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Significant factors influencing inadvertent hypothermia in pediatric anesthesia
Lee-Lee Lai1, Mee-Hoong See2, Sanjay Rampal3
1Department of Anesthesia, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. laill@um.edu.my.
Insights
Intraoperative hypothermia affects nearly half of pediatric surgical patients, leading to complications. Active warming, like the Bair Hugger system, can effectively maintain patient body temperature during surgery.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Patient Safety
Background:
- Thermal imbalances, specifically hypothermia, are frequent during surgical procedures.
- Intraoperative hypothermia can lead to serious adverse outcomes, including shivering, cardiac dysfunction, coagulopathy, increased bleeding, wound infections, delayed recovery, and extended hospital stays.
- Factors such as patient age, weight, surgery duration, type of surgery, blood loss, anesthesia type, and operating room temperature contribute to hypothermia.
Purpose of the Study:
- To investigate the incidence of intraoperative hypothermia in pediatric surgical patients.
- To identify factors contributing to intraoperative hypothermia.
- To evaluate the effectiveness of active warming devices in preventing hypothermia.
Main Methods:
- A prospective cohort study involving observation and temperature measurement of pediatric surgical patients.
- Temperature monitoring from operating table transfer through recovery and discharge.
- Recording of initial skin and core temperatures at multiple intervals during surgery.
Main Results:
- The overall incidence of intraoperative hypothermia was 46.6%, despite active and passive temperature management.
- Patient age, body weight, surgery duration, surgery type, intraoperative blood loss, anesthesia type, and operating room temperature were identified as contributing factors.
- The Bair Hugger® air-forced warming system demonstrated effectiveness in reducing hypothermia risk and maintaining normothermia.
Conclusions:
- Intraoperative hypothermia remains a significant concern in pediatric surgery, particularly for major and long-duration procedures.
- Careful management is crucial as intraoperative hypothermia can be life-threatening.
- Active warming devices, such as the Bair Hugger system, appear to be a valuable method for mitigating intraoperative hypothermia and maintaining normothermia across various surgical types.
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.
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