A novel thermal compression device for perioperative warming: a randomized trial for feasibility and efficacy

Intraoperative Hypothermia Versus Normothermia in Breast Reconstruction: A Systematic Review and Meta-Analysis

Despite advancements in breast reconstruction, the precise impact of intraoperative hypothermia on postoperative complications remains unclear. Recent literature suggests that intraoperative hypothermia is a risk factor for impaired wound healing and increases the incidence of surgical site infections. This study examines the effect of intraoperative hypothermia on postoperative outcomes in breast reconstruction. We searched PubMed, Embase, and Cochrane Library for studies comparing hypothermia with normothermia in breast reconstruction. A meta-analytical method was employed to estimate the risk of postoperative complications among patients undergoing breast reconstruction. Data synthesis employed the random-effects models, presenting the results as risk ratio (RR) with corresponding 95% confidence intervals (CIs). Statistical analysis was performed using Review Manager 5.4 (Cochrane Collaboration), and heterogeneity was assessed using I2 statistics. Four studies meeting our inclusion criteria were included in the meta-analysis, comprising 871 participants. The average age and body mass index were 52.98 years and 27.76 kg/m2, with a follow-up duration of 3-6 months. In our analysis, intraoperative hypothermia was associated with an increase in the incidence of wound healing complications in breast reconstruction (RR 1.68; 95% CI 1.24 to 2.27; p = 0.0008). Despite lower incidence of infection, hematoma, seroma, and necrosis in the hypothermia group, no significant differences were observed. Our meta-analysis assessing intraoperative hypothermia in breast reconstruction indicates that hypothermia is a significant risk factor for wound healing complications.

Immediate fever during anaesthesia recovery after surgical procedure with scoliosis: A case report and literature review

INTRODUCTION AND IMPORTANCE

Fever is a common clinical symptom in patients with postoperative scoliosis. However, there are rare reports of immediately fevers occurring following operative procedures.

CASE PRESENTATION

A 15-year-old female with a 1-year history of scoliosis was admitted to the hospital after a health examination. The patient was diagnosed with idiopathic scoliosis and underwent a posterior idiopathic scoliosis procedure and correction for pedicle fixation. The clinical symptoms, including chills, fever, increased heart rate and increased blood pressure, were observed immediately following surgery during anaesthesia recovery. The patient was discharged from the hospital 12 days post-surgery. Over the 90-day follow-up, no chills, fever (≥38 °C), deep tissue infection, or surgery-related complications were reported. This remained consistent for the subsequent 3-year follow-up.

CLINICAL DISCUSSION

The patient was discharged 12 days after the operation, and no chills or fever (≥38 °C) occurred during the 90-day follow-up. Furthermore, there were no instances of deep tissue infection or any other surgery-related complications throughout the subsequent 3-year follow-up duration. A literature review has performed for this subject by systematic review. We identified only three reports that specifically examined postoperative fever as an observational measure among spine surgical patients. Unfortunately, none of these reports mentioned immediate postoperative fever.

CONCLUSION

Based on the available clinical data and research evidence, it is recommended to exercise caution when treating patients who experience postoperative chill and fever, as it may be caused by a combination of intraoperative hypothermia and anaesthesia inhibition. While these symptoms may be self-limiting in nature, close monitoring and appropriate management should be implemented to ensure patient safety and to identify any potential complications.

Effect of Prewarming on Postoperative Hypothermia, Vital Signs, and Thermal Comfort: A Randomized Controlled Trial

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).

The Relationship of Perioperative Inadvertent Hypothermia with Anxiety and Comfort

The study aimed to investigate the relationship of perioperative inadvertent hypothermia with anxiety and thermal and general comfort in surgical patients. Inadvertent perioperative hypothermia occurs after surgery and affects many patient outcomes. However, the relationship between hypothermia and anxiety has been given little attention. The research is of descriptive type. A total of 117 surgical patients who met the inclusion criteria were sampled and divided into two groups: hypothermic (n = 54) and normothermic (n = 63). Patients undergoing surgery were monitored for body temperature, systolic and diastolic blood pressure, heart rate, pain intensity, anxiety (Numeric Rating Scale [NRS] and State Anxiety Scale [SAI]), and comfort (Perianesthesia Comfort Questionnaire) levels. The groups were similar in terms of descriptive characteristics (p > 0.05). Among the patients undergoing surgical intervention, 46.1% were hypothermic. Compared with the normothermic group, the hypothermic group had significantly lower body temperature until the second postoperative hour, lower thermal comfort score until the third postoperative hour, and higher heart rate and anxiety (NRS) score until the first postoperative day. Furthermore, there was a significant difference between the groups in terms of pain intensity up to the first 30 minutes after surgery (p < 0.05). Moreover, there was no significant difference between the groups in terms of pre and postoperative day one anxiety (SAI) and Periantesthesia Comfort Scale mean scores (p > 0.05). The study findings showed that hypothermia affected thermal comfort up to the first 3 hours after surgery, pain intensity up to the first 30 minutes, and heart rate and anxiety (NRS) levels up to the first day.

Effects of Active Heating Methods on Body Temperature, Shivering, Thermal Comfort, Pain, Nausea and Vomiting During General Anesthesia: A Randomized Controlled Trial

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).

The effects of prolonged intraoperative hypothermia on patient outcomes in immediate implant-based breast reconstruction

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.

Back to Basics: Unplanned Patient Hypothermia: 1.3 www.aornjournal.org/content/cme

Unplanned perioperative hypothermia is a common occurrence and can negatively affect a patient's postoperative course. Perioperative nurses are responsible for identifying patients at risk for hypothermia and working with the entire surgical team to prevent this complication from occurring. Multiple interventions can be implemented to address hypothermia, including active or passive warming and warm IV and irrigation fluids. This Back to Basics article addresses patient assessment concerns, identifies a variety of evidence-based interventions that can prevent or mitigate perioperative patient temperature changes, and provides basic steps for perioperative RNs to follow to help prevent perioperative hypothermia in their patients.