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The effects of hydration on core temperature in pediatric surgical patients
Tiberiu Ezri1, Peter Szmuk, Marian Weisenberg
1Department of Anesthesia, Wolfson Medical Center, Sackler School of Medicine, Tel Aviv, Israel. tezri@wolfson.health.gov.il
Insights
Mild hypovolemia, achieved through conservative fluid management in pediatric patients, effectively prevented intraoperative hypothermia. This approach maintained core body temperature during surgery by reducing heat loss.
Area of Science:
- Pediatric Anesthesiology
- Thermoregulation
- Fluid Management
Background:
- Reduced vascular volume may influence body temperature by altering heat flow from peripheral to central tissues.
- Hypothermia is a common concern in pediatric surgery.
Purpose of the Study:
- To test the hypothesis that mild hypovolemia can prevent intraoperative hypothermia in pediatric patients.
- To investigate the effect of different perioperative fluid management strategies on core body temperature.
Main Methods:
- A randomized controlled trial involving 22 pediatric patients (1-3 years) undergoing minor surgery.
- Two groups: conservative fluid management (8h fast, 1 ml/kg/h crystalloid) and aggressive fluid management (3h liquid intake, 8 ml/kg/h crystalloid).
- Anesthesia with halothane and nitrous oxide; ambient temperature maintained at 25°C without active warming.
Main Results:
- Conservative fluid management resulted in a 1% decrease in body weight, while the aggressive group maintained weight.
- Esophageal temperature increased by 0.4°C in the conservative group (to 37.1°C) but decreased by 0.4°C in the aggressive group (to 36.4°C).
- Temperature differences between groups were statistically significant (P < 0.001) and persisted 1 hour post-surgery.
Conclusions:
- Conservative fluid management prevented intraoperative hypothermia in pediatric patients.
- This strategy likely reduces heat dissipation from the core to peripheral tissues, preserving metabolic heat.
- Mild hypovolemia is a viable method for maintaining core body temperature during pediatric surgery.
Background:
Reduced vascular volume might influence body temperature by diverting heat flow from peripheral tissues to the central organs. We therefore tested the hypothesis that mild hypovolemia helps to prevent intraoperative hypothermia in pediatric patients.
Methods:
Twenty-two pediatric patients (aged 1-3 yr) undergoing prolonged minor surgery were randomly assigned to conservative (n = 12) or aggressive (n = 10) perioperative fluid management. The conservative group fasted 8 h before surgery and received a crystalloid at 1 ml. kg-1. h-1 during surgery. The aggressive group was allowed to drink liquids until 3 h before surgery and was given a maintenance crystalloid at 8 ml. kg-1. h-1. Anesthesia was induced and maintained with halothane in nitrous oxide. Ambient temperature was kept near 25 degrees C, but the patients were not actively warmed. During recovery from anesthesia, additional fluid was given to the conservative group so that perioperative fluid totaled 9.5 ml. kg-1. h-1 in both groups.
Results:
Intraoperative body weight remained unchanged in the aggressive group and decreased only 1% in patients managed conservatively. Heart rate was slightly greater in the conservative group (107 +/- 9 vs. 95 +/- 4 beats/min, P = 0.002), but blood pressure was similar. Esophageal temperature in patients whose fluid was managed conservatively increased significantly, by 0.4 +/- 0.3 degrees C, to 37.1 degrees C; in contrast, temperature in the aggressive group decreased significantly, by 0.4 +/- 0.2 degrees C, to 36.4 degrees C (P < 0.001 between groups). Temperatures remained significantly different 1 h after surgery.
Conclusions:
Conservative fluid management, which decreased body weight by only 1%, prevented reduction in core body temperature, presumably by reducing dissipation of metabolic heat from the core thermal compartment to peripheral tissues.