Advertisement

Journal of Clinical Monitoring and Computing

, Volume 33, Issue 6, pp 1105–1112 | Cite as

Significant factors influencing inadvertent hypothermia in pediatric anesthesia

  • Lee-Lee LaiEmail author
  • Mee-Hoong See
  • Sanjay Rampal
  • Kee-Seong Ng
  • Lucy Chan
Original Research
  • 193 Downloads

Abstract

Thermal imbalances are very common during surgery. Hypothermia exposes the patient to post-operative shivering, cardiac dysfunction, coagulopathy, bleeding, wound infection, delayed anesthesia recovery, prolonged hospital stay and increased hospitalization cost. There are many factors contributing to intraoperative hypothermia. This is a prospective cohort study conducted through observation and measurement of pediatric surgical patients’ temperature. Convenience sampling methods were used in this study. Initial skin temperature and core temperature at 10 min, 30 min,1 h, 2 h, 3 h, 4 h, 5 h, 6 h and at the end of surgery were recorded. Body temperature was monitored from time of transfer to the operating table until recovery and discharge to the respective pediatric ward. The overall incidence of intraoperative hypothermia was still very high at about 46.6% even though active and passive temperature management were carried out during surgery. Patient’s age, body weight, duration of surgery, type of surgery, intraoperative blood loss, type of anesthesia and operating room temperature were factors that contributed to intraoperative hypothermia. Hypothermia is common in surgery, especially in major and long duration surgery. Intraoperative hypothermia can be life threatening if it is not handled carefully. Various methods are used before, during and after surgery to maintain a patient’s body temperature within the normothermia range. The use of an active warming device like the Bair Hugger® air-forced warming system seems to be a good method for reducing the risk of intraoperative hypothermia and effectively maintaining body temperature for all major and minor surgeries.

Keywords

Intraoperative hypothermia Risk factors Pediatric surgery 

Notes

Author contributions

LLL designed the current study protocol, data collection tool and database with substantial intellectual input from Professor LC and Professor SR. Data collection was performed by LLL. Data cleaning, validation and queries were performed by LLL. All statistical analysis was performed by LLL with advice from Professor SR. Contributions to interpretation of data were received from all authors. First draft of manuscript was written by LLL with intellectual input from Professor LC. In addition, critical review of and contributions to subsequent drafts were received from Dr. KSN Associate Professor MHS, Professor LC and Professor SR. All authors reviewed and approved the final draft of the manuscript prior to submission. All authors agree to be accountable for the accuracy and integrity of the piece of work.

Compliance with ethical standards

Conflict of interest

No conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the director of University of Malaya Medical Centre (UMMC), as well as from the Medical Centre Research Committee (MCRC).

References

  1. 1.
    Sessler D. Perioperative thermoregulation and heat balance. The Lancet. 2016;387(10038):2655–64.  https://doi.org/10.1016/S0140(15)00981-2.CrossRefGoogle Scholar
  2. 2.
    Diaz JH. Perinatal anesthersia and critical care. Philadelphia: W.B. Saunder Company; 1991.Google Scholar
  3. 3.
    Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996;334(19):1209–15.  https://doi.org/10.1056/NEJM199605093341901.CrossRefPubMedGoogle Scholar
  4. 4.
    Tander B, Bari S, Karakaya D, Ariturk E, Rizalar R, Bernay F. Risk factors influencing inadvertent hypothermia in infants and neonates during anesthesia. Pediatr Anesth. 2005;15:574–9.CrossRefGoogle Scholar
  5. 5.
    Stoddart PA, Lauder GR. Problems in anesthesia: pediatric anesthesia. London: Martin Dunitz; 2004.CrossRefGoogle Scholar
  6. 6.
    Agrawal N, Sewell DA, Griswold ME, Frank SM, Hessel TW, Eisele DW. Hypothermia during head and neck surgery. Am Laryngol Rhinol Otol Soc Inc. 2003;113(8):1278–1282.Google Scholar
  7. 7.
    Frank SM, Nguyen JM, Garcia CM, Barnes A. Temperature monitoring practices during regional anesthesia. Anesth Analg. 1999;88(2):373–7.PubMedGoogle Scholar
  8. 8.
    Sessler DI. (2002). Temperature disturbances Gregory G.A’s pediatric anesthesia. (4th ed.). New York: Churchill Livingstone. pp. 53–84.Google Scholar
  9. 9.
    Uzun G, Mutluoglu M, Evinc R, Ozdemir O, Sen H. Severe burn injury associated with misuse of forced-air warming device. J Anesth. 2010; 24:980–981.  https://doi.org/10.1007/s00540-010-1031-1.CrossRefPubMedGoogle Scholar
  10. 10.
    Yi J, Xiang ZY, Deng XM, Fan T, Fu RG, Geng WM, Guo RH, He N, Li CH, Li L, Li M, Li TZ, Tian M, Wang G, Wang L, Wang TL, Wu AS, Wu D, Xue XD, Xu MG, Yang XM, Yang ZM, Yuan JH, Zhao QH, Zhou GQ, Zuo MZ, Pan S, Zhan LJ, Yao M, Huang YG. Incidence of inadvertent intraoperative hypothermia and its risk factors in patients undergoing general anesthesia in Beijing: a prospective regional survey. PLoS ONE. 2015.  https://doi.org/10.1371/journal.pone.0136136.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Azzam FK, Krock JL. Thermal burn in two infants associated with a forced air warming system (letter). Anesth Analg. 1995;81(3):661.PubMedGoogle Scholar
  12. 12.
    Kafrouni H. & Fadel Z.Thermal injury due to use of a forced air warming blanket during paediatric surgery. Anaesth Crit Care Pain Med. 2016;35(2):175.  https://doi.org/10.1016/j.accpm.2015.11.003.CrossRefPubMedGoogle Scholar
  13. 13.
    Metha SP. Burn injuries from warming devices in the operating room. Am Soc Anaesthesiol. 2013;77(2):16–7.Google Scholar
  14. 14.
    Chung K, Lee SM, Oh SC, Choi J, Cho HS. Thermal burn injury associated with a forced-air warming device. Korean J Anesthesiol. 2012 Apr;62(4):391–2.  https://doi.org/10.4097/kjae.2012.62.4.391.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Oatley HK, Blencowe H, Lawn JE. (2016). The effect of coverings, including plastic bags and wraps, on mortality and morbidity in preterm and full-term neonates. J Perinatol. 2016;36:S82–S88.  https://doi.org/10.1038/jp.2016.35.
  16. 16.
    Guideline for the prevention of unplanned patient hypothermia. In: Guidelines for perioperative practice. Denver, CO: AORN, Inc. https://www.aorn.org/guidelines/clinical-resources/clinical-faqs/hypothermia. Accessed 17 Nov 2015
  17. 17.
    Guideline for a safe environment of care, part 2. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc. https://www.aorn.org/guidelines/clinical-resources/clinical-faqs/hypothermia. Accessed 17 Nov 2015.
  18. 18.
    NICE. Inadvertent hypothermia overview. National Institute for Health and Clinical Excellent. http://pathways.nice.org.uk/pathways/inadvertent-perioperative-hypothermia. Accessed 2016.

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Lee-Lee Lai
    • 1
    Email author
  • Mee-Hoong See
    • 2
  • Sanjay Rampal
    • 3
  • Kee-Seong Ng
    • 4
  • Lucy Chan
    • 1
  1. 1.Department of Anesthesia, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
  2. 2.Department of Surgery, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
  3. 3.Department of Social Preventive Medicine, Faculty of Medicine, Julius Centre University of MalayaUniversity of MalayaKuala LumpurMalaysia
  4. 4.Department of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia

Personalised recommendations