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[Prevention of intraoperative hypothermia in children]
J Leben1, M Tryba, K Kurz-Müller
1Klinik für Anaesthesiologie, Intensiv- und Schmerztherapie, Universitätsklinik Bergmannsheil Bochum.
Insights
Convective warming devices effectively prevent intraoperative hypothermia (HT) in children during surgery. This method is superior to increasing room temperature or using aluminum blankets, even in cooler operating rooms.
Area of Science:
- Pediatric Anesthesiology
- Thermoregulation in Children
- Surgical Patient Safety
Background:
- Children are highly susceptible to intraoperative hypothermia (core temperature ≤ 36.0°C) due to immature thermoregulation and high surface-area-to-mass ratio.
- Effective prevention of hypothermia is crucial for pediatric surgical patient outcomes.
Purpose of the Study:
- To compare the efficacy of various heating devices in preventing intraoperative hypothermia in pediatric patients undergoing general anesthesia.
- To identify optimal strategies for maintaining normothermia in children during surgery.
Main Methods:
- 50 children (1-7 years) undergoing surgery ≥ 2 hours were randomized into 5 groups with different warming strategies.
- Strategies included elevated room temperature, aluminum blankets, convective warming blankets, and combinations thereof.
- Core body and room temperatures were continuously monitored; statistical analysis used ANOVA and Fisher's exact Test (p < 0.05).
Main Results:
- Convective warming systems (Group 5) maintained normothermia (core temperature +0.2°C) and were as effective as elevated room temperature with aluminum blankets (Group 2).
- Elevated room temperature with cotton blankets (Group 1) and aluminum blankets alone at 22°C (Group 4) resulted in significant core temperature drops (-1.7°C and -1.6°C, respectively).
- Elevated room temperature combined with a convective warming blanket (Group 3) showed a significant core temperature increase (+0.7°C).
Conclusions:
- Convective warming devices are highly effective in preventing intraoperative hypothermia in pediatric patients, even at lower operating room temperatures (approx. 22°C).
- Increasing operating room temperature alone or with cotton sheets is insufficient for preventing heat loss.
- Convective heating systems offer a superior alternative to ambient room heating for maintaining normothermia in pediatric surgical patients.
Unlabelled:
Children are very sensible to the occurrence of intraoperative hypothermia (HT) (core temperature < or = 36.0 degrees C) during general anaesthesia because their regulation capacity is less effective than in adults and due to a large skin-surface area compared with their body mass. We compared the efficacy of different heating devices to prevent HT in children during surgery.
Methods:
With approval of the local ethics committee 50 children between one and seven years, scheduled for peripheral surgery lasting at least 2 hours were included in this study. Anaesthesia was standardized in all patients. Patients were randomly divided into 5 groups. In group 1, in addition to the usual cotton blankets, room temperature was elevated to 27-28 degrees C. In group 2, room temperature was maintained at 27-28 degrees C, and the patients were additionally wrapped into an aluminum blanket. In group 3, elevated room temperature was combined with a convective heating blanket. Patients in group 4 were warmed with an aluminum blanket, while the room temperature was maintained at 22 degrees C. In group 5, room temperature was maintained at 22 degrees C and patients were warmed with a convective heating device (Tab. 1). Room and core body temperature (tympanon membrane) were continuously measured. ANOVA and Fisher's exact Test (significance level: p < 0.05) were performed for the statistical analysis of the results.
Results:
The demographic data of all 5 groups, the infused fluid volume and the anaesthetic technique were similar. There were no significant differences concerning age, height and weight of the pediatric patients (Tab. 2). The core temperature decreased by -1.7 degrees C in group 1. In group 4 core temperature decreased by -1.6 degrees C. Using a convective warming system in normal ambient temperature (group 5) core temperature increased by 0.2 degree C and was as effective in the prevention of HT as group 2. A significant increase in core temperature occurred in group 3 +0.7 degree C (Tab. 3 and Fig. 1).
Discussion:
OR temperature seems to be a critical factor influencing heat loss. Increasing OR temperature and covering with cotton sheets was not effective in preventing the heat loss. Increasing room temperature in combination with aluminum sheets is one alternative to prevent HT. Our study shows that the use of a convective warming device prevents HT during a 2-hour surgery in young children even at a OR temperature of about 22 degrees C. In conclusion, in pediatric patients the use of a convective heating system proved to be an effective alternative to room heating.