic surgery. A variety of active warming systems has received close attention and has been researched by related scholars. However, the relative efficacy of these systems and which active warming system is preferred for such patients remain unclear. The aim of this study was to compare and rank six active warming systems regarding intraoperative warming efficacy in adult patients undergoing laparoscopic surgery. Following the PRISMA 2020 guidelines, relevant randomized controlled trials (RCTs) on the efficacy of different active warming systems in warming adult patients undergoing laparoscopic surgery were searched from five English databases and three Chinese databases. The quality of the studies was assessed using the Cochrane Risk of Bias tool (RoB2). The outcome was the final intraoperative core temperature. We estimated direct effects by using pairwise meta-analysis, estimated relative effects and ranking with the consistency model to conduct an NetworkMeta-Analysis (NMA). We used GRADE (Grading of Recommendations Assessment, Development, and Evaluation) to assess the certainty of the evidence. Sensitivity analysis was performed to test the robustness of the results. This study is registered with PROSPERO, with number CRD42022309057. In total, 19 RCTs involving 6 active warming systems and comprising 1364 patients were included in this NMA. The NMA once again confirmed the validity of forced-air warming (FAW) systems compared with other active warming systems, and further showed that underbody FAW was associated with more remarkable warming efficacy in different types of FAW systems. NMA was used to perform an exhaustive comparison of the warming efficacy of six active warming systems and indicated that underbody FAW was most likely to be the most effective warming system in adult patients undergoing laparoscopic surgery; however, considering the sparsity of the network, our results should be cautiously interpreted. Furthermore, a large number of high-quality RCTs comparing the warming efficacy of different competitive active warming systems are needed.
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Affiliation(s)
- Yan-Ni Tian
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Wei-Yin Gao
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiao-Rong Tian
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhi-Wen Wang
- School of Nursing, Peking University, Beijing, China
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Li L, Ye W, Li Y, Chen Y, Zeng J. Intraoperative accidental hypothermia as a probable cause of malignant ventricular arrhythmias in an elderly patient undergoing transurethral resection of prostate: A case report. Heliyon 2023; 9:e19006. [PMID: 37600405 PMCID: PMC10432956 DOI: 10.1016/j.heliyon.2023.e19006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/23/2023] [Accepted: 08/04/2023] [Indexed: 08/22/2023] Open
Abstract
Background Intraoperative hypothermia is a common but severe condition that is defined as a core body temperature below 36 °C. Accidental hypothermia can produce coagulopathy, immunosuppression and peripheral hypoperfusion that can ultimately lead to life-threatening ventricular arrhythmias and vital organ injury, and it is significantly associated with perioperative complications and mortality. Case description We report the case of an 82-year-old man who presented with persistent ventricular tachycardia intraoperatively due to accidental hypothermia. The patient was diagnosed with benign prostatic hypertrophy and scheduled for transurethral resection of the prostate. Laboratory tests showed moderate anemia, and echocardiography indicated mild tricuspid and mitral regurgitation. The patient received general anesthesia with endotracheal intubation. Four hours after the start of surgery, the patient developed sudden ventricular tachycardia with severe hypotension. Arterial blood gas sampling indicated that there was no disturbance of electrolytes, acid-base balance or excessive bleeding. The rectal temperature was measured immediately, and the core temperature was 32 °C. The patient received antiarrhythmic therapy and rewarming measures. No additional ventricular arrhythmias appeared after the core temperature rose to 35 °C and the blood pressure returned to normal. The patient was transferred to the intensive care unit after surgery for further observation and was moved to the general ward the next day. He was discharged 4 days later without significant organ damage. Conclusions Intraoperative hypothermia may increase ventricular arrhythmia risk, especially in elderly patients. Surgeons and anesthesiologists should pay more attention to preventing and reversing accidental hypothermia, necessitating aggressive efforts to maintain normothermia during surgery.
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Affiliation(s)
| | | | - Yongxing Li
- Department of Anesthesiology, The Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yingzhen Chen
- Department of Anesthesiology, The Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianfeng Zeng
- Department of Anesthesiology, The Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
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Elmer J, Callaway CW. Temperature control after cardiac arrest. Resuscitation 2023; 189:109882. [PMID: 37355091 PMCID: PMC10530429 DOI: 10.1016/j.resuscitation.2023.109882] [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: 05/19/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/26/2023]
Abstract
Managing temperature is an important part of post-cardiac arrest care. Fever or hyperthermia during the first few days after cardiac arrest is associated with worse outcomes in many studies. Clinical data have not determined any target temperature or duration of temperature management that clearly improves patient outcomes. Current guidelines and recent reviews recommend controlling temperature to prevent hyperthermia. Higher temperatures can lead to secondary brain injury by increasing seizures, brain edema and metabolic demand. Some data suggest that targeting temperature below normal could benefit select patients where this pathology is common. Clinical temperature management should address the physiology of heat balance. Core temperature reflects the heat content of the head and torso, and changes in core temperature result from changes in the balance of heat production and heat loss. Clinical management of patients after cardiac arrest should include measurement of core temperature at accurate sites and monitoring signs of heat production including shivering. Multiple methods can increase or decrease heat loss, including external and internal devices. Heat loss can trigger compensatory reflexes that increase stress and metabolic demand. Therefore, any active temperature management should include specific pharmacotherapy or other interventions to control thermogenesis, especially shivering. More research is required to determine whether individualized temperature management can improve outcomes.
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Affiliation(s)
- Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Paul F, Alef M. Variation of rectal temperature in dogs undergoing 3T-MRI in general anesthesia. Front Vet Sci 2023; 10:1156773. [PMID: 37559890 PMCID: PMC10409483 DOI: 10.3389/fvets.2023.1156773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/06/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVES Managing body temperature during MRI scanning under general anesthesia poses challenges for both human and veterinary patients, as many temperature monitoring devices and patient warming systems are unsuitable for the use inside an MRI scanner. MRI has the potential to cause tissue and body warming, but this effect may be counteracted by the hypothermia induced by general anesthesia and the low ambient temperature usually encountered in scanner rooms. This study aimed to observe temperature variations in dogs undergoing MRI under general anesthesia. MATERIALS AND METHODS In this prospective observational study, client-owned dogs scheduled for 3-Tesla MRI under anesthesia between February and October 2020 at a veterinary teaching hospital were eligible for enrollment. Recorded data included breed, body mass, body condition score, age, fur quality, pre- and post-MRI rectal temperatures, time in the MRI room, scan area and coil used, application of contrast medium, choice of anesthetic agents, use of blankets, and infusion therapy. Group comparisons were conducted using the Mann-Whitney U-test or Kruskal-Wallis test, with p < 0.05 considered significant. RESULTS In total 171 dogs met the inclusion criteria. The median body temperature at admission was 38.4°C (IQR 38.1-38.7°C). The median body temperature before MRI was 38.2°C (IQR 37.8-38.6°C), and the median temperature after the MRI scan was 37.7°C (IQR 37.238.2°C) resulting in a median temperature difference (∆T) before and after MRI of - 0.6°C (IQR -0.8--0.1°C). The median duration of MRI scans was 49 min (IQR 38-63 min). A temperature loss of more than 0.1°C was observed in 121 (70.8%) dogs, 29 (16.9%) dogs maintained their temperature within 0.1°C, and 21 (12.3%) dogs experienced a temperature increase of more than 0.1°C. Factors associated with a higher post-MRI temperature included greater body mass, medium or long fur, and the application of α2- receptor-agonists. CONCLUSION Dogs undergoing MRI under general anesthesia are likely to experience temperature loss in the given circumstances. However, in larger dogs and those with much fur, an increase in body temperature is possible and more common than generally anticipated, although clinically insignificant in most cases.
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Affiliation(s)
- Frauke Paul
- Department for Small Animals, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
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Dibiasi C, Agibetov A, Kapral L, Zeiner S, Kimberger O. Predicting Intraoperative Hypothermia Burden during Non-Cardiac Surgery: A Retrospective Study Comparing Regression to Six Machine Learning Algorithms. J Clin Med 2023; 12:4434. [PMID: 37445469 DOI: 10.3390/jcm12134434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Inadvertent intraoperative hypothermia is a common complication that affects patient comfort and morbidity. As the development of hypothermia is a complex phenomenon, predicting it using machine learning (ML) algorithms may be superior to logistic regression. METHODS We performed a single-center retrospective study and assembled a feature set comprised of 71 variables. The primary outcome was hypothermia burden, defined as the area under the intraoperative temperature curve below 37 °C over time. We built seven prediction models (logistic regression, extreme gradient boosting (XGBoost), random forest (RF), multi-layer perceptron neural network (MLP), linear discriminant analysis (LDA), k-nearest neighbor (KNN), and Gaussian naïve Bayes (GNB)) to predict whether patients would not develop hypothermia or would develop mild, moderate, or severe hypothermia. For each model, we assessed discrimination (F1 score, area under the receiver operating curve, precision, recall) and calibration (calibration-in-the-large, calibration intercept, calibration slope). RESULTS We included data from 87,116 anesthesia cases. Predicting the hypothermia burden group using logistic regression yielded a weighted F1 score of 0.397. Ranked from highest to lowest weighted F1 score, the ML algorithms performed as follows: XGBoost (0.44), RF (0.418), LDA (0.406), LDA (0.4), KNN (0.362), and GNB (0.32). CONCLUSIONS ML is suitable for predicting intraoperative hypothermia and could be applied in clinical practice.
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Affiliation(s)
- Christoph Dibiasi
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Währinger Straße 104/10, 1180 Vienna, Austria
| | - Asan Agibetov
- Center for Medical Statistics, Informatics and Intelligent Systems, Institute of Artificial Intelligence, Medical University of Vienna, Währinger Straße 25a, 1090 Vienna, Austria
| | - Lorenz Kapral
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Währinger Straße 104/10, 1180 Vienna, Austria
| | - Sebastian Zeiner
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Oliver Kimberger
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Währinger Straße 104/10, 1180 Vienna, Austria
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Chen YC, Cherng YG, Romadlon DS, Chang KM, Huang CJ, Tsai PS, Chen CY, Chiu HY. Comparative effects of warming systems applied to different parts of the body on hypothermia in adults undergoing abdominal surgery: A systematic review and network meta-analysis of randomized controlled trials. J Clin Anesth 2023; 89:111190. [PMID: 37390588 DOI: 10.1016/j.jclinane.2023.111190] [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: 12/19/2022] [Revised: 05/27/2023] [Accepted: 06/18/2023] [Indexed: 07/02/2023]
Abstract
STUDY OBJECTIVE The prevention of perioperative hypothermia after anesthesia induction is a critical concern in patients undergoing abdominal surgery. The effectiveness of various warming systems for preventing hypothermia and shivering when applied to specific areas of the body remains undetermined. DESIGN Systematic review and network meta-analysis. SETTING Operating room. INTERVENTION Five electronic databases were searched, including only randomized control trials (RCTs) reporting the effects of warming systems applied to specific body sites on the intraoperative core temperature and postoperative risk of shivering in adults undergoing abdominal surgery. A multivariate random-effects network meta-analysis with a frequentist framework was implemented for data analysis. MEASUREMENTS The primary outcome was the core body temperature 60 and 120 min after anesthesia induction for abdominal surgery. The secondary outcome was the incidence of postoperative shivering. RESULTS This review comprised a total of 24 RCTs including 1119 patients. At 60 and 120 min after anesthesia induction, a forced-air warming system applied to the upper body (0.3 °C and 95% confidence intervals = [0.3 to 0.4], 1.0 °C [0.7 to 1.3]), lower body (0.4 °C [0.3 to 0.5], 0.9 °C [0.5 to 1.2]), and underbody (0.5 °C [0.5 to 0.6], 1.2 °C [0.9 to 1.6]) was superior to passive insulation in terms of core body temperature regulation. Compared with passive insulation, the forced-air warming system applied to the lower body (odds ratio = 0.06) or underbody (0.44) and the electric heating blanket to the lower body (0.02) or the whole body (0.07) significantly reduced the risk of shivering. CONCLUSIONS The results of this NMA revealed that forced-air warming with an underbody blanket effectively elevates core body temperatures in 60 and 120 min after induction of anesthesia and prevents shivering in patients recovering from abdominal surgery.
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Affiliation(s)
- Yi-Chen Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Yih-Giun Cherng
- Department of Anaesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Anaesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Kai-Mei Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chun-Jen Huang
- Department of Anaesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yu Chen
- Department of Anaesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Anaesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University, Taipei, Taiwan.
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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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Feng Y, Zhang Y, Sun B, He Y, Pei L, Huang Y. Effect of active warming on perioperative cardiovascular outcomes: a systematic review and meta-analysis of randomized controlled trials. J Anesth 2023:10.1007/s00540-023-03205-4. [PMID: 37291280 PMCID: PMC10390383 DOI: 10.1007/s00540-023-03205-4] [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: 02/01/2023] [Accepted: 05/20/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE The objective of this study was to provide an updated review on the active warming effects on major adverse cardiac events, 30-day all-cause mortality, and myocardial injury after noncardiac surgery. METHOD We systematically searched MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, Web of Science, and Chinese BioMedical Literature Database. We included randomized controlled trials of adult population undergoing noncardiac surgeries that concentrate on the comparison of active warming methods and passive thermal management. Cochrane Collaboration's tool was applied for risk-of-bias assessment. We used trial sequential analysis to evaluate the possibility of false positive or negative results. RESULTS A total of 13,316 unique records were identified, of which only 19 with reported perioperative cardiovascular outcomes were included in the systematic review and nine of them were included in final meta-analysis. No statistically significant difference between active warming methods and routine care was found in major adverse cardiac events (RR 0.56, 95% confidence interval (CI) 0.14-2.21, I2 = 71%, number of events 59 vs. 70), 30-day all-cause mortality (RR 0.81, 95% CI 0.43-1.54, I2 = 0%, number of events 17 vs. 21), and myocardial injury after noncardiac surgery (RR 0.61, 95% CI 0.17-2.22, I2 = 79%, number of events 236 vs. 234). Trial sequential analysis suggests that current trials did not reach the minimum information size regarding the major cardiovascular events. CONCLUSIONS Compared to routine perioperative care, we found that active warming methods are not necessary for cardiovascular prevention in patients undergoing noncardiac surgery.
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Affiliation(s)
- Yunying Feng
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- Joint Laboratory of Anesthesia and Pain, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-Year Program of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuelun Zhang
- Medical Research Centre, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Boyuan Sun
- Eight-Year Program of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yumiao He
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- Joint Laboratory of Anesthesia and Pain, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lijian Pei
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- Joint Laboratory of Anesthesia and Pain, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
- Joint Laboratory of Anesthesia and Pain, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Munday J, Delaforce A, Heidke P, Rademakers S, Sturgess D, Williams J, Douglas C. Perioperative temperature monitoring for patient safety: A period prevalence study of five hospitals. Int J Nurs Stud 2023; 143:104508. [PMID: 37209531 DOI: 10.1016/j.ijnurstu.2023.104508] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Monitoring body temperature is essential for safe perioperative care. Without patient monitoring during each surgical phase, alterations in core body temperature will not be recognised, prevented, or treated. Safe use of warming interventions also depends on monitoring. Yet there has been limited evaluation of temperature monitoring practices as the primary endpoint. OBJECTIVE To investigate temperature monitoring practices during all stages of perioperative care. We examined what patient characteristics are associated with the rate of temperature monitoring, along with clinical variables such as warming intervention or exposure to hypothermia. DESIGN An observational period-prevalence study over seven days across five Australian hospitals. SETTINGS Four metropolitan, tertiary hospitals and one regional hospital. PARTICIPANTS We selected all adult patients (N = 1690) undergoing any surgical procedure and any mode of anaesthesia during the study period. METHODS Patient characteristics, perioperative temperature data, warming interventions and exposure to hypothermia were retrospectively collected from patient charts. We describe the frequencies and distribution of temperature data at each perioperative stage, including adherence to minimum temperature monitoring based on clinical guidelines. To examine associations with clinical variables, we also modelled the rate of temperature monitoring using each patient's count of recorded temperature measurements within their calculated time interval from anaesthetic induction to postanaesthetic care unit discharge. All analyses adjusted 95% confidence intervals (CI) for patient clustering by hospital. RESULTS There were low levels of temperature monitoring, with most temperature data clustered around admission to postanaesthetic care. Over half of patients (51.8%) had two or less temperatures recorded during perioperative care and one-third (32.7%) had no temperature data at all prior to admission to postanaesthetic care. Of all patients that received active warming intervention during surgery, over two-thirds (68.5%) had no temperature monitoring recorded. In our adjusted model, associations between clinical variables and the rate of temperature monitoring often did not reflect clinical risk or need: rates were decreased for those with greatest operative risk (American Society of Anesthesiologists Classification IV: rate ratio (RR) 0.78, 95% CI 0.68-0.89; emergency surgery: RR 0.89, 0.80-0.98), and neither warming interventions (intraoperative warming: RR 1.01, 0.93-1.10; postanaesthetic care unit warming: RR 1.02, 0.98-1.07) nor hypothermia at postanaesthetic care unit admission (RR 1.12, 0.98-1.28) were associated with monitoring rate. CONCLUSIONS Our findings point to the need for systems-level change to enable proactive temperature monitoring over all phases of perioperative care to enhance patient safety outcomes. REGISTRATION Not a clinical trial.
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Affiliation(s)
- Judy Munday
- School of Nursing & Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059, Australia; Royal Brisbane and Women's Hospital, Herston, Queensland 4029, Australia; Faculty of Health and Nursing Science, University of Agder, Norway.
| | - Alana Delaforce
- School of Nursing & Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059, Australia; Mater Health Services, South Brisbane, Queensland 4101, Australia; CSIRO Australian e-Health Research Centre, Brisbane, QLD 4029, Australia
| | - Penny Heidke
- School of Nursing & Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059, Australia; Central Queensland University, Brisbane, Queensland 4000, Australia
| | - Sasha Rademakers
- School of Nursing & Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059, Australia; Department of Health Western Australia, Perth 6000, Western Australia, Australia
| | - David Sturgess
- University of Queensland, St Lucia 4072, Queensland, Australia
| | | | - Clint Douglas
- School of Nursing & Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059, Australia; Metro North Hospital and Health Service, Herston, Queensland 4029, Australia
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Oh EJ, Han S, Lee S, Choi EA, Ko JS, Gwak MS, Kim GS. Forced-air prewarming prevents hypothermia during living donor liver transplantation: a randomized controlled trial. Sci Rep 2023; 13:3713. [PMID: 37024533 PMCID: PMC10079654 DOI: 10.1038/s41598-022-23930-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 11/07/2022] [Indexed: 04/08/2023] Open
Abstract
Despite various intraoperative thermal strategies, core heat loss is considerable during liver transplantation and hypothermia is common. We tested whether forced-air prewarming prevents hypothermia during liver transplantation. Adult patients undergoing living donor liver transplantation were randomly assigned to non-prewarming group (n = 20) or prewarming group (n = 20). Patients in prewarming group underwent 30-min forced-air warming before anesthetic induction. During surgery, core temperature was measured in the pulmonary artery. The primary outcome was intraoperative hypothermia (< 36.0 °C). The secondary outcomes included plasma lactate concentration. Intraoperative hypothermia risk was significantly lower in prewarming group than in non-prewarming group (60.0% vs. 95.0%, P = 0.020). The difference in hypothermia incidence between groups was greater in the post-induction phase (20.0% vs. 85.0%, P < 0.001) than in the anhepatic or post-reperfusion phase, suggesting that prewarming mainly acts on preventing post-induction core-to-peripheral heat redistribution. Hypothermia duration was significantly shorter in prewarming group (60 [0-221] min vs. 383 [108-426] min, P = 0.001). Lactate concentration decreased during 3 h after graft reperfusion in prewarming group, whereas it continuously increased in non-prewarming group (- 0.19 [- 0.48 to 0.13] mmol/L vs. 1.17 [3.31-0.77] mmol/L, P = 0.034). In conclusion, forced-air prewarming decreases the incidence and duration of intraoperative hypothermia with potential clinical benefit while mainly acting by preventing the core-to-peripheral heat redistribution.Clinical trial registration: Registered at the Clinical Research Information Service ( https://cris.nih.go.kr , [KCT0003230]) on 01/10/2018.
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Affiliation(s)
- Eun Jung Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
- Department of Anesthesiology and Pain Medicine, Gwangmyeong Hospital, Chung-Ang University School of Medicine, Gwangmyeong, South Korea
| | - Sangbin Han
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
| | - Sooyeon Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Eun Ah Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Justin S Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Mi Sook Gwak
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Gaab Soo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
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