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Mazzinari G, Rovira L, Vila Montañes M, García Gregorio N, Ayas Montero B, Alberola Estellés MJ, Flor B, Argente Navarro MP, Diaz-Cambronero O. Estimation of the difference between peritoneal microenvironment and core body temperature during laparoscopic surgery - a prospective observational study. Sci Rep 2024; 14:20408. [PMID: 39223302 PMCID: PMC11368933 DOI: 10.1038/s41598-024-71611-z] [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: 11/01/2023] [Accepted: 08/29/2024] [Indexed: 09/04/2024] Open
Abstract
Maintaining patients' temperature during surgery is beneficial since hypothermia has been linked with perioperative complications. Laparoscopic surgery involves the insufflation of carbon dioxide (CO2) into the peritoneal cavity and has become the standard in many surgical indications since it is associated with better and faster recovery. However, the use of cold and dry CO2 insufflation can lead to perioperative hypothermia. We aimed to assess the difference between intraperitoneal and core temperatures during laparoscopic surgery and evaluate the influence of duration and CO2 insufflation volume by fitting a mixed generalized additive model. In this prospective observational single-center cohort trial, we included patients aged over 17 with American Society of Anesthesiology risk scores I to III undergoing laparoscopic surgery. Anesthesia, ventilation, and analgesia followed standard protocols, while patients received active warming using blankets and warmed fluids. Temperature data, CO2 ventilation parameters, and intraabdominal pressure were collected. We recruited 51 patients. The core temperature was maintained above 36 °C and progressively raised toward 37 °C as pneumoperitoneum time passed. In contrast, the intraperitoneal temperature decreased, thus creating a widening difference from 0.4 [25th-75th percentile: 0.2-0.8] °C at the beginning to 2.3 [2.1-2.3] °C after 240 min. Pneumoperitoneum duration and CO2 insufflation volume significantly increased this temperature difference (P < 0.001 for both parameters). Core vs. intraperitoneal temperature difference increased linearly by 0.01 T °C per minute of pneumoperitoneum time up to 120 min and then 0.05 T °C per minute. Each insufflated liter per unit of time, i.e. every 10 min, increased the temperature difference by approximately 0.009 T °C. Our findings highlight the impact of pneumoperitoneum duration and CO2 insufflation volume on the difference between core and intraperitoneal temperatures. Implementing adequate external warming during laparoscopic surgery effectively maintains core temperature despite the use of dry and unwarmed CO2 gases, but peritoneal hypothermia remains a concern, suggesting the importance of further research into regional effects.Trial registration: Clinicaltrials.gov: NCT04294758.
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Affiliation(s)
- Guido Mazzinari
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain.
- Department of Statistics and Operational Research, Universidad de Valencia, Valencia, Spain.
| | - Lucas Rovira
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain
- Department of Anaesthesiology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Maria Vila Montañes
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain
| | - Nuria García Gregorio
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain
| | - Begoña Ayas Montero
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain
| | - Maria Jose Alberola Estellés
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain
| | - Blas Flor
- Coloproctology Unit, Department of Surgery, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Maria Pilar Argente Navarro
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain
| | - Oscar Diaz-Cambronero
- Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
- Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain
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Brandes IF, Tirilomis T, Nemeth M, Wieditz J, Bräuer A. Intraoperative zero-heat-flux thermometry overestimates nasopharyngeal temperature by 0.39 °C: an observational study in patients undergoing congenital heart surgery. J Clin Monit Comput 2024:10.1007/s10877-024-01204-8. [PMID: 39127818 DOI: 10.1007/s10877-024-01204-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024]
Abstract
During surgery for congenital heart disease (CHD) temperature management is crucial. Vesical (Tves) and nasopharyngeal (TNPH) temperature are usually measured. Whereas Tves slowly responds to temperature changes, TNPH carries the risk of bleeding. The zero-heat-flux (ZHF) temperature monitoring systems SpotOn™ (TSpotOn), and Tcore™ (Tcore) measure temperature non-invasively. We evaluated accuracy and precision of the non-invasive devices, and of Tves compared to TNPH for estimating temperature. In this prospective observational study in pediatric and adult patients accuracy and precision of TSpotOn, Tcore, and Tves were analyzed using the Bland-Altman method. Proportion of differences (PoD) and Lin´s concordance correlation coefficient (LCC) were calculated. Data of 47 patients resulted in sets of matched measurements: 1073 for TSpotOn vs. TNPH, 874 for Tcore vs. TNPH, and 1102 for Tves vs. TNPH. Accuracy was - 0.39 °C for TSpotOn, -0.09 °C for Tcore, and 0.07 °C for Tves. Precisison was between - 1.12 and 0.35 °C for TSpotOn, -0.88 to 0.71 °C for Tcore, and - 1.90 to 2.05 °C for Tves. PoD ≤ 0.5 °C were 71% for TSpotOn, 71% for Tcore, and 60% for Tves. LCC was 0.9455 for TSpotOn, 0.9510 for Tcore, and 0.9322 for Tves. Temperatures below 25.2 °C (TSpotOn) or 27.1 (Tcore) could not be recorded non-invasively, but only with Tves. Trial registration German Clinical Trials Register, DRKS00010720.
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Affiliation(s)
- Ivo F Brandes
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Theodor Tirilomis
- Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Marcus Nemeth
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Johannes Wieditz
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Anselm Bräuer
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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Mai L, Boardman G, Robinson K, Edgar DW, Wood FM. Postoperative hypothermia is associated with reduced length of stay in adult acute burn survivors. Burns 2024; 50:1536-1543. [PMID: 38705776 DOI: 10.1016/j.burns.2024.02.033] [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: 06/04/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND The hypermetabolic response after a burn predisposes patients to hypothermia due to dysfunction of thermoregulation. Traditionally, hypothermia is avoided actively in burn care due to reported complications associated with low body temperature. The likelihood of hypothermia with acute burn surgery is compounded by general anesthesia, exposure of wound areas and prolonged operation times. However, we find limited studies exploring the effects of perioperative hypothermia on length of stay in the adult burn population. OBJECTIVE To determine associations between postoperative hypothermia and hospital length of stay in adult burns patients. METHOD This retrospective cohort study involved patients admitted to the State Adult Burn Unit in Western Australia between 1st January 2015 to 28th February 2021. All adults who underwent surgery for acute burn, and had postoperative recovery room body temperature recorded, were included in the study. In this study, we defined normothermia as >36.5C and hypothermia as < 36.0 °C with mild, moderate, and severe hypothermia being 35.0-35.9 °C, 34.0-34.9 °C and < 34.0 °C, respectively. Patients with hyperthermia were excluded. Multivariable general linear models explored if hypothermia was independently associated with length of stay. RESULTS Among 1486 adult patients, 1338 (90%) were normothermic postoperatively, with temperatures >36.0C. We included 148 (10%) patients with hypothermia (temperature <36.0 °C) postoperatively. Most burns in the study population were minor: 96% had burns < 15% TBSA. Data modelling demonstrated that hypothermia was associated with a shorter length of hospital stay (coefficient = -0.129, p = 0.041). CONCLUSION In adult acute burn patients, postoperative hypothermia was associated with reduced length of stay after surgery. The positive results of this study indicate that a review of the core temperature targets with acute burn surgery, and timing of burn patient cooling practices in general is warranted.
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Affiliation(s)
- Linda Mai
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Anaesthesia Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Australia; Fiona Wood Foundation, Perth, WA, Australia
| | - Glenn Boardman
- Research Support and Development Unit, South Metropolitan Health Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Kieran Robinson
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Anaesthesia Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Fiona Wood Foundation, Perth, WA, Australia; The Institute for Health Research, The University of Notre Dame, Fremantle, Australia; Armadale Kalamunda Group Health Service, Safety and Quality Unit, East Metropolitan Health Service, Mt Nasura, Western Australia, Australia; Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Fiona M Wood
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Fiona Wood Foundation, Perth, WA, Australia; Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia.
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Heidke P, Duff J, Keogh S, Munday J. Barriers and facilitators to evidence-based perioperative hypothermia management for orthopaedic patients: A systematic review. J Clin Nurs 2024; 33:3329-3354. [PMID: 39020519 DOI: 10.1111/jocn.17338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 04/30/2024] [Accepted: 06/03/2024] [Indexed: 07/19/2024]
Abstract
AIM To assess barriers and facilitators to the implementation of guidelines for the prevention of inadvertent perioperative hypothermia in orthopaedic patients. DESIGN Systematic review. DATA SOURCES Nine databases: PubMed, Embase, CINAHL, Cochrane CENTRAL, PsycINFO, ProQuest Dissertations and Theses, Scopus, Web of Science and Trip Clinical Evidence Database. METHODS Primary studies published in English between January 2008 to July 2022 were screened. Study selection, quality assessment, and data extraction were completed independently by researchers. Data were extracted using the Consolidated Framework for Implementation Research and mapped to the Expert Recommendations for Implementing Change strategies. RESULTS Eighty-seven studies were included in the review. The most frequently reported barriers and facilitators related to evidence strength, relative advantage, and cost of implementing perioperative hypothermia prevention guidelines. The top four ERIC strategies were: Identify and prepare champions; Conduct educational meetings; Assess for readiness and identify barriers and facilitators; and Inform local opinion leaders. CONCLUSION This review provides synthesized evidence regarding barriers and facilitators to perioperative hypothermia guidelines for patients undergoing orthopaedic surgery. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Our work provides theory guided strategies to promote implementation of perioperative hypothermia prevention to assist nurses caring for patients undergoing orthopaedic surgery. IMPACT Findings provide professionals caring for patients undergoing orthopaedic surgery with theory-informed strategies to improve perioperative hypothermia prevention. Reducing perioperative hypothermia will improve outcomes for patients undergoing orthopaedic surgery. REPORTING METHOD The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. NO PATIENT OR PUBLIC CONSULTATION Due to the study design, no patient or public consultation took place.
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Affiliation(s)
- Penny Heidke
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
- Central Queensland University, Brisbane, Queensland, Australia
| | - Jed Duff
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
- Faculty of Health and Sports Sciences, University of Agder, Grimstad, Norway
| | - Samantha Keogh
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
- Faculty of Health and Sports Sciences, University of Agder, Grimstad, Norway
| | - Judy Munday
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology (QUT), Kelvin Grove, Queensland, Australia
- Royal Brisbane and Women's Hospital, Nursing and Midwifery Research Centre, Herston, Queensland, Australia
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Humphries K, Page T, Donaldson T, Blaney S. Inadvertent perioperative hypothermia prevention strategies for urology surgical patients who received a blood transfusion: A retrospective analysis. J Perioper Pract 2024; 34:212-218. [PMID: 38205579 DOI: 10.1177/17504589231215940] [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: 01/12/2024]
Abstract
OBJECTIVES This study aimed to establish whether hypothermia was present in patients who required a blood transfusion and underwent a urology procedure, as well as identify staff knowledge and understanding. PATIENTS AND METHODS A staff survey was conducted with respondents from a range of clinical settings, with some staff working across more than one area. A retrospective review of 46 medical records was conducted between January 2021 and July 2022. All data were exported into an Excel spreadsheet and analysed. RESULTS Staff (70%) were unaware of guidelines informing thermoregulation practices; however, 90% understood the importance of normothermia in the perioperative environment. Medical record review demonstrated temperature monitoring and intervention implementation varied across the perioperative journey, with 20% of patients hypothermic on admission and 89% of the cohort having two or more risk factors. CONCLUSION There is no formal process for the management of inadvertent perioperative hypothermia throughout the patient journey at the hospital. A variety of intrinsic factors (age, patient comorbidities, American Society of Anaesthesiologists score) and external factors (patient waiting times, anaesthetic modality, type of procedure, environmental influences), impact each patient's risk of inadvertent perioperative hypothermia.
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Affiliation(s)
| | - Tamara Page
- St Andrew's Hospital, Adelaide, SA, Australia
- The University of Adelaide, Adelaide, SA, Australia
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Akpolat R, Arslan S. Effect of Prewarming on Postoperative Hypothermia, Vital Signs, and Thermal Comfort: A Randomized Controlled Trial. Ther Hypothermia Temp Manag 2024; 14:89-98. [PMID: 37327382 DOI: 10.1089/ther.2023.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Abstract
This study aimed to determine the effects of preoperative active and passive warming on postoperative hypothermia, vital signs, and perception of thermal comfort in patients scheduled to undergo elective open abdominal surgery. This was a randomized controlled study. The study sample comprised 90 patients (30 in the active warming group, 30 in the passive warming group, and 30 in the control group) who agreed to participate and met the research criteria. According to the comparison of patients' vital signs, a statistically significant difference was observed in terms of patients' preoperative body temperature values (χ2 = 56.959; p = 0.000). A comparison of the patients' postoperative thermal comfort perception scores yielded a statistically significant difference (χ2 = 39.693; p = 0.000). Postoperative comfort scores in the active warming group were significantly higher than those in the passive warming and control groups. In conclusion, warming methods are effective in preventing undesirable postoperative hypothermia. The time to reach normothermia after surgery was shorter, vital signs were at a desirable level, and thermal comfort perceptions were higher in patients who were prewarmed. ClinicalTrials.gov (Identifier: NCT04997694).
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Affiliation(s)
- Refiye Akpolat
- Nursing Department, Faculty of Health Sciences, Kocaeli Health and Technology University, Kocaeli, Turkey
| | - Sevban Arslan
- Nursing Department, Faculty of Health Sciences, Cukurova University, Adana, Turkey
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Stuart CM, Dyas AR, Bronsert MR, Abrams BA, Kelleher AD, Colborn KL, Randhawa SK, David EA, Mitchell JD, Meguid RA. Perioperative hypothermia in robotic-assisted thoracic surgery: Incidence, risk factors, and associations with postoperative outcomes. J Thorac Cardiovasc Surg 2024; 167:1979-1989.e1. [PMID: 37865182 PMCID: PMC11034550 DOI: 10.1016/j.jtcvs.2023.10.031] [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: 05/29/2023] [Revised: 09/27/2023] [Accepted: 10/15/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE Inadvertent perioperative hypothermia has been associated with poor surgical outcomes. The purpose of this study was to evaluate the incidence and associated postoperative complications of inadvertent perioperative hypothermia in patients undergoing robotic-assisted thoracic surgery lung resections. METHODS This was a single-center, retrospective cohort study evaluating all consecutive patients who underwent robotic-assisted thoracic surgery lung resection between January 1, 2021, and November 30, 2022. Temperatures were measured at 5 time points: preprocedure unit, anesthesia induction, 30 minutes postinduction, extubation, and recovery room arrival. Temperature changes were calculated at each interval. Adjusted and unadjusted comparison was performed between those who experienced varying levels of inadvertent perioperative hypothermia (Hypothermia I: <36 °C, Hypothermia II: <35.5 °C, and Hypothermia III: <35 °C) and those who did not. RESULTS A total of 313 patients were included, and 201 (64.2%) lobectomies, 50 (16.0%) segmentectomies, and 62 (19.8%) wedge resections were performed. Across all patients, 291 (93.0%) had a temperature less than 36 °C, 195 (62.3%) had a temperature less than 35.5 °C, and 100 (31.9%) had a temperature less than 35.0 °C. Patients experienced significant temperature change at all intervals (P < .001), with the greatest loss occurring during the preprocedure interval (between leaving preprocedure unit and anesthesia induction). On adjusted analysis, patients who experienced inadvertent perioperative hypothermia less than 35.5 °C were older (odds ratio, 1.03; 95% CI, 1.01-1.05), had lower body mass index (odds ratio, 0.95; 95% CI, 0.87-0.98), and had increasing operative time (odds ratio, 1.00; 95% CI, 1.00-1.01). Patients who experienced inadvertent perioperative hypothermia had higher risk-adjusted rates of overall morbidity and infectious postoperative complications. CONCLUSIONS The majority of patients undergoing robotic-assisted thoracic surgery lung resections experience some degree of inadvertent perioperative hypothermia and have associated increased rates of 30-day morbidity. Structured and interval-specific interventions should be implemented to decrease rates of inadvertent perioperative hypothermia and subsequent complications.
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Affiliation(s)
- Christina M Stuart
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo.
| | - Adam R Dyas
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colo
| | - Benjamin A Abrams
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colo
| | - Alyson D Kelleher
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - Kathryn L Colborn
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colo
| | - Simran K Randhawa
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - Elizabeth A David
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - John D Mitchell
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - Robert A Meguid
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colo
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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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Alkan Bayburt F, Meyanci Koksal G, Bulut A, Sengul I. Intraoperative Patient Warming Instead of Gas on the Management of Postoperative Pain in Laparoscopic Colectomy and Cholecystectomy: A Randomized Controlled Trial. Cureus 2024; 16:e57989. [PMID: 38601811 PMCID: PMC11006424 DOI: 10.7759/cureus.57989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION Blurred lines remain in details of the association between patient warming with postoperative pain and a proper analgesic requirement. Therefore, the present study proposes to observe the effects of intraoperative patient warming and carbon dioxide insufflation duration in laparoscopic colectomy (LCol) and laparoscopic cholecystectomy (LChol) procedures on postoperative pain, analgesic requirements, and hemodynamics. METHODS The present study involved 80 cases aged 18-80 years with the American Society of Anesthesiologists I-III classification, possessing two initial groups primarily, one for LCol and one for LChol. Subsequently, each was divided into two through randomization for intraoperative warming. Postoperatively, pain perception, per se, was evaluated using the visual analog scale (VAS) score at the 30 minutes, 1st, 6th, 12th, and 24th hours, along with the impact of pain on hemodynamic parameters and side effects such as nausea/vomiting and the dosage of analgesics used. RESULTS Groups actively heated with warm air-blowing devices detected significantly higher intraoperative core and skin temperature measurements, and postoperative early pain perception was significantly lower in the warmed ones. Furthermore, a significant decrease in the VAS scores and the analgesic at the 12th and 24th hours compared to the first six hours was recognized between them. CONCLUSION Consequently, herewith, we postulate that so-called patient warming positively affects the VAS scores.
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Affiliation(s)
- Fatma Alkan Bayburt
- Anesthesiology and Reanimation, Giresun Education and Research Hospital, Giresun, TUR
| | - Guniz Meyanci Koksal
- Anesthesiology and Reanimation, Istanbul University Faculty of Medicine, Istanbul, TUR
| | - Azime Bulut
- Anesthesiology and Reanimation, Giresun University Faculty of Medicine, Giresun, TUR
| | - Ilker Sengul
- Endocrine and General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
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Bratke S, Schmid S, Ulm B, Jungwirth B, Blobner M, Borgstedt L. Genotype- and sex-specific changes in vital parameters during isoflurane anesthesia in a mouse model of Alzheimer's disease. Front Med (Lausanne) 2024; 11:1342752. [PMID: 38601113 PMCID: PMC11004241 DOI: 10.3389/fmed.2024.1342752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/20/2024] [Indexed: 04/12/2024] Open
Abstract
Background The prevalence of neurodegenerative diseases is increasing as is life expectancy with Alzheimer's disease accounting for two-thirds of dementia cases globally. Whether general anesthesia and surgery worsen cognitive decline is still a matter of debate and most likely depending on the interplay of various influencing factors. In order to account for this complexity, Alzheimer's disease animal models have been developed. The Tg2576 model of Alzheimer's disease is a well-established mouse model exhibiting amyloidopathy and age-dependent sex-specific differences in Alzheimer's disease symptomology. Yet, data on anesthesia in this mouse model is scarce and a systematic comparison of vital parameters during anesthesia with wild-type animals is missing. In order to investigate the safety of general anesthesia and changes in vital parameters during general anesthesia in Tg2576 mice, we did a secondary analysis of vital parameters collected during general anesthesia in aged Tg2576 mice. Methods After governmental approval (General Administration of the Free State of Bavaria, file number: 55.2-1-54-2532-149-11) 60 mice at 10-12 months of age were exposed to isoflurane (1.6 Vol%) for 120 min, data of 58 mice was analyzed. During general anesthesia, heart rate, respiratory rate, temperature, isoflurane concentration and fraction of inspired oxygen were monitored and collected. Data were analyzed using univariate and multivariate linear mixed regression models. Results During general anesthesia, heart rate decreased in a sex-specific manner. Respiratory rate decreased and body temperature increased dependent on genotype. However, the changes were limited and all vital parameters stayed within physiological limits. Conclusion Isoflurane anesthesia in the Tg2576 mouse model is safe and does not seem to influence experimental results by interacting with vital parameters. The present study provides information on appropriate anesthesia in order to advance research on anesthesia and AD and could contribute to improving laboratory animal welfare.
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Affiliation(s)
- Sebastian Bratke
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University of Ulm, Ulm, Germany
| | - Sebastian Schmid
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University of Ulm, Ulm, Germany
| | - Bernhard Ulm
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University of Ulm, Ulm, Germany
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bettina Jungwirth
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University of Ulm, Ulm, Germany
| | - Manfred Blobner
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University of Ulm, Ulm, Germany
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Laura Borgstedt
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
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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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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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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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Diaz M, Duclos A, Mifsud M, Wofford KA. Warming bundle for patients with microvascular free-flaps: A quality improvement project. Nursing 2023; 53:52-56. [PMID: 37973015 DOI: 10.1097/01.nurse.0000991572.95456.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Mayte Diaz
- Mayte Diaz is an instructor and Kenneth Wofford is an associate professor and the DNP program director at the University of South Florida (USF) College of Nursing. April Duclos is the lead CRNA for the Department of Otolaryngology at Tampa General Hospital. Matthew Mifsud is an assistant professor with the Department of Otolaryngology-Head and Neck Surgery at USF's College of Medicine
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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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刘 雨, 梁 诗, 范 美, 龚 仁, 李 卡. [Correlation Between 6 Characteristics of Perioperative Hypothermia and Allogeneic Red Blood Cell Transfusion in Abdominal Surgery Patients]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:1256-1262. [PMID: 38162052 PMCID: PMC10752764 DOI: 10.12182/20230960507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Indexed: 01/03/2024]
Abstract
Objective To explore the correlation between six characteristics of perioperative hypothermia and allogeneic red blood cell (RBC) transfusions in patients who underwent abdominal surgeries. Methods Patients who underwent abdominal surgeries at West China Hospital, Sichuan University between October 2019 and July 2021 were retrospectively enrolled. A wearable wireless temperature sensor was used to continuously monitor the core body temperature of patients throughout the perioperative period. The perioperative temperature nadir, maximum temperature loss, percentage of time with hypothermia, time-weighted average temperature, area under the curve (AUC) at 36 ℃, and AUC at 37 ℃ were calculated for the period from entering the operation room to 24 hours after the end of anesthesia. The restricted cubic spline (RCS) and multiple logistic regression models were used to explore the correlation between these temperature characteristics and perioperative allogeneic RBC transfusions. Results A total of 3119 patients were included in the study, with an allogeneic RBC transfusion rate of 2.8%. The RCS model showed that allogeneic RBC transfusion was associated with the perioperative temperature nadir (Poverall=0.048) and AUC at 36 ℃ (Poverall=0.026) and no statistical significance was found in the nonlinear test. The association between allogeneic RBC transfusions and other temperature characteristics was not statistically significant. According to the RCS model results, cut-off points were taken to form groups based on the body temperature characteristics. Multivariate logistic regression showed that the perioperative temperature nadir<35.5 ℃ (odds ratio [OR]=2.47, 95% confidence interval [CI]: 1.21-5.03) and AUC at 36 ℃≥100 ℃·min (OR=2.24, 95% CI:1.09-4.58) were associated with increased demand for allogeneic RBC transfusion. Conclusion Hypothermia is associated with an increased need for perioperative allogeneic RBC transfusions and has a cumulative effect over time. For patients at high risk of bleeding, attention should be paid to the prevention of perioperative hypothermia and reduction in the cumulative exposure to hypothermia, thereby reducing the need for blood transfusion.
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Affiliation(s)
- 雨薇 刘
- 四川大学华西医院普通外科/四川大学华西护理学院 (成都 610041)Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- 护理学四川省重点实验室 (成都 610041)Sichuan Provincial Key Laboratory of Nursing, Chengdu 610041, China
| | - 诗琪 梁
- 四川大学华西医院普通外科/四川大学华西护理学院 (成都 610041)Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - 美龄 范
- 四川大学华西医院普通外科/四川大学华西护理学院 (成都 610041)Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - 仁蓉 龚
- 四川大学华西医院普通外科/四川大学华西护理学院 (成都 610041)Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- 护理学四川省重点实验室 (成都 610041)Sichuan Provincial Key Laboratory of Nursing, Chengdu 610041, China
| | - 卡 李
- 四川大学华西医院普通外科/四川大学华西护理学院 (成都 610041)Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- 护理学四川省重点实验室 (成都 610041)Sichuan Provincial Key Laboratory of Nursing, Chengdu 610041, China
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Cho SA, Lee SJ, Kim JH, Kwon W, Sung TY. The effect of combining prewarming with intraoperative phenylephrine infusion on the prevention of hypothermia in patients undergoing urological surgery: a prospective, randomized, and controlled trial. Int J Med Sci 2023; 20:1774-1782. [PMID: 37928872 PMCID: PMC10620862 DOI: 10.7150/ijms.89671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/15/2023] [Indexed: 11/07/2023] Open
Abstract
Background: Hypothermia is common in patients undergoing urological surgery; however, no single preventative modality is completely effective. This study evaluated the effects of combining prewarming with intraoperative phenylephrine infusion for the prevention of hypothermia in patients undergoing urological surgery. Methods: This prospective study enrolled 58 patients scheduled for urological surgery under general anesthesia. The patients were randomized into two groups (n = 29). Patients in the experimental (prewarming and phenylephrine infusion) group (PP group) received prewarming for 20 min and intraoperative phenylephrine infusion, whereas those in the control group (C group) received no active prewarming with only intermittent administration of vasoactive agents. The patient's sublingual temperatures before and after anesthesia and nasopharyngeal temperature during anesthesia were recorded as core temperatures. Results: The incidence of intraoperative hypothermia was higher in the C group than in the PP group (57.7% [15/26] vs. 23.1% [6/26], P = 0.01). The severity of intraoperative hypothermia was higher in the C group than in the PP group (P = 0.004). The nasopharyngeal temperature at the end of surgery was lower in the C group than in the PP group (35.8 ± 0.6°C vs. 36.3 ± 0.4°C, P = 0.002). The trend of core temperature decline during the first hour after anesthesia induction differed between the two groups (P = 0.003; its decline was more gradual in the PP group). Conclusions: The combination of prewarming for 20 min and intraoperative phenylephrine infusion reduced the incidence and severity of intraoperative hypothermia and modified the trend of decreasing core temperatures in patients undergoing urological surgery.
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Affiliation(s)
- Sung-Ae Cho
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Konyang University Myunggok Medical Research Institute, Konyang University College of Medicine, Daejeon, Korea
| | - Seok-Jin Lee
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Jun-Ho Kim
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Woojin Kwon
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Tae-Yun Sung
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Konyang University Myunggok Medical Research Institute, Konyang University College of Medicine, Daejeon, Korea
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Golpanian S, Rahal GA, Rahal WJ. Outpatient-Based High-Volume Liposuction: A Retrospective Review of 310 Consecutive Patients. Aesthet Surg J 2023; 43:1310-1324. [PMID: 37227017 DOI: 10.1093/asj/sjad164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Currently, the definition of large-volume liposuction is the removal of 5 L or more of total aspirate. Higher volumes of lipoaspirate come into consideration with higher BMIs, because more than 5 L is often required to achieve a satisfactory aesthetic result. The boundaries of what lipoaspirate volume is considered safe are based on historical opinion and are constantly in question. OBJECTIVES Because to date there have been no scientific data available to support a specific safe maximum volume of lipoaspirate, the authors discuss necessary conditions for safe high-volume lipoaspirate extraction. METHODS This retrospective study included 310 patients who had liposuction of ≥5 L over a 30-month period. All patients had 360° liposuction alone or in combination with other procedures. RESULTS Patient ages ranged from 20 to 66 with a mean age of 38.5 (SD = 9.3). Average operative time was 202 minutes (SD = 83.1). Mean total aspirate was 7.5 L (SD = 1.9). An average of 1.84 L (SD = 0.69) of intravenous fluids and 8.99 L (SD = 1.47) of tumescent fluid were administered. Urine output was maintained above 0.5 mL/kg/hr. There were no major cardiopulmonary complications or cases requiring blood transfusion. CONCLUSIONS High-volume liposuction is safe if proper preoperative, intraoperative, and postoperative protocols and techniques are employed. The authors believe that this bias should be modified and that sharing their experience with high-volume liposuction may help guide other surgeons to incorporate this practice with confidence and safety for better patient outcomes. LEVEL OF EVIDENCE: 3
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Yoshimura M, Kohno M, Okamoto Y, Tsuchiya S, Ogawa K, Fukuma A, Kurihara C, Miyama M, Matsumura H. The incidence of intraoperatively acquired pressure injuries in the park-bench position was reduced by applying soft silicone multilayer foam dressings. Int Wound J 2023; 21:e14407. [PMID: 37814469 PMCID: PMC10824620 DOI: 10.1111/iwj.14407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 10/11/2023] Open
Abstract
The Park-Bench Position (PBP) is associated with a high incidence rate of intraoperatively acquired pressure injuries (IAPIs). Preventive measures must be established to prevent the development of IAPIs. We investigated the risk factors for PBP by applying a soft silicone multilayered foam dressing (SMD) under core temperature management to prevent IAPIs. We conducted a prospective, single-centre, open-label observational study of patients undergoing elective neurosurgery operations using PBP in a university hospital in Japan. The incidence rate of IAPIs in this study was compared with that in our two previous studies, in which a film dressing was applied and core temperature management was not performed. IAPIs developed in 90 patients (6.7%); in the lateral thoracic region in five patients and the iliac crest region in one patient. The operative time (every 1 h: p = 0.0001, OR: odds ratio 3.62, 95% CI: confidence interval 1.73-11.42) was significantly associated with the incidence of IAPIs. In our two previous studies, the incidence rate of IAPIs was 11.0% and 24.1%, respectively, when film dressing was used. SMD may weaken the involvement of risk factors in IAPIs.
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Affiliation(s)
- Mine Yoshimura
- Department of NursingTokyo Medical University HospitalTokyoJapan
| | - Michihiro Kohno
- Department of NeurosurgeryTokyo Medical UniversityTokyoJapan
| | - Yukako Okamoto
- Department of NursingTokyo Medical University HospitalTokyoJapan
| | - Sakura Tsuchiya
- Department of NursingTokyo Medical University HospitalTokyoJapan
| | - Kyoko Ogawa
- Department of NursingTokyo Medical University HospitalTokyoJapan
| | - Akane Fukuma
- Department of NursingTokyo Medical University HospitalTokyoJapan
| | - Chie Kurihara
- Department of NursingTokyo Medical University HospitalTokyoJapan
| | - Mari Miyama
- Department of NursingTokyo Medical University HospitalTokyoJapan
| | - Hajime Matsumura
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
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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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22
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Silvasti-Lundell M, Makkonen O, Kivisaari R, Luostarinen T, Pesonen E, Mäkinen MT. Zero-heat-flux thermometry over the carotid artery in assessment of core temperature in craniotomy patients. J Clin Monit Comput 2023; 37:1153-1159. [PMID: 36879085 PMCID: PMC10520089 DOI: 10.1007/s10877-023-00984-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/08/2023] [Indexed: 03/08/2023]
Abstract
Zero-heat-flux core temperature measurements on the forehead (ZHF-forehead) show acceptable agreement with invasive core temperature measurements but are not always possible in general anesthesia. However, ZHF measurements over the carotid artery (ZHF-neck) have been shown reliable in cardiac surgery. We investigated these in non-cardiac surgery. In 99 craniotomy patients, we assessed agreement of ZHF-forehead and ZHF-neck (3M™ Bair Hugger™) with esophageal temperatures. We applied Bland-Altman analysis and calculated mean absolute differences (difference index) and proportion of differences within ± 0.5 °C (percentage index) during entire anesthesia and before and after esophageal temperature nadir. In Bland-Altman analysis [mean (limits of agreement)], agreement with esophageal temperature during entire anesthesia was 0.1 (-0.7 to +0.8) °C (ZHF-neck) and 0.0 (-0.8 to +0.8) °C (ZHF-forehead), and, after core temperature nadir, 0.1 (-0.5 to +0.7) °C and 0.1 (-0.6 to +0.8) °C, respectively. In difference index [median (interquartile range)], ZHF-neck and ZHF-forehead performed equally during entire anesthesia [ZHF-neck: 0.2 (0.1-0.3) °C vs ZHF-forehead: 0.2 (0.2-0.4) °C], and after core temperature nadir [0.2 (0.1-0.3) °C vs 0.2 (0.1-0.3) °C, respectively; all p > 0.017 after Bonferroni correction]. In percentage index [median (interquartile range)], both ZHF-neck [100 (92-100) %] and ZHF-forehead [100 (92-100) %] scored almost 100% after esophageal nadir. ZHF-neck measures core temperature as reliably as ZHF-forehead in non-cardiac surgery. ZHF-neck is an alternative to ZHF-forehead if the latter cannot be applied.
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Affiliation(s)
- Marja Silvasti-Lundell
- Anaesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
| | - Otto Makkonen
- Anaesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teemu Luostarinen
- Anaesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Eero Pesonen
- Anaesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Marja-Tellervo Mäkinen
- Anaesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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23
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Lauronen SL, Kalliovalkama J, Aho A, Mäkinen MT, Huhtala H, Yli-Hankala AM, Kalliomäki ML. Self-warming blanket versus forced-air warming blanket during total knee arthroplasty under spinal anaesthesia: A randomised non-inferiority trial. Acta Anaesthesiol Scand 2023; 67:1102-1109. [PMID: 37246242 DOI: 10.1111/aas.14283] [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: 03/15/2023] [Revised: 04/27/2023] [Accepted: 05/08/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Arthroplasty patients are at high risk of hypothermia. Pre-warming with forced air has been shown to reduce the incidence of intraoperative hypothermia. There is, however, a lack of evidence that pre-warming with a self-warming (SW) blanket can reduce the incidence of perioperative hypothermia. This study aims to evaluate the effectiveness of an SW blanket and a forced-air warming (FAW) blanket peri-operatively. We hypothesised that the SW blanket is inferior to the FAW blanket. METHODS In total, 150 patients scheduled for primary unilateral total knee arthroplasty under spinal anaesthesia were randomised to this prospective study. Patients were pre-warmed with SW blanket (SW group) or upper-body FAW blanket (FAW group) set to 38°C for 30 min before spinal anaesthesia induction. Active warming was continued with the allocated blanket in the operating room. If core temperature fell below 36°C, all patients were warmed using the FAW blanket set to 43°C. Core and skin temperatures were measured continuously. The primary outcome was core temperature on admission to the recovery room. RESULTS Both methods increased mean body temperature during pre-warming. However, intraoperative hypothermia occurred in 61% of patients in the SW group and in 49% in the FAW group. The FAW method set to 43°C could rewarm hypothermic patients. Core temperature did not differ between groups on admission to the recovery room, p = .366 (CI: -0.18-0.06). CONCLUSIONS Statistically, the SW blanket was non-inferior to the FAW method. Yet, hypothermia was more frequent in the SW group, requiring rescue warming as we strictly held to the NICE guideline. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT03408197.
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Affiliation(s)
| | - Jarkko Kalliovalkama
- Department of Anaesthesia, Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Antti Aho
- Department of Anaesthesia, Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Marja-Tellervo Mäkinen
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Arvi M Yli-Hankala
- Department of Anaesthesia, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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24
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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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25
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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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26
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Hara K, Kaneko S, Ishioka T, Tobinaga S, Urabe S, Nakao A, Hamada K, Nagaoka K, Taniguchi M, Yamaguchi M, Takeshita H, Tanaka J, Kuroda H, Matsuura E, Ishimatsu Y, Honda S, Sawai T. Relationship between perfusion index and central temperature before and after induction of anesthesia in laparoscopic gastrointestinal surgery: A prospective cohort study. Medicine (Baltimore) 2023; 102:e33169. [PMID: 36862881 PMCID: PMC9981403 DOI: 10.1097/md.0000000000033169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
The perfusion index (PI) cutoff value before anesthesia induction and the ratio of PI variation after anesthesia induction remain unclear. This study aimed to clarify the relationship between PI and central temperature during anesthesia induction, and the potential of PI in individualized and effective control of redistribution hypothermia. This prospective observational single center study analyzed 100 gastrointestinal surgeries performed under general anesthesia from August 2021 to February 2022. The PI was measured as peripheral perfusion, and the relationship between central and peripheral temperature values was investigated. Receiver operating characteristic curve analysis was performed to identify baseline PI before anesthesia, which predicts a decrease in central temperature 30 minutes after anesthesia induction, and the rate of change in PI that predicts the decrease in central temperature 60 minutes after anesthesia induction. In cases with a central temperature decrease of ≥ 0.6°C after 30 minutes, the area under the curve was 0.744, Youden index was 0.456, and the cutoff value of baseline PI was 2.30. In cases with a central temperature decrease of ≥ 0.6°C after 60 minutes, the area under curve was 0.857, Youden index was 0.693, and the cutoff value of the PI ratio of variation after 30 minutes of anesthesia induction was 1.58. If the baseline PI is ≤ 2.30 and the PI 30 minutes after anesthesia induction is at least 1.58-fold the PI ratio of variation, there is a high probability of a central temperature decrease of at least 0.6°C within 30 minutes after 2 time points.
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Affiliation(s)
- Kentaro Hara
- Department of Operation Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- * Correspondence: Kentaro Hara, Department of Operation Center, National Hospital Organization Nagasaki Medical Center, Kubara 2-1001-1, Omura, Nagasaki 856-8562, Japan (e-mail: )
| | - Shohei Kaneko
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Taichi Ishioka
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Shohei Tobinaga
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shigehiko Urabe
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Akiha Nakao
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Kozue Hamada
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Kyoko Nagaoka
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Miwa Taniguchi
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Michiko Yamaguchi
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Hiroaki Takeshita
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Junichi Tanaka
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiromi Kuroda
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Emi Matsuura
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuji Ishimatsu
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Sumihisa Honda
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Terumitsu Sawai
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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27
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Kim DD, DeSnyder SM, Dougherty PM, Cata JP. Effect of neoadjuvant chemotherapy on intraoperative core temperature in patients with breast cancer: a retrospective cohort study. BJA OPEN 2023; 5:100119. [PMID: 37587989 PMCID: PMC10430839 DOI: 10.1016/j.bjao.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 08/18/2023]
Abstract
Background Clinical evidence suggests that chemotherapeutic agents are associated with neuropathy and peripheral autonomic dysfunction. However, the possible effects of neoadjuvant chemotherapy on intraoperative temperature remain poorly characterised. Methods We evaluated patients who underwent a mastectomy for breast cancer between April 2016 and July 2020. Propensity scores were used to match patients who received neoadjuvant chemotherapy with those who did not, and intraoperative core temperature patterns were analysed in the matched cohort. The independent associations between vasopressor use and heart rate during general anaesthesia in the matched cohort were also analysed. Results Data from 1764 patients were analysed (882 patients in each group). Both groups presented a similar pattern of heat redistribution and subsequent rewarming; however, the neoadjuvant chemotherapy group did not reach the same intraoperative plateau temperature as the group that did not receive prior chemotherapy, with differences of up to 0.4°C (95% confidence interval: 0.11-0.63°C; P=0.005). In a subgroup analysis, neuropathy in patients who received neoadjuvant chemotherapy was associated with increased use of vasopressors and higher heart rate. Conclusions In patients with breast cancer, neoadjuvant chemotherapy is associated with lower plateau core temperatures, increased vasopressor use, and higher heart rates during general anaesthesia, which is more severe in the presence of neuropathy.
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Affiliation(s)
- Daniel D. Kim
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Sarah M. DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patrick M. Dougherty
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan P. Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
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28
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The effects of prolonged intraoperative hypothermia on patient outcomes in immediate implant-based breast reconstruction. J Plast Reconstr Aesthet Surg 2023; 77:1-7. [PMID: 36543055 DOI: 10.1016/j.bjps.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 09/01/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The importance of thermoregulation in surgical procedures has become a recent focus for anesthesiologists and surgeons to improve patient outcomes. In breast surgery, maintenance of normothermia has been shown to reduce surgical-site infections. However, there is a paucity of information evaluating the relationship between intraoperative core body temperatures and reconstructive surgical outcomes. METHODS A retrospective review of patients who underwent immediate breast reconstruction following mastectomy from 2015 to 2020 was performed. Patients were classified into a majority normothermic (NT) group if patients spent greater than half of the operative time ≥36 °C or a majority hypothermic (HT) group if patients spent greater than or equal to half of the operative time <36 °C. Patient demographics, comorbidities, surgical techniques, and postoperative complications were recorded. Complications were classified according to the Clavien-Dindo Classification. Univariate and multivariate statistics were used to assess significant relationships. RESULTS A total of 329 patients met inclusion criteria, of which 174 were in the NT group and 155 were in the HT group, yielding 302 and 264 total breasts, respectively. There was no significant difference in rates of infection (p = 1.0), seroma (p = 0.27), hematoma (p = 0.61), or wound dehiscence (p = 1.0). However, patients in the HT group had significantly more overall ischemic complications (p = 0.009) and, specifically, grade IIIb ischemic complications (p = 0.04). After controlling for tobacco use, body mass index, mastectomy pattern, radiation, operating surgeon, and mastectomy weight, multivariate analysis showed increased ischemic complications in the HT group (p = 0.04). CONCLUSION Prolonged intraoperative hypothermia can increase the risk for the development of ischemic wounds such as tissue necrosis or eschar formation that require operative intervention. This presents reconstructive complications that increase both patient and health system burdens that could be addressed through the maintenance of normothermia. Further studies using real-time flap temperature would provide more accurate insight into the relationship between temperature and implant-based breast reconstruction.
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29
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Bräuer A, Fazliu A, Brandes IF, Vollnhals F, Grote R, Menzel M. Evaluation of the Temple Touch Pro™ noninvasive core-temperature monitoring system in 100 adults under general anesthesia: a prospective comparison with esophageal temperature. J Clin Monit Comput 2023; 37:29-36. [PMID: 35377051 PMCID: PMC9852212 DOI: 10.1007/s10877-022-00851-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/16/2022] [Indexed: 01/24/2023]
Abstract
Perioperative hypothermia is still common and has relevant complication for the patient. An effective perioperative thermal management requires essentially an accurate method to measure core temperature. So far, only one study has investigated the new Temple Touch Pro™ (Medisim Ltd., Beit-Shemesh, Israel). during anesthesia Therefore, we assessed the agreement between the Temple Touch Pro™ thermometer (TTP) and distal esophageal temperature (TEso) in a second study. After approval by the local ethics committee we studied 100 adult patients undergoing surgery with general anesthesia. Before induction of anesthesia the TTP sensor unit was attached to the skin above the temporal artery. After induction of anesthesia an esophageal temperature probe was placed in the distal esophagus. Recordings started 10 min after placement of the esophageal temperature probe to allow adequate warming of the probes. Pairs of temperature values were documented in five-minute intervals until emergence of anesthesia. Accuracy of the two methods was assessed by Bland-Altman comparisons of differences with multiple measurements. Core temperatures obtained with the TTP in adults showed a mean bias of -0.04 °C with 95% limits of agreement within - 0.99 °C to + 0.91 °C compared to an esophageal temperature probe. We consider the TTP as a reasonable tool for perioperative temperature monitoring. It is not accurate enough to be used as a reference method in scientific studies, but may be a useful tool especially for conscious patients undergoing neuraxial anesthesia or regional anesthesia with sedation. Trial registration This study was registered in the German Clinical Trials Register (DRKS-ID: 00024050), day of registration 12/01/2021.
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Affiliation(s)
- Anselm Bräuer
- Department of Anesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Albulena Fazliu
- Department of Anesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Ivo F Brandes
- Department of Anesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Falk Vollnhals
- Department of Anesthesiology, Emergency Medicine, Intensive Care Medicine and Pain Therapy, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Rolf Grote
- Department of Anesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.,Department of Anesthesiology, Emergency Medicine, Intensive Care Medicine and Pain Therapy, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Matthias Menzel
- Department of Anesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.,Department of Anesthesiology, Emergency Medicine, Intensive Care Medicine and Pain Therapy, Klinikum Wolfsburg, Wolfsburg, Germany
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30
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Lei J, Huang K, Dai Y, Yin G. Evaluating outcomes of patient-centered enhanced recovery after surgery (ERAS) in percutaneous nephrolithotomy for staghorn stones: An initial experience. Front Surg 2023; 10:1138814. [PMID: 37025266 PMCID: PMC10071039 DOI: 10.3389/fsurg.2023.1138814] [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: 01/06/2023] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
Objective To evaluate the outcomes of patient-centered enhanced recovery after surgery (ERAS) in -percutaneous nephrolithotomy (PCNL) for staghorn stones. Patients and methods A retrospective analysis of 106 patients with staghorn calculi who underwent PCNL treatment at the Third Xiangya Hospital from October 01, 2018 to September 30, 2021 was performed. The patients were divided into the ERAS group (n = 56) and traditional group (n = 50). The ERAS program focused on a patient-centered concept, with elaboration on aspects, such as patient education, nutritional support, analgesia, body warming, early mobilization, nephrostomy tube removal, and strict follow-up. Results The total stone free rate and total complication rate were similar in both groups. The visual analogue scale (VAS) 6 h after surgery, ambulation off bed time, indwelling fistula time, indwelling catheter time, and postoperative hospital stays were lower in the ERAS group than in the traditional group (P < 0.05). The multiple session rate in the ERAS group (19, 28.57%) was lower than that in the traditional group (30, 60%) (P = 0.007). The 1-year stone recurrence rate in the ERAS group (7, 17.5%) was lower than that in the traditional group (14, 38.9%) (P = 0.037). Conclusion The patient-centered ERAS in PCNL for staghorn stones accelerated rehabilitation by relieving postoperative pain, shortening hospitalization time, accelerating early ambulation, and reducing multiple session rate and 1-year stone recurrence rate, which have socioeconomic benefits.
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Affiliation(s)
- Jun Lei
- Department of Urology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Kai Huang
- Department of Urology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Yingbo Dai
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Guangming Yin
- Department of Urology, Third Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Guangming Yin
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Zucconi G, Marchello AM, Demarco C, Fortina E, Milano L. Health Technology Assessment for the Prevention of Peri-Operative Hypothermia: Evaluation of the Correct Use of Forced-Air Warming Systems in an Italian Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:133. [PMID: 36612455 PMCID: PMC9819292 DOI: 10.3390/ijerph20010133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
This study investigates the implications of using a system for the maintenance of normothermia in the treatment of patients undergoing surgery, determining whether the FAW (Forced-Air Warming) systems are more effective and efficient than the non-application of appropriate protocols (No Technology). We conducted Health Technology Assessment (HTA) analysis, using both real-world data and the data derived from literature, assuming the point of view of a medium-large hospital. The literature demonstrated that Inadvertent Perioperative Hypothermia (IPH) determines adverse events, such as surgical site infection (FAW: 3% vs. No Technology: 12%), cardiac events (FAW: 3.5% vs. No Technology: 7.6%) or the need for blood transfusions (FAW: 6.2% vs. No Technology: 7.4%). The correct use of FAW allows a medium saving of 16% per patient to be achieved, compared to the non-use of devices. The Cost Effectiveness Value (CEV) is lower in the hypothesis of FAW: it enables a higher efficacy level with a contextual optimization of patients' path costs. The social cost is reduced by around 30% and the overall hospital days are reduced by between 15% and 26%. The qualitative analyses confirmed the results. In conclusion, the evidence-based information underlines the advantages of the proper use of FAW systems in the prevention of accidental peri-operative hypothermia for patients undergoing surgery.
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Affiliation(s)
| | | | | | | | - Ljdia Milano
- Hospital Consulting Spa, 50012 Bagno a Ripoli, Italy
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Khalilov RA, Dzhafarova AM, Abdullaev VR. Activity and Catalytic Characteristics of Rat Liver Mitochondrial Succinate Dehydrogenase under Moderate Hypothermia. Biophysics (Nagoya-shi) 2022. [DOI: 10.1134/s0006350922060094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
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Sultana R, Allen JC, Siow YN, Bong CL, Lee SY. Development of local guidelines to prevent perioperative hypothermia in children: a prospective observational cohort study. Can J Anaesth 2022; 69:1360-1374. [PMID: 36109455 DOI: 10.1007/s12630-022-02317-x] [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: 03/06/2021] [Revised: 03/23/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Perioperative hypothermia (PH) is defined as core body temperature < 36°C during the perioperative period. The incidence of PH is not well established in children because of variations in perioperative temperature monitoring and control measures. We sought to 1) establish the incidence of pediatric PH, 2) assess its adverse outcomes, and 3) identify risk factors in our pediatric population to develop local guidelines for prevention of PH. METHODS We conducted a prospective observational cohort study at a single tertiary hospital (KK Women's and Children's Hospital, Singapore) from June 2017 to December 2017 based on existing institutional practice. We recruited patients aged ≤ 16 yr undergoing surgery and determined the incidence and adverse outcomes of hypothermia. We identified risk factors for PH using univariate and multiple logistic regression analysis and used these to develop local guidelines. RESULTS Of 1,766 patients analyzed, 213 (12.1%; 95% confidence interval, 10.6 to 13.7) developed PH. Among these cases of PH, only 4.5% would have been detected by a single measurement in the postanesthesia care unit (PACU). Adverse outcomes included a longer stay in the PACU (47 vs 39 min; P < 0.01), a higher incidence of shivering (7.1 vs 2.6%; P = 0.01), and more discomfort (3.8 vs 1.4%; P = 0.02) compared with normothermic patients. Risk factors for PH included preoperative temperature < 36°C, surgery duration > 60 min, ambient operating room temperature < 23.0°C, and several "high-risk" surgeries. Guidelines were developed based on these risk factors and customized according to clinical and workflow considerations. CONCLUSIONS Perioperative hypothermia was a common problem in our pediatric population and was associated with significant adverse outcomes. Guidelines developed based on risk factors identified in the local context can facilitate workflow and implementation within the institution.
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Affiliation(s)
- Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Rd., Singapore, 169857, Singapore.
| | - John C Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Rd., Singapore, 169857, Singapore
| | - Yew Nam Siow
- Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore
| | - Choon Looi Bong
- Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore
| | - Shu Ying Lee
- Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore
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Bardia A, Deshpande R, Michel G, Yanez D, Dai F, Pace NL, Schuster K, Mathis MR, Kheterpal S, Schonberger RB. Demonstration and Performance Evaluation of Two Novel Algorithms for Removing Artifacts From Automated Intraoperative Temperature Data Sets: Multicenter, Observational, Retrospective Study. JMIR Perioper Med 2022; 5:e37174. [PMID: 36197702 PMCID: PMC9591708 DOI: 10.2196/37174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The automated acquisition of intraoperative patient temperature data via temperature probes leads to the possibility of producing a number of artifacts related to probe positioning that may impact these probes' utility for observational research. OBJECTIVE We sought to compare the performance of two de novo algorithms for filtering such artifacts. METHODS In this observational retrospective study, the intraoperative temperature data of adults who received general anesthesia for noncardiac surgery were extracted from the Multicenter Perioperative Outcomes Group registry. Two algorithms were developed and then compared to the reference standard-anesthesiologists' manual artifact detection process. Algorithm 1 (a slope-based algorithm) was based on the linear curve fit of 3 adjacent temperature data points. Algorithm 2 (an interval-based algorithm) assessed for time gaps between contiguous temperature recordings. Sensitivity and specificity values for artifact detection were calculated for each algorithm, as were mean temperatures and areas under the curve for hypothermia (temperatures below 36 C) for each patient, after artifact removal via each methodology. RESULTS A total of 27,683 temperature readings from 200 anesthetic records were analyzed. The overall agreement among the anesthesiologists was 92.1%. Both algorithms had high specificity but moderate sensitivity (specificity: 99.02% for algorithm 1 vs 99.54% for algorithm 2; sensitivity: 49.13% for algorithm 1 vs 37.72% for algorithm 2; F-score: 0.65 for algorithm 1 vs 0.55 for algorithm 2). The areas under the curve for time × hypothermic temperature and the mean temperatures recorded for each case after artifact removal were similar between the algorithms and the anesthesiologists. CONCLUSIONS The tested algorithms provide an automated way to filter intraoperative temperature artifacts that closely approximates manual sorting by anesthesiologists. Our study provides evidence demonstrating the efficacy of highly generalizable artifact reduction algorithms that can be readily used by observational studies that rely on automated intraoperative data acquisition.
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Affiliation(s)
- Amit Bardia
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Ranjit Deshpande
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States
| | - George Michel
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States
| | - David Yanez
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States
| | - Feng Dai
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States
| | - Nathan L Pace
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, United States
| | - Kevin Schuster
- Department of Surgery, Yale School of Medicine, New Haven, CT, United States
| | - Michael R Mathis
- Department of Anesthesiology, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Robert B Schonberger
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States
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Deng X, Yan J, Wang S, Li Y, Shi Y. Clinical Survey of Current Perioperative Body Temperature Management: What Major Factors Influence Effective Hypothermia Prevention Practice? J Multidiscip Healthc 2022; 15:1689-1696. [PMID: 35965636 PMCID: PMC9374200 DOI: 10.2147/jmdh.s376423] [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: 05/27/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Inadvertent intraoperative hypothermia (IIH) is generally associated with several postoperative complications. Inspite of the existing guidelines, the global incidence of IIH remains unacceptably high. Understanding the conditions that influence temperature management is critical for developing future interventions to improve the postoperative patient outcomes. This study aimed to identify the major factors that hinder the implementation of IIH prevention practices. Methods Through a literature research, pilot small-sample investigation, and expert suggestions, 11 factors that may hinder the implementation of IIH prevention practices were identified. A questionnaire was developed, and each question was used to assess each factor. After approval by the Research Ethics Board, the questionnaires were sent to the staff anaesthesiologists at two academic hospitals via WeChat. Each answer was coded according to the degree to which the factor was affected, as anticipated. Finally, the answers were analysed based on the 80/20 rule to identify the major barriers to effective temperature management. Results We included 195 participants. Knowledge, memory, attention and decision processes, beliefs about consequences, and environmental context and resources were the major factors, with cumulative composition ratios of 24%, 43.4%, 57.7%, and 70.7%, respectively. Meanwhile, behavioural regulation and social influence were the secondary factors, with cumulative composition ratios of 80.4% and 87.5%, respectively. Reinforcement, confidence in capacity, duty realisation, skills, and intention were the general factors with cumulative composition ratios of 94.3%, 99.8%, 100%, 100%, and 100%, respectively. Conclusion Four factors-knowledge, memory, attention and decision process, beliefs about consequences, and environmental context and resources-were the major factors that influence the effective hypothermia prevention practice. Relevance to Clinical Practice These major factors will be used in further studies as a basis to develop the corresponding solutions and improve the patient outcomes in clinical practice.
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Affiliation(s)
- Xiaoqian Deng
- Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, People's Republic of China
| | - Junyu Yan
- Department of Anesthesiology, Karamay Hospital of Integrated Traditional Chinese and Western Medicine, Karamay, People's Republic of China
| | - Shaungwen Wang
- West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Yifan Li
- West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Yun Shi
- Department of Anesthesiology, Children's Hospital of Fudan University, Fudan University, Shanghai, People's Republic of China
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Garoufalia Z, Aggelis A, Antoniou EA, Kouraklis G, Vagianos C. Operating on Jehovah's Witnesses: A Challenging Surgical Issue. JOURNAL OF RELIGION AND HEALTH 2022; 61:2447-2457. [PMID: 33417056 DOI: 10.1007/s10943-020-01175-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/26/2020] [Indexed: 06/12/2023]
Abstract
Blood transfusion is often utilized in surgery. Greece is the second-highest consumer of blood components in Europe. It has been shown that at least half of all transfusions are unnecessary and could be avoided. Jehovah's Witnesses (JWs) are a Christian religion that do not accept transfusion of whole blood or the four primary components of blood-namely, red blood cells, white blood cells, platelets, and plasma. This a retrospective study from September of 2015 to January of 2018, analyzing all JWs who underwent an elective operation at the Second Department of Propaedeutic Surgery in Laiko University Hospital. Twenty-nine (Rogers et al. in NCCN Guidelines Version 2.2014 Cancer- and Chemotherapy-Induced Anemia. NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network, Fort Washington, 2013) JW patients, 23 females (74.1%) and eight males, were operated on during the aforementioned period. The median ASA score was 1 (range 1-3), and only two of the patients needed postoperative monitoring in the ICU. Almost half of the patients (45.1%) needed iron infusion and EPO injection preoperatively. Two patients presented with postoperative complications, with no postoperative deaths. In conclusion, we found that surgery, in our small group of JW patients, was safe and successful despite the lack of blood transfusion. Techniques developed to treat JW patients should be more widely used to improve clinical outcomes and reduce costs to the healthcare system.
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Affiliation(s)
- Zoe Garoufalia
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece.
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, 17 AgiouThoma Street, 11527, Athens, Greece.
| | - Apostolos Aggelis
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios A Antoniou
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Gregory Kouraklis
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Costantine Vagianos
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece
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Sessler DI, Pei L, Li K, Cui S, Chan MTV, Huang Y, Wu J, He X, Bajracharya GR, Rivas E, Lam CKM. Aggressive intraoperative warming versus routine thermal management during non-cardiac surgery (PROTECT): a multicentre, parallel group, superiority trial. Lancet 2022; 399:1799-1808. [PMID: 35390321 DOI: 10.1016/s0140-6736(22)00560-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/03/2022] [Accepted: 03/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Moderate intraoperative hypothermia promotes myocardial injury, surgical site infections, and blood loss. Whether aggressive warming to a truly normothermic temperature near 37°C improves outcomes remains unknown. We aimed to test the hypothesis that aggressive intraoperative warming reduces major perioperative complications. METHODS In this multicentre, parallel group, superiority trial, patients at 12 sites in China and at the Cleveland Clinic in the USA were randomly assigned (1:1) to receive either aggressive warming to a target core temperature of 37°C (aggressively warmed group) or routine thermal management to a target of 35·5°C (routine thermal management group) during non-cardiac surgery. Randomisation was stratified by site, with computer-generated, randomly sized blocks. Eligible patients (aged ≥45 years) had at least one cardiovascular risk factor, were scheduled for inpatient non-cardiac surgery expected to last 2-6 h with general anaesthesia, and were expected to have at least half of the anterior skin surface available for warming. Patients requiring dialysis and those with a body-mass index exceeding 30 kg/m2 were excluded. The primary outcome was a composite of myocardial injury (troponin elevation, apparently of ischaemic origin), non-fatal cardiac arrest, and all-cause mortality within 30 days of surgery, as assessed in the modified intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT03111875. FINDINGS Between March 27, 2017, and March 16, 2021, 5056 participants were enrolled, of whom 5013 were included in the intention-to-treat population (2507 in the aggressively warmed group and 2506 in the routine thermal management group). Patients assigned to aggressive warming had a mean final intraoperative core temperature of 37·1°C (SD 0·3) whereas the routine thermal management group averaged 35·6°C (SD 0·3). At least one of the primary outcome components (myocardial injury after non-cardiac surgery, cardiac arrest, or mortality) occurred in 246 (9·9%) of 2497 patients in the aggressively warmed group and in 239 (9·6%) of 2490 patients in the routine thermal management group. The common effect relative risk of aggressive versus routine thermal management was an estimated 1·04 (95% CI 0·87-1·24, p=0·69). There were 39 adverse events in patients assigned to aggressive warming (17 of which were serious) and 54 in those assigned to routine thermal management (30 of which were serious). One serious adverse event, in an aggressively warmed patient, was deemed to be possibly related to thermal management. INTERPRETATION The incidence of a 30-day composite of major cardiovascular outcomes did not differ significantly in patients randomised to 35·5°C and to 37°C. At least over a 1·5°C range from very mild hypothermia to full normothermia, there was no evidence that any substantive outcome varied. Keeping core temperature at least 35·5°C in surgical patients appears sufficient. FUNDING 3M and the Health and Medical Research Fund, Food and Health Bureau, Hong Kong. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; Population Health Research Institute, McMaster University, ON, Canada.
| | - Lijian Pei
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Kai Li
- China-Japan Union Hospital of Jilin University, Jilin, China
| | - Shusen Cui
- China-Japan Union Hospital of Jilin University, Jilin, China
| | - Matthew T V Chan
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China.
| | - Jingxiang Wu
- Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xuemei He
- West China Hospital, Sichuan University, Sichuan, China
| | - Gausan R Bajracharya
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eva Rivas
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Anesthesia, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Carmen K M Lam
- Tuen Mun Hospital, Hong Kong Special Administrative Region, China
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Van Duren A. Perioperative Prewarming: Heat Transfer and Physiology. AORN J 2022; 115:407-422. [PMID: 35476210 DOI: 10.1002/aorn.13667] [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: 07/02/2021] [Revised: 11/19/2021] [Accepted: 12/12/2021] [Indexed: 11/07/2022]
Abstract
To appreciate the strategy of prewarming, perioperative personnel should have a basic understanding of the physics of heat transfer and the thermoregulatory pathophysiology of anesthesia. The dominant cause of postinduction hypothermia is anesthesia-related redistribution of heat within the body; the role of cutaneous heat loss is minimal. Physiologic thermoregulatory system changes that occur in response to anesthesia make it almost impossible to reverse intraoperative hypothermia. However, prewarming is an effective strategy to prevent postinduction hypothermia from redistribution because it creates a temporary excess of heat in the body's peripheral thermal compartment. Perioperative nurses should implement active and passive prewarming strategies in accordance with the warming devices at their facility and available time. This article focuses on two major topics necessary to understand prewarming: the effect of anesthesia on postinduction thermoregulation and thermodynamic conditions that successful treatment strategies must exploit to produce desired outcomes.
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Namisnak LH, Haghayegh S, Khoshnevis S, Diller KR. Bioheat Transfer Basis of Human Thermoregulation: Principles and Applications. JOURNAL OF HEAT TRANSFER 2022; 144:031203. [PMID: 35833149 PMCID: PMC8823203 DOI: 10.1115/1.4053195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 12/06/2021] [Indexed: 05/29/2023]
Abstract
Thermoregulation is a process that is essential to the maintenance of life for all warm-blooded mammalian and avian species. It sustains a constant core body temperature in the face of a wide array of environmental thermal conditions and intensity of physical activities that generate internal heat. A primary component of thermoregulatory function is the movement of heat between the body core and the surface via the circulation of blood. The peripheral vasculature acts as a forced convection heat exchanger between blood and local peripheral tissues throughout the body enabling heat to be convected to the skin surface where is may be transferred to and from the environment via conduction, convection, radiation, and/or evaporation of water as local conditions dictate. Humans have evolved a particular vascular structure in glabrous (hairless) skin that is especially well suited for heat exchange. These vessels are called arteriovenous anastomoses (AVAs) and can vasodilate to large diameters and accommodate high flow rates. We report herein a new technology based on a physiological principle that enables simple and safe access to the thermoregulatory control system to allow manipulation of thermoregulatory function. The technology operates by applying a small amount of heating local to control tissue on the body surface overlying the cerebral spine that upregulates AVA perfusion. Under this action, heat exchangers can be applied to glabrous skin, preferably on the palms and soles, to alter the temperature of elevated blood flow prior to its return to the core. Therapeutic and prophylactic applications are discussed.
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Affiliation(s)
- Laura H Namisnak
- Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas at Austin, Austin, TX 78712
| | - Shahab Haghayegh
- Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas at Austin, Austin, TX 78712; Department of Biostatics, T.H. Chan School of Public Health, Harvard Medical School, Boston, MA 02138
| | - Sepideh Khoshnevis
- Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas at Austin, Austin, TX 78712
| | - Kenneth R Diller
- Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas at Austin, Austin, TX 78712
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Wang J, Fang P, Sun G, Li M. Effect of active forced air warming during the first hour after anesthesia induction and intraoperation avoids hypothermia in elderly patients. BMC Anesthesiol 2022; 22:40. [PMID: 35130863 PMCID: PMC8819880 DOI: 10.1186/s12871-022-01577-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/25/2022] [Indexed: 01/03/2023] Open
Abstract
Background The study aimed at exploring an optimal temperature model of forced air warming during the first hour after induction and intraoperation to prevent hyperthermia for elderly patients undergoing laparoscopic abdominal surgery. Methods There were 218 patients that were randomly divided into 3 groups warmed with a forced-air warmer during surgery: Group L (intraoperative warming set to 38 °C, n = 63), Group H (intraoperative warming set to 42 °C, n = 65) and Group LH (intraoperative warming set to 42 °C for the first hour then set to 38 °C, n = 65). Core temperature in the preoperative room and PACU was measured by a tympanic membrane thermometer and in the operation room, a nasopharyngeal temperature probe was recorded. The rate of perioperative hypothermia, defined as a reduction in body temperature to < 36 °C was recorded as the primary outcome. Intraoperative anesthetic dosage, recovery time, adverse events, thermal comfort and satisfaction score were measured as secondary outcome. Results The incidence of intraoperative and postoperative hypothermia was significantly lower in Group LH and Group H than Group L (18.75 and 15.62% vs 44.44%, P<0.001; 4.69 and 4.69% vs 20.63%, P<.05). Anesthetic dosage of rocuronium was lower in Group L than other two groups, with the opposite result of recovery time. The number of patients with shivering was higher in Group L but sweating was higher in Group H. Both of the thermal comfort and satisfaction score was highest in Group LH. Conclusion A temperature pattern of forced air warming set at 42 °C during the first hour after anesthesia induction and maintained with 38 °C was a suitable choice for elderly patients undergoing laparoscopic abdominal surgery lasting for more than 120 min. Trial registration Chictr.org.cn ChiCTR-2,100,053,211.
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Affiliation(s)
- Jingyu Wang
- Department of Surgical Anesthesia Center, LiHuili Hospital, Ningbo Medical Center, No.57 Xingning Road, Yinzhou District, Ningbo, 315000, Zhejiang Province, China
| | - Ping Fang
- Department of Surgical Anesthesia Center, LiHuili Hospital, Ningbo Medical Center, No.57 Xingning Road, Yinzhou District, Ningbo, 315000, Zhejiang Province, China.
| | - Gangqiang Sun
- Department of Surgical Anesthesia Center, LiHuili Hospital, Ningbo Medical Center, No.57 Xingning Road, Yinzhou District, Ningbo, 315000, Zhejiang Province, China
| | - Ming Li
- Department of Surgical Anesthesia Center, the Second Hospital of Haishu District, No.52 Yizhi Middle Road, Shiqi Street, Haishu District, Ningbo, 315000, Zhejiang Province, China
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Cumin D, Fogarin J, Mitchell SJ, Windsor JA. Perioperative hypothermia in open and laparoscopic colorectal surgery. ANZ J Surg 2022; 92:1125-1131. [PMID: 35088504 DOI: 10.1111/ans.17493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The consequences of even mild inadvertent perioperative hypothermia (IPH) are significant. There is a perception laparoscopic abdominal surgery is less prone to cause hypothermia than open surgery. However, during laparoscopic surgery, the peritoneal cavity is insufflated with carbon dioxide, which has a greater evaporative capacity than ambient air. This study compared the intra-operative temperature profile of patients undergoing open and laparoscopic colorectal surgery to define the incidence and severity of hypothermia. METHODS All adult patients undergoing colorectal surgery between May 2005 and August 2013 were identified from an electronic database. Cases were categorized into laparoscopic and open cases. Hypothermic episodes were defined as a temperature less than 36°C lasting for more than two consecutive minutes. The incidence of hypothermic episodes, the total time under 36°C and the area under the curve (degree-minutes) were calculated. RESULTS A total of 1547 cases were analysed. The overall incidence of hypothermia was 67.0%. The incidence of cases with a hypothermic episode was greater in the laparoscopic group compared to the open group (71.23% versus 63.16%; chi-squared P-value 0.001). However, when other factors were considered, there was no significant difference in the relative risk of a hypothermic episode between types of surgery. There were significant differences in the severity of hypothermia. CONCLUSION Despite current measures to reduce the incidence, IPH remains a significant problem in colorectal surgery irrespective of the surgical approach. Further research is required to better characterize techniques that can reduce its incidence.
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Affiliation(s)
- David Cumin
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Jessica Fogarin
- Surgical, Fisher & Paykel Healthcare Ltd., Auckland, New Zealand
| | - Simon J Mitchell
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.,Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - John A Windsor
- HPB/Upper GI Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand.,Surgical Trials Unit, Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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42
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Xu G, Li T, Huang Y. The Effects of Intraoperative Hypothermia on Postoperative Cognitive Function in the Rat Hippocampus and Its Possible Mechanisms. Brain Sci 2022; 12:brainsci12010096. [PMID: 35053838 PMCID: PMC8773779 DOI: 10.3390/brainsci12010096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 02/07/2023] Open
Abstract
Intraoperative hypothermia is a common complication during operations and is associated with several adverse events. Postoperative cognitive dysfunction (POCD) and its adverse consequences have drawn increasing attention in recent years. There are currently no relevant studies investigating the correlation between intraoperative hypothermia and POCD. The aim of this study was to assess the effects of intraoperative hypothermia on postoperative cognitive function in rats undergoing exploratory laparotomies and to investigate the possible related mechanisms. We used the Y-maze and Morris Water Maze (MWM) tests to assess the rats’ postoperative spatial working memory, spatial learning, and memory. The morphological changes in hippocampal neurons were examined by haematoxylin-eosin (HE) staining and hippocampal synaptic plasticity-related protein expression. Activity-regulated cytoskeletal-associated protein (Arc), cyclic adenosine monophosphate-response element-binding protein (CREB), S133-phosphorylated CREB (p-CREB [S133]), α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor 1 (AMPAR1), and S831-phosphorylated AMPAR1 (p-AMPAR1 [S831]) were evaluated by Western blotting. Our results suggest a correlation between intraoperative hypothermia and POCD in rats and that intraoperative hypothermia may lead to POCD regarding impairments in spatial working memory, spatial learning, and memory. POCD induced by intraoperative hypothermia might be due to hippocampal neurons damage and decreased expression of synaptic plasticity-related proteins Arc, p-CREB (S133), and p-AMPAR1 (S831).
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43
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Lauronen SL, Kalliomäki ML, Kalliovalkama J, Aho A, Huhtala H, Yli-Hankala AM, Mäkinen MT. Comparison of zero heat flux and double sensor thermometers during spinal anaesthesia: a prospective observational study. J Clin Monit Comput 2022; 36:1547-1555. [PMID: 34978656 PMCID: PMC9508040 DOI: 10.1007/s10877-021-00799-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022]
Abstract
Because of the difficulties involved in the invasive monitoring of conscious patients, core temperature monitoring is frequently neglected during neuraxial anaesthesia. Zero heat flux (ZHF) and double sensor (DS) are non-invasive methods that measure core temperature from the forehead skin. Here, we compare these methods in patients under spinal anaesthesia. Sixty patients scheduled for elective unilateral knee arthroplasty were recruited and divided into two groups. Of these, thirty patients were fitted with bilateral ZHF sensors (ZHF group), and thirty patients were fitted with both a ZHF sensor and a DS sensor (DS group). Temperatures were saved at 5-min intervals from the beginning of prewarming up to one hour postoperatively. Bland–Altman analysis for repeated measurements was performed and a proportion of differences within 0.5 °C was calculated as well as Lin`s concordance correlation coefficient (LCCC). A total of 1261 and 1129 measurement pairs were obtained. The mean difference between ZHF sensors was 0.05 °C with 95% limits of agreement − 0.36 to 0.47 °C, 99% of the readings were within 0.5 °C and LCCC was 0.88. The mean difference between ZHF and DS sensors was 0.33 °C with 95% limits of agreement − 0.55 to 1.21 °C, 66% of readings were within 0.5 °C and LCCC was 0.59. Bilaterally measured ZHF temperatures were almost identical. DS temperatures were mostly lower than ZHF temperatures. The mean difference between ZHF and DS temperatures increased when the core temperature decreased. Trial registration: The study was registered in ClinicalTrials.gov on 13th May 2019, Code NCT03408197.
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Affiliation(s)
- Sirkka-Liisa Lauronen
- Department of Anaesthesia, Tampere University Hospital, Elämänaukio 2, POB 2000, 33521, Tampere, Finland.
| | - Maija-Liisa Kalliomäki
- Department of Anaesthesia, Tampere University Hospital, Elämänaukio 2, POB 2000, 33521, Tampere, Finland
| | | | - Antti Aho
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Arvi M Yli-Hankala
- Department of Anaesthesia, Tampere University Hospital, Elämänaukio 2, POB 2000, 33521, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Marja-Tellervo Mäkinen
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
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Dai Z, Zhang Y, Yi J, Huang Y. Validation of a Prediction Model for Intraoperative Hypothermia in Patients Receiving General Anesthesia. Int J Clin Pract 2022; 2022:6806225. [PMID: 36187909 PMCID: PMC9509213 DOI: 10.1155/2022/6806225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES There have been no fully validated tools for the rapid identification of surgical patients at risk of intraoperative hypothermia. The objective of this study was to validate the performance of a previously established prediction model in estimating the risk of intraoperative hypothermia in a prospective cohort. METHODS In this observational study, consecutive adults scheduled for elective surgery under general anesthesia were enrolled prospectively at a tertiary hospital between September 4, 2020, and December 28, 2020. An intraoperative hypothermia risk score was calculated by a mobile application of the prediction model. A wireless axillary thermometer was used to continuously measure perioperative core temperature as the reference standard. The discrimination and calibration of the model were assessed, using the area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow goodness-of-fit test, and Brier score. RESULTS Among 227 participants, 99 (43.6%) developed intraoperative hypothermia, and 10 (4.6%) received intraoperative active warming with forced-air warming. The model had an AUC of 0.700 (95% confidence interval [CI], 0.632-0.768) in the overall cohort with adequate calibration (Hosmer-Lemeshow χ 2 = 13.8, P=0.087; Brier score = 0.33 [95% CI, 0.29-0.37]). We categorized the risk scores into low-risk, moderate-risk, and high-risk groups, in which the incidence of intraoperative hypothermia was 23.0% (95% CI, 12.4-33.5), 43.4% (95% CI, 33.7-53.2), and 62.7% (95% CI, 51.5-74.3), respectively (P for trend <0.001). CONCLUSIONS The intraoperative hypothermia prediction model demonstrated possibly helpful discrimination and adequate calibration in our prospective validation. These findings suggest that the risk screening model could facilitate future perioperative temperature management.
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Affiliation(s)
- Ziyi Dai
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jie Yi
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Varner KL, Hines CB. Reducing Hypothermia After Cardiac Ablation Using the ASPAN Normothermia Guidelines. J Perianesth Nurs 2022; 37:162-166. [DOI: 10.1016/j.jopan.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/16/2021] [Accepted: 03/28/2021] [Indexed: 10/19/2022]
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Teshima R, Nishimura A, Hara A, Ubukata Y, Chizuwa S, Wakatsuki M, Iijima T. Anesthesia Management of a Patient With Familial Cold Autoinflammatory Syndrome: A Case Report. Anesth Prog 2022; 69:38-39. [PMID: 36223190 PMCID: PMC9552617 DOI: 10.2344/anpr-69-02-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/04/2022] [Indexed: 03/03/2023] Open
Abstract
Familial cold autoinflammatory syndrome (FCAS) is a rare phenotype of cryopyrin-associated periodic syndrome (CAPS) and is characterized by repetitive systemic inflammation triggered by cold stimulation. Recently, we treated a 13-year-old female with FCAS/CAPS scheduled to undergo removal of an impacted tooth. To minimize perioperative heat loss, a forced-air warming system was utilized to prewarm the patient for 10 minutes before induction of general anesthesia. The patient's core and peripheral temperatures were monitored with axillary, superficial temporal artery, and rectal thermometers. The difference in temperatures at these 3 locations decreased to 0.4° C within 60 minutes as a result of the forced-air warming system before induction. Perioperative use of the warming system successfully prevented the occurrence any significant redistribution hypothermia and any symptoms of FCAS/CAPS.
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Affiliation(s)
- Ruri Teshima
- Department of Perioperative Medicine, Division of Anesthesiology, Showa University School of Dentistry, Tokyo, Japan
| | - Akiko Nishimura
- Department of Perioperative Medicine, Division of Anesthesiology, Showa University School of Dentistry, Tokyo, Japan
| | - Akira Hara
- Department of Perioperative Medicine, Division of Anesthesiology, Showa University School of Dentistry, Tokyo, Japan
| | - Yuhei Ubukata
- Department of Perioperative Medicine, Division of Anesthesiology, Showa University School of Dentistry, Tokyo, Japan
| | - Sayaka Chizuwa
- Department of Perioperative Medicine, Division of Anesthesiology, Showa University School of Dentistry, Tokyo, Japan
| | - Mone Wakatsuki
- Department of Perioperative Medicine, Division of Anesthesiology, Showa University School of Dentistry, Tokyo, Japan
| | - Takehiko Iijima
- Department of Perioperative Medicine, Division of Anesthesiology, Showa University School of Dentistry, Tokyo, Japan
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47
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Reeves N, White J, Bird S, Shinkwin M, Cornish J, Torkington J. Warmed and humidified insufflation to prevent perioperative hypothermia and improve the quality of recovery in elective laparoscopic colorectal resection patients: a feasibility study for a triple-blind randomized controlled trial. Colorectal Dis 2021; 23:3262-3271. [PMID: 34747558 DOI: 10.1111/codi.15984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/26/2021] [Accepted: 10/31/2021] [Indexed: 02/08/2023]
Abstract
AIM The use of standard CO2 for insufflation during laparoscopic colorectal surgery may be associated with cooling and drying of the peritoneal cavity, contributing to perioperative hypothermia. The aim of this work was the assess the feasibility of a study to compare insufflation of warmed, humidified CO2 (WHCO2) (using HumiGard, Fisher and Paykel Healthcare) with standard measures and its impact on the quality of recovery of surgical patients. METHOD A single-centre, triple-blind, feasibility, randomized controlled trial (RCT) of adults scheduled for planned laparoscopic colorectal surgery. The primary outcome was recruitment. Secondary outcomes included feasibility of blinding, acceptability to patients and suitability of objective measures: patient-reported quality of recovery using a validated questionnaire (QoR-40), patient pain scores and semi-continuous core temperature measurements. RESULTS Thirty-nine participants were randomized to either the WHCO2 group (n = 19) or standard care alone (n = 20). Recruitment to the study was successful and acceptable to patients. Blinding of the surgeons, patients and assessors was effective. Response rates to QoR-40 were high but ceiling effects were observed, indicating that the tool was unsuitable in this population. Fewer patients in the WHCO2 group reported postoperative nausea and vomiting (PONV) at days 1 (53% vs. 65%) and 3 (37% vs. 60%). The median hospital length of stay was 5.5 days in the standard care group and 4 days in the WHCO2 group. CONCLUSION A study of WHCO2 for insufflation in laparoscopic colorectal surgery would be highly acceptable to both patients and researchers. Potential reductions in PONV and hospital length of stay in patients treated with WHCO2 merit further investigation. The design of the full-scale RCT will benefit from this feasibility study.
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Affiliation(s)
| | - Judith White
- Cedar, Cardiff and Vale University Health Board, Cardiff, UK
| | - Samuel Bird
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Michael Shinkwin
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Julie Cornish
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Jared Torkington
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
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48
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Postoperative hypothermia following non-cardiac high-risk surgery: A prospective study of temporal patterns and risk factors. PLoS One 2021; 16:e0259789. [PMID: 34780517 PMCID: PMC8592479 DOI: 10.1371/journal.pone.0259789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/26/2021] [Indexed: 12/16/2022] Open
Abstract
Background and objectives Hypothermia occurs commonly during surgery and can cause postoperative complications. We aimed to describe the characteristics and outcomes of hypothermia in patients undergoing major surgeries. Methods This prospective, observational, multicenter study of a nationally representative sample included all patients over 18 years of age admitted to an intensive care unit (ICU). Thirty ICUs were selected randomly at national level. The main outcome measure was the proportion of patients who developed postoperative hypothermia in the first 24 hours of ICU admission. Patients were divided into three groups based on temperature: <35°C, <36°C, and ≥36°C (no hypothermia). Patients’ characteristics, postoperative complications, and risk factors were evaluated in all groups. To verify whether hypothermia was a strong risk factor for postoperative complications, a Kaplan–Meier curve was generated and adjusted using a Cox regression model. Results In total, 738 patients had their temperatures measured. The percentage of patients with temperature <35°C (median [Q1-Q3], 34.7°C [34.3–34.9°C]) was 19.1% (95% confidence interval [CI] = 16.1–22.5) and that of patients with temperature <36°C (median [Q1-Q3], 35.4°C [35.0–35.8°C]) was 64% (95% CI = 58.3–70.0). The percentage of surgical complications was 38.9%. Patients with hypothermia were older, had undergone abdominal surgeries, had undergone procedures of longer duration, and had more comorbidities. A postoperative temperature ≤35°C was an independent risk for composite postoperative complications (hazard ratio = 1.523, 95% CI = 1.15–2.0), especially coagulation and infection. Conclusions Inadvertent hypothermia was frequent among patients admitted to the ICU and occurred more likely after abdominal surgery, after a long procedure, in elderly patients, and in patients with a higher number of comorbidities. Low postoperative temperature was associated with postoperative complications.
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Wallisch C, Zeiner S, Scholten P, Dibiasi C, Kimberger O. Development and internal validation of an algorithm to predict intraoperative risk of inadvertent hypothermia based on preoperative data. Sci Rep 2021; 11:22296. [PMID: 34785724 PMCID: PMC8595364 DOI: 10.1038/s41598-021-01743-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/02/2021] [Indexed: 11/08/2022] Open
Abstract
Intraoperative hypothermia increases perioperative morbidity and identifying patients at risk preoperatively is challenging. The aim of this study was to develop and internally validate prediction models for intraoperative hypothermia occurring despite active warming and to implement the algorithm in an online risk estimation tool. The final dataset included 36,371 surgery cases between September 2013 and May 2019 at the Vienna General Hospital. The primary outcome was minimum temperature measured during surgery. Preoperative data, initial vital signs measured before induction of anesthesia, and known comorbidities recorded in the preanesthetic clinic (PAC) were available, and the final predictors were selected by forward selection and backward elimination. Three models with different levels of information were developed and their predictive performance for minimum temperature below 36 °C and 35.5 °C was assessed using discrimination and calibration. Moderate hypothermia (below 35.5 °C) was observed in 18.2% of cases. The algorithm to predict inadvertent intraoperative hypothermia performed well with concordance statistics of 0.71 (36 °C) and 0.70 (35.5 °C) for the model including data from the preanesthetic clinic. All models were well-calibrated for 36 °C and 35.5 °C. Finally, a web-based implementation of the algorithm was programmed to facilitate the calculation of the probabilistic prediction of a patient's core temperature to fall below 35.5 °C during surgery. The results indicate that inadvertent intraoperative hypothermia still occurs frequently despite active warming. Additional thermoregulatory measures may be needed to increase the rate of perioperative normothermia. The developed prediction models can support clinical decision-makers in identifying the patients at risk for intraoperative hypothermia and help optimize allocation of additional thermoregulatory interventions.
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Affiliation(s)
- C Wallisch
- Section for Clinical Biometrics, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - S Zeiner
- Department of Anesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - P Scholten
- Department of Anesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - C Dibiasi
- Department of Anesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBI-DHPS), Medical University of Vienna, Vienna, Austria
| | - O Kimberger
- Department of Anesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBI-DHPS), Medical University of Vienna, Vienna, Austria
- Outcomes Research Consortium, Cleveland, OH, USA
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50
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Steyn F, Du Toit L, Naidoo T, Hofmeyr R. A descriptive study of the relationship between preoperative body temperature and intraoperative core temperature change in adults under general anaesthesia. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.6.2600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- F Steyn
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, and Groote Schuur Hospital, Cape Town,
South Africa
| | - L Du Toit
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, and Groote Schuur Hospital, Cape Town,
South Africa
| | - T Naidoo
- Statistical Consulting Services, University of Cape Town,
South Africa
| | - R Hofmeyr
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, and Groote Schuur Hospital, Cape Town,
South Africa
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