Perioperative Hypothermia: Causes & Consequences

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Literature Review

Gathering and analysing research evidence is essential for understanding various health conditions and can thus assist health professionals in developing and implementing practice improvements. Perioperative hypothermia is a relatively widespread condition that can affect up to 60% of patients who undergo surgery (McSwain et al., 2015). It can have significant consequences for the patient and worsen surgery outcomes by increasing the risk of blood loss, surgical wound infections and cardiac events, as well as by prolonging hospital stay (McSwain et al., 2015). Therefore, reviewing current research evidence on perioperative hypothermia can help to improve patient safety during surgical procedures.

The purpose of the present review is to examine scholarly articles on the topic of perioperative hypothermia. As part of the literature review, databases of peer-reviewed scholarly articles were searched. Search results were limited to the past five years, and items were included based on their relevance and topic coverage. A total of eight articles on the topic were selected, most of which focused either on the factors affecting the development of perioperative hypothermia or on prevention strategies. Hence, the literature review has helped to synthesise current knowledge on the topic.

Unintended Perioperative Hypothermia

Rosenkilde, Vamosi, Lauridsen and Hasfeldt, (2017) sought to determine the fact that, Hyperthermia in turn is referred to as the core body temperature of an individual which is less than 96.8 degree Fahrenheit or 36 degree Celsius. This in turn is usually one of the most common occurrence within un- warmed surgical patient. There seems to be an increase within the frequency of surgical site who in turn tends to experience perioperative hypothermia. The researcher of the study tends to review physiology of the temperature regulation and key mechanisms of the Hypothermia.

On the contrary, Rosenkilde, Vamosi, Lauridsen and Hasfeldt, (2017) established the fact that, a mild degree of Perioperative Hypothermia tends to eventually results in mortality and morbidity. The results tends to establish the fact that, pre- warming for the minimum of 30 minutes helps in reducing the risk associated with the subsequent hypothermia. It has been concluded that, frequently monitoring of the body temperature and also avoiding unintended perioperative hypothermia with the help of passive and active warming measures are useful in the prevention of such complications.

Factors that Influence Effective Perioperative Temperature Management by Anesthesiologists: A Qualitative Study Using the Theoretical Domains Framework

Boet et al. (2017) sought to determine the fact that, Inadvertent perioperative hypothermia is mainly associated with the various set of adverse outcomes. Usage of the effective and safe warming techniques which is very useful in the prevention of the Inadvertent perioperative hypothermia. The researcher of the study tends to use qualitative approach where semi- structured interview has been carried out with staff anesthesiologists at the Canadian academic hospital. The interview transcripts in turn were coded with the help of direct content management. On the contrary, Boet et al. (2017) established the fact that, there are various set of potential targets which in turn is considered to be very useful in improving the temperature management practice which in turn includes intervention and helps in the improvement of the temperature management practice. This is considered to be one of the most effective practice which in turn is considered to be very useful in effective perioperative temperature management by anesthesiologists.

Preventing Inadvertent Perioperative Hypothermia

Torossian et al. (2015) sought to determine the fact that, there are around 25% to 90% of the patients who in turn tends to undergo elective surgery and also suffers from Inadvertent Perioperative Hypothermia i.e., the core body temperature of the patient is below 36 degree Celsius. When compared with the normothermic patients, these patients in turn are usually at the higher risk with high degree of wound infections. They tend to have high degree of relative risk, cardiac complications and also blood transfusion. The patients who in turn tends to have Perioperative Hypothermia tends to feel more uncomfortable and also shivering in turn results in the rise in the level of oxygen levels by around 40%. This research guideline in turn is usually based on the systematic review with the structured consensus by collaborating with the 5 medical speciality societies. The results tends to evaluate that, the core temperature of the patient should be effectively measured every 1 to 2 hours before starting off with the anaesthesia and continuously every minutes at the time of surgery. The site associated with the temperature measurements must be oral, esophageal, naso-/oropharyngeal, vesical, or tympanic. On the contrary, Torossian et al. (2015) established the fact that, the patient must actively engage in pre- warmed activity every 20-30 minutes before the surgery in order to counteract the decline within the temperature. The temperature within the operating room must be at least around 21 degree Celsius for older patients and at least around 24 degree Celsius for children. Blood transfusions and infusions in turn has been given at the rate of >500 mL/h which should be first warmed. Postoperative hypothermia must be treated with conductive heat and also shivering of the patient must be treated with the help of medication.

Inadvertent Perioperative Hypothermia: A Literature Review of an Old Overlooked Problem.

Fatemi, Armat, Zeydi, Soleimani and Kiabi (2016) sought to determine the fact that, inadvertent perioperative hypothermia is considered to be as one of the most common anaesthesia related complications when the patients undergo certain surgery. This eventually leads to certain clinical complications which largely influence the outcomes and results of the surgery especially in the case of high risk patient. The combination of cold operating room environment and anaesthetic drugs are considered to be as the most common pre- disposing factors associated with the perioperative hypothermia. The search of the specific literature has been carried out through international database using Science direct and PubMed. On the contrary, Fatemi, Armat, Zeydi, Soleimani and Kiabi (2016) established the fact that, Perioperative Hypothermia eventually leads to various set of post- operative complications which mainly includes drug metabolism impairment, high plasma concentration, impaired wound healing, postoperative shivering, wound infections, decrease level of partial oxygen pressure, imp[aired function associated with macrophages and neutrophils, variation in the potassium levels, pulmonary vasoconstriction, impaired wound healing, etc. Shivering in turn is considered to be as one of the most common complication associated with the Perioperative Hypothermia which in turn tends to increase total body oxygen consumption because of the increase in the rate of metabolism by 400 to 500%. This is highly detrimental for the high risk patients.

Approach to Perioperative Hypothermia by Anaesthesiology and Reanimation Specialist in Turkey: A Survey Investigation.

İnal, Ural, Çakmak, Arslan and Polat (2017) sought to determine the fact that, 26% of the physicians tend to use temperature monitoring. There are various range of temperature monitoring. However, skin/axilla in turn is considered to be as the preferred monitoring site and forced air warming device in turn is considered to be as the most commonly preferred heating system. The researcher of the study will use questionnaire which mainly comprise of 25 questions and the data was collected through such questionnaires. New born are the most commonly monitored group by effectively using Turkish Anaesthesiology and Reanimation Society guideline.

Inadvertent Hypothermia After Procedural Sedation and Analgesia in a Cardiac Catheterization Laboratory: A Prospective Observational Study.

Conway, Kennedy and Sutherland, (2015) established the fact that, the researcher of the study in turn uses single centre observational study in order to critically identify various set of risk factors associated with the inadvertent hypothermia after the procedure has been performed with analgesia and procedural sedation in a cardiac catheterization laboratory. Around 399 patients gas undergone elective procedures with analgesia and procedural sedation. On the contrary, Conway, Kennedy and Sutherland, (2015) sought to determine the fact that, Pharmalogical management of the shivering tends to focus on pharmalogical treatment. Shivering in turn can be effectively treated by IV administration of the pethidine in 90% of the postoperative patients.

Perioperative warming therapy for preventing surgical site infection in adults undergoing surgery (Protocol)

Ousey et al. (2015) sought to determine the fact that, Perioperative hypothermia is referred to as the core temperature of the body which is less than 36 degree Celsius. However, the unintended perioperative hypothermia is considered to be very common and usually Perioperative hypothermia in turn is usually caused due to various factors which includes the injury of thermoregulation which results from a core to periphery thermal redistribution. Reduced metabolic heat creation due to the effects of anaesthetic agents, and also noteworthy heat loss, etc. are considered to be as the causes of perioperative hypothermia. This study has been further carried out using randomized control trials and also tends to include clusters. Patients tends to undergo surgery within general anaesthesia in turn are included while carrying out the study. On the contrary, Ousey et al. (2015) established the fact that, the key available interventions associated with the perioperative hypothermia in turn includes passive and active warming, use of the warmed IV fluids and increase in the OR temperature under certain set of circumstances.

Meta-analysis: effectiveness of forced-air warming for prevention of perioperative hypothermia in surgical patients.

Nieh and Su (2016) sought to determine the fact that, perioperative hypothermia in turn is considered to be as one of the most commonly occurred illness who in turn has been receiving anaesthesia at the time of surgery. The researcher will carry out the specific study using meta-analysis. The key data sources used were Cochrane Library, Medline, OVID, PubMed, CINAHL, CETD and CEPS databases for the random control trials. On the contrary, Nieh and Su (2016) established that forced air warming is more effective than circulating water mattresses and passive insulation. There seemed to be no statistically significant difference between forced air warming, radiant warming systems, resistive heating blankets and circulating water garments. Hence, it has been concluded that, forced air warming is very useful in preventing perioperative hypothermia more effectively and efficiently.

Conclusion

On the whole, the studies selected for the review outline the key practice recommendations for preventing perioperative hypothermia. The findings outlined in current research on the topic could be implemented to enhance perioperative nursing practice in hospitals, thus contributing to patient outcomes and reducing the risk of complications. Future research should focus on evaluating the effectiveness of specific prevention strategies, such as air warming, in preventing complications resulting from hypothermia using randomised controlled trials. These studies would provide high-quality evidence that could become the basis for future practice improvement efforts.

References

Boet, S., Patey, A. M., Baron, J. S., Mohamed, K., Pigford, A. A. E., Bryson, G. L.,… & Grimshaw, J. M. (2017). Factors that influence effective perioperative temperature management by anesthesiologists: A qualitative study using the Theoretical Domains Framework. Canadian Journal of Anesthesia/Journal Canadien D’anesthésie, 64(6), 581-596.
Conway, A., Kennedy, W., & Sutherland, J. (2015). Inadvertent hypothermia after procedural sedation and analgesia in a cardiac catheterization laboratory: A prospective observational study. Journal of Cardiothoracic and Vascular Anesthesia, 29(5), 1285-1290.
Fatemi, S. N. L., Armat, M. R., Zeydi, A. E., Soleimani, A., & Kiabi, F. H. (2016). Inadvertent perioperative hypothermia: A literature review of an old overlooked problem. Acta Facultatis Medicae Naissensis, 33(1), 5-11.
İnal, M. A., Ural, S. G., Çakmak, H. Ş., Arslan, M., & Polat, R. (2017). Approach to perioperative hypothermia by anaesthesiology and reanimation specialist in Turkey: A survey investigation. Turkish Journal of Anaesthesiology and Reanimation, 45(3), 139-145.
McSwain, J. R., Yared, M., Doty, J. W., & Wilson, S. H. (2015). Perioperative hypothermia: Causes, consequences and treatment. World Journal of Anesthesiology, 27(4), 58-65.
Nieh, H. C., & Su, S. F. (2016). Meta-analysis: Effectiveness of forced-air warming for prevention of perioperative hypothermia in surgical patients. Journal of Advanced Nursing, 72(10), 2294-2314.
Ousey, K. J., Edward, K. L., Lui, S., Stephenson, J., Duff, J., Walker, K. N., & Leaper D. J. (2015). Perioperative warming therapy for preventing surgical site infection in adults undergoing surgery. Cochrane Database of Systematic Reviews, 6(CD011731), 1-13.
Rosenkilde, C., Vamosi, M., Lauridsen, J. T., & Hasfeldt, D. (2017). Efficacy of prewarming with a self-warming blanket for the prevention of unintended perioperative hypothermia in patients undergoing hip or knee arthroplasty. Journal of PeriAnesthesia Nursing, 32(5), 419-428.
Torossian, A., Bräuer, A., Höcker, J., Bein, B., Wulf, H., & Horn, E. P. (2015). Preventing inadvertent perioperative hypothermia. Deutsches Ärzteblatt International, 112(10), 166-172.

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