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Inadvertent Hypothermia After Procedural Sedation and Analgesia in a Cardiac Catheterization Laboratory: A
Aaron Conway1, Wendy Kennedy2, Joanna Sutherland3
1Institute of Health and Biomedical Innovation, Queensland University Technology, Kelvin Grove, QLD, Australia.
Objectives:
To identify the prevalence of and risk factors for inadvertent hypothermia after procedures performed with procedural sedation and analgesia in a cardiac catheterization laboratory.
Design:
A single-center, prospective observational study.
Setting:
A tertiary-care private hospital in Australia.
Participants:
399 patients undergoing elective procedures with procedural sedation and analgesia were included. Propofol infusions were used when an anesthesiologist was present. Otherwise, bolus doses of either midazolam or fentanyl or a combination of these medications was used.
Interventions:
None
Measurements And Main Results:
Hypothermia was defined as a temperature<36.0°C. Multivariate logistic regression was used to identify risk factors. Hypothermia was present after 23.3% (n = 93; 95% confidence interval [CI] 19.2%-27.4%) of 399 procedures. Sedative regimens with the highest prevalence of hypothermia were any regimen that included propofol (n = 35; 40.2%; 95% CI 29.9%-50.5%) and the use of fentanyl combined with midazolam (n = 23; 20.3%; 95% CI 12.9%-27.7%). Difference in mean temperature from pre-procedure to post-procedure was -0.27°C (standard deviation 0.45). Receiving propofol (odds ratio [OR] 4.6 95% CI 2.5-8.6), percutaneous coronary intervention (OR 3.2; 95% CI 1.7-5.9), body mass index<25 (OR 2.5; 95% CI 1.4-4.4) and being hypothermic prior to the procedure (OR 4.9; 95% CI 2.3-10.8) were independent predictors of post-procedural hypothermia.
Conclusions:
A moderate prevalence of hypothermia was observed. The small absolute change in temperature observed may not be a clinically important amount. More research is needed to increase confidence in the authors' estimates of hypothermia in sedated patients and its impact on clinical outcomes.
