Perioperative Risk Factors for Intraoperative Hypothermia in Adult Patients Undergoing Elective Surgery at a National Referral Hospital in Bhutan: A Prospective Observational Study

Authors

  • Kinley Zangmo Central Regional Referral Hospital, Gelephu, 31101, Bhutan.
  • Sunisa Chatmongkolchart Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
  • Pasuree Sangsupawanich Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.

DOI:

https://doi.org/10.31584/jhsmr.201966

Keywords:

core body temperature, complications from hypothermia, intraoperative hypothermia, intraoperative monitoring, perioperative care, perioperative risk factors

Abstract

Objective: Intraoperative hypothermia is commonly encountered in anesthetic practice. It is related to several risk factors and can lead to various adverse events. It is important to detect it early and prevent the complications related to it. This study was done to identify incidence and perioperative risk factors of intraoperative hypothermia at a national referral hospital in Bhutan.
Material and Methods: A prospective observational study was conducted in adult patients who underwent elective surgery lasting more than 30 minutes. Patient characteristics, incidence of hypothermia, and any interventions for treatment of hypothermia during the operation were recorded. Intraoperative hypothermia was defined as a core body temperature less than 36 °C measured with an esophageal probe.
Results: Data were obtained from 91 patients with a mean (±standard deviation; S.D.) age of 42.3 (17.2) and American Society of Anesthesiologists (ASA) scores of 1 and 2 in 62.6% and 37.4% of the patients, respectively The patients underwent elective surgery with a mean (S.D.) duration of 73.24 (48.1) minutes and a mean (S.D.) duration of anaesthesia of 80.9 (49.2) minutes. The incidence of intraoperative hypothermia was 61.5% (56/91). Preoperative heart rate more than 80 beats per minute [hazard ratio (HR) 0.45, 95% confidence interval (CI), 0.26-0.77] was a protective factor and duration of anesthesia more than 60 minutes (HR 1.82, 95% CI, 0.98–3.38) was a risk factor for intraoperative hypothermia.
Conclusion: Patients with a preoperative heart rate less than 80 beats per minute and undergoing duration of anesthesia more than 60 minutes should be assessed from the preoperative period and continuously monitored throughout the intraoperative period.

References

1. Yi J, Xiang Z, Deng X, Fan T, Fu R, Geng W, et al. Incidence of inadvertent intraoperative hypothermia and its risk factors in patients undergoing general anesthesia in Beijing: a prospective regional survey. PLoS One 2015. doi: 10.1371/journal.pone.0136136.

2. Frisch NB, Pepper AM, Jildeh TR, Shaw J, Guthrie T, Silverton C. Intraoperative hypothermia during surgical fixation of hip fractures. Orthopedics 2016;39:e1170-7.

3. Kim EJ, Yoon H. Preoperative factors affecting the intraoperative core body temperature in abdominal surgery under general anesthesia: an observational cohort. Clin Nurse Spec 2014;28:268-76.

4. Rajagopalan S, Masche E, Na J, Sessler DI. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology 2008;108:71-7.

5. Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A. Mild hypothermia increases blood loss and transfusion requirement during total hip arthroplasty. Lancet 1996;347:289-92.

6. Bock M, Müller J, Bach A, Böhrer H, Martin E, Motsch J. Effects of preinduction and intraoperative warming during major laparotomy. Br J Anaesth 1998;80:159-63.

7. Eberhart LH, Döderlein F, Eisenhardt G, Kranke P, Sessler DI, Torossian A, et al. Independent risk factors for postoperative shivering. Anesth Analg 2005;101:1849–57.

8. Lenhardt R, Marker E, Goll V, Tschernich H, Kurz A, Sessler DI, et al. Mild Intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology 1997;87:1318-23.

9. National Collaborating Centre for Nursing and Supportive Care Commissioned by National Institute for Health and Clinical Excellence. The management of inadvertent perioperative hypothermia in adults [homepage on the Internet]. London:Royal College of Nursing; 2008 [cited 2018 Aug 21]. Available from: https://www.rcn.org.uk/-/media/royal-college-ofnursing/.../2008/.../pub-003282.pdf

10. American Society of Anesthesiologists. Standards for basic anesthetic monitoring. Committee of origin: standards and practice parameters [homepage on the Internet]. Illinois:ASA; 2015 [cited 2018 Aug 21]. Available from: https://www.asahq.org/~/media/Sites/ASAHQ/Files/Public/Resources/standards-guidelines/standards-for-basicanesthetic-monitoring.pdf

11. American Association of Nurse Anesthetists. Standards for nurse anesthesia practice [homepage on the Internet]. Illinois: AANA; 2013 [cited 2018 Aug 21]. Available from:https://www.aana.com/docs/default-source/practice-aanacomaana-com-web-documents-(all)/standards-for-nurse-anesthesiapractice.pdf?sfvrsn=e00049b1_2

12. Torossian A, TEMMP (Thermoregulation in Europe Monitoring and Managing Patient Temperature) Study Group. Survey on intraoperative temperature management in Europe. Eur J Anaesthesiol 2007;24:668-75.

13. Silva AB, Peniche Ade C. Perioperative hypothermia and incidence of surgical wound infection: a bibliographic study. Einstein (Sao Paulo) 2014;12:513-17.

14. Wetz AJ, Perl T, Brandes IF, Harden M, Bauer M, Bräuer A. Unexpectedly high incidence of hypothermia before induction of anesthesia in elective surgical patients. J Clin Anesth 2016;34:282-89.

15. Yang L, Huang CY, Zhou ZB, Wen ZS, Zhang GR, Liu KX, et al. Risk factors for hypothermia in patients under general anesthesia: is there a drawback of laminar airflow operating rooms? A prospective cohort study. Int J Surg 2015;21:14-7.

16. de Brito Poveda V, Galvão CM, dos Santos CB. Factors associated to the development of hypothermia in the intraoperative period. Rev Lat Am Enfermagem 2009;17:228-33.

17. Kasai T, Hirose M, Matsukawa T, Takamata A, Yaegashi K, Tanaka Y. Preoperative blood pressure and catecholamines related to hypothermia during general anesthesia. Acta Anaesthesiol Scand 2003;47:208-12.

18. Fernandes LA, Braz LG, Koga FA, Kakuda CM, Módolo NS, de Carvalho LR, et al. Comparison of peri-operative core temperature in obese and non-obese patients. Anaesthesia 2012;67:1364-9.

19. Michiaki Y, Yasuhiro K, Yasuyuki H, Naoki T, Akiyoshi N. Predictive variables of hypothermia in the early phase of general anesthesia. Anesth Analg 2000;90:456-9.

20. Matsukawa T, Sessler DI, Sessler AM, Schroeder. Heat flow and distribution during induction of general anesthesia. Anesthesiology 1995;82:662-73.

21. de Brito Poveda V, Galvão CM, Dantas SAR. Intraoperative hypothermia in patients undergoing elective surgery. Acta Paul Enferm 2009;22:361-6.

22. Torossian A, Van Gerven E, Geertsen K, Horn B, Van de Velde M, Raeder J. Active perioperative patient warming using a self-warming blanket (BARRIER EasyWarm) is superior to passive thermal insulation: a multinational, multicenter, randomized trial. J Clin Anesth 2016;34:547-54.

23. Sessler DI. Temperature regulation and monitoring. In: Miller RD, editor. Miller’s anesthesia. 7th ed. London: Churchill Livingstone; 2010.

24. Sessler DI, McGuire J, Moayeri A, Hynson J. Isofluraneinduced vasodilation minimally increases cutaneous heat loss. Anesthesiology 1991;74:226–32.

25. El-Gamal N, Elkassabany N, Frank SM, Amar R, Khabar HA, El-Rahmany HK, et al. Age-related thermoregulatory differences in a warm operating room environment (approximately 26 degrees C). Anesth Analg 2000;90:694-8.

26. Horn EP, Bein B, Böhm R, Steinfath M, Sahili N, Höcker J. The effect of short time periods of preoperative warming in the prevention of peri-operative hypothermia. Anaesthesia 2012;67:612-7.

27. Torossian A, Brauer A, Hocker J, Bein B, Wulf H, Horn EP. Preventing inadvertent perioperative hypothermia. Dtsch Arztebl Int 2015;112:166-72.

28. Andrzejowski J, Hoyle J, Eapen G, Turnbull D. Effect of prewarming on post-induction core temperature and the incidence of inadvertent perioperative hypothermia in patients undergoing general anaesthesia. Br J Anaesth 2008;101:627-31.

Downloads

Published

2019-10-02

How to Cite

1.
Zangmo K, Chatmongkolchart S, Sangsupawanich P. Perioperative Risk Factors for Intraoperative Hypothermia in Adult Patients Undergoing Elective Surgery at a National Referral Hospital in Bhutan: A Prospective Observational Study. J Health Sci Med Res [Internet]. 2019 Oct. 2 [cited 2024 Nov. 23];37(4):313-20. Available from: https://he01.tci-thaijo.org/index.php/jhsmr/article/view/219387

Issue

Section

Original Article