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The intervention and prevention of perioperative hypothermia is not only reflected in the technical level, but also reveals the important role of humanistic care in the whole intervention work. If perioperative patients have hypothermia, it is likely to cause a series of complications such as postoperative shivering, which seriously threatens the life safety of patients. Prevention and intervention was based on a comprehensive understanding of the causes and hazards of hypothermia, especially the impact on the lives of the elderly. Effective supervision was implemented in the whole process of operation, such as dynamic monitoring of vital signs including body temperature, followed by room temperature regulation, body temperature protection and preoperative and postoperative psychological nursing. At this time, the sense of responsibility, good humanistic care of medical staff are of positive significance to effectively prevent and reduce the probability of perioperative hypothermia and accelerate the postoperative rehabilitation of patients.
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【Objective】 To explore the causes of hypothermia in patients undergoing transurethral thulium laser prostatectomy. 【Methods】 A total of 170 patients who underwent transurethral thulium laser prostatectomy in our hospital during Sep.2020 and May 2021 were prospectively enrolled in the study. The patients were divided into normal body temperature group (n=143) and hypothermia group (n=27), based on whether perioperative hypothermia happened. The clinical data were analyzed to evaluate the risk factors of hypothermia. 【Results】 Univariate analysis showed that there were statistical differences in anesthesia time, operation time, prostate size and total amount of perfusion fluid between the two groups (P<0.05). Logistic analysis showed that the size of prostate was the independent risk factor of perioperative hypothermia (P<0.05). Patients were further divided according to prostate size. For patients with prostate < 80 g, the size of prostate was the independent risk factor of perioperative hypothermia (P<0.05), while for patients with prostate ≥ 80 g, the amount of perfusion fluid was the independent risk factor (P<0.05). 【Conclusion】 Perioperative hypothermia in patients undergoing transurethral thulium laser prostatectomy is related to the anesthesia time, operation time, prostate size and total amount of perfusion fluid. It is necessary to evaluate the risk factors before operation and take effective thermal insulation measures.
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Objective:To evaluate the effect of self-made lithotomy heating mask on intraoperative and postoperative body temperature and short-term postoperative outcome indicators in patients undergoing radical resection of rectal cancer.Methods:Using the method of quasi experimental research design, 100 patients with open rectal cancer in Ningbo Huamei Hospital of the University of Chinese Academy of Sciences from February to July 2021 were selected as the research objects. The patients were divided into experimental group and control group with 50 cases in each group. The control group was kept warm by routine methods, and the experimental group was kept warm by self-made lithotomy heating hood. The changes of core temperature at different time points before, during and after operation were compared between the two groups. The incidence of accidental hypothermia and shivering, the recovery time of anesthesia, and the incidence of various complications within 48 hours after operation were compared between the two groups after operation from the beginning of the operation to 6 hours after returning to the ward.Results:From 30 minutes after anesthesia to 3 hours after entering the ward, the core temperatures of the experimental group at 10 time points were higher than that of the control group, and the differences were statistically significant ( t values were 3.48-37.30, all P<0.01). From the beginning of surgery to 6 h after returning to the ward, the incidence of perioperative accidental hypothermia in the experimental group was 2% (1/50), lower than 24% (12/50) in the control group, and the difference was statistically significant ( χ2=11.06, P<0.05) . The number of cases of shivering in the experimental group was 10, lower than that in the control group of 22, the difference was statistically significant ( χ2=6.62, P<0.05) . The recovery time, extubation time and stay time in anesthesia recovery room of the experimental group were (8.44 ± 2.83), (13.05 ± 4.72), (74.51 ± 11.82) min, which were shorter than those of the control group (15.35 ± 2.09), (17.62 ± 3.28), (89.14 ± 9.19) min, and the difference was statistically significant ( t=-13.89, -5.62, -6.91, all P<0.01). The number of cases of agitation, delirium and nausea and vomiting in the experimental group was 3, 1 and 2 respectively, which was lower than 13, 7 and 8 in the control group, and the difference were statistically significant ( χ2=7.44, 4.89, 4.00, all P<0.05). There was no significant difference in the incidence of adverse cardiac events between the two groups ( P>0.05). Conclusions:The application of self-made lithotomy heating mask in open rectal cancer surgery can effectively improve the risk of hypothermia at different time points during and after surgery, reduce the incidence of shivering, restlessness, postoperative nausea, vomiting and delirium, shorten the time of awakening and extubation, and prevent postoperative complications. It has practical value in clinic.
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Objective To analyze the effects of anesthesia-induced thermoregulatory system impairment and low temperature environment of the operating room on the perioperative thermoregulation of individualized patients by constructing a computer simulation model. Methods A simple anesthesia model was proposed and then incorporated into the self-developed individualized thermoregulatory model, in which human body was represented as a cylinder with two layers of the core and the skin. The integrated model could be used to assess the effects of individualized characteristics such as age, obesity, and cardiovascular diseases on thermoregulation by modifying different physiological parameters involving sweating, shivering and cutaneous vasomotion. Simulation of the general anesthesia effects on human thermoregulation could be achieved by reducing basal metabolic rate and thresholds for vasoconstriction and shivering. Results The elderly people showed lower core temperature but higher skin temperature, compared with the young people. In a low temperature environment, an increase in fat thickness or an increase in severity degree of the left ventricular failure (LVF) might alleviate the decrease in core temperature, while an increase in wind speed or relative humidity could result in a decrease in core temperature. When the threshold setting of vasoconstriction was reduced by 0-5-3 ℃, the core temperature showed a significant decrease. Conclusions By comparing model simulations with experimental measurements, the reliability and validity of the model in predicting human transient thermal responses during varying external thermal environment was verified. The individualized characteristics of human body had an important influence on human body temperature in a low temperature environment. Moreover, the combination of individualized characteristics of human body and general anesthesia further complicated the body′s thermoregulation and posed significant challenges for clinicians.
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Objective To observe the effect of body temperature protection on enhanced recovery after surgery of patients undergoing laparotomy radical gastrectomy.Methods Sixty of patients ASA physical status Ⅰ or Ⅱ,aged 45-76 years,scheduled for elective radical gastrectomy were ran domly divided into 2 groups (n=30 each):heating blanket group and control group.In the heating blanket group,patients were warmed up during the whole perioperative period using the warmblanket until discharge from PACU;exposed skin as covered with clean surgical dressing;infusion,irrigation fluids and blood transfusions were warmed to 40℃;the bacteriological and viral filters were placed between the Y-piece of the breathing circuit and the tracheal tube.In the control group,patients were not given special heat preservation measures.For temperature measurements,an infrared tympanic ear thermometer was used.The core temperature of two groups were recorded at the pre-operative period (T1),before induction (T2),1 h after induction (T3),closing (T4),extubation （T5),discharging from PACU (T6).The dosage of anesthetic drug,volume of fluids infused,peritoneal fluid flushing volume,operation time,anesthesia time,ambient temperature,amount of bleeding,intrao perative blood transfusion,shivering,extubation time,incision infection and hospitalization time were recorded.Results There was no statistical difference in terms of temperature at T1 between the two groups.Compared with the T1,the core temperature of two groups of patients in T2-T6 were signifi cantly decreased (P ＜0.05).The perioperative core body temperature at T2-T6 was significantly higher in the heating blanket group than in the control group.The amount of bleeding and blood transfusion in perioperative period was significantly less that in the heating blanket group (P＜0.05).The incidence of shivering and surgical-wound infection were significantly lower in the heating blanket group (P＜0.05).The extubation time and hospitalization time were shorter in the heating blanket group (P＜0.05).Conclusion Combined body temperature protection measures can significantly reduce the incidence of inadvertent perioperative hypothermia (IPH) and improve postoperative outcomes for patients undergoing laparotomy radical gastrectomy.
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BACKGROUND: At least 30 minutes of pre-warming has been recommended for the prevention of redistribution hypothermia. However, it has been reported that less than 30 minutes of pre-warming is also effective. The aim of this study was to evaluate the ability of 10 minutes of pre-warming to prevent inadvertent perioperative hypothermia. Results were compared with 30 minutes of pre-warming. METHODS: In this prospective randomized study, 59 patients scheduled for elective surgery less than 120 minutes under general anesthesia were divided into 2 groups: the first group was pre-warmed for 10 minutes (n = 30), the second group for 30 minutes (n = 29). The patients were pre-warmed for 10 or 30 minutes in the pre-anesthetic area using a forced-air warmer. When the patients' body temperatures decreased below 36℃, we warmed them with a forced-air warmer intraoperatively and postoperatively. Body temperatures were recorded during perioperative periods. Shivering and thermal comfort were evaluated in the pre-anesthetic area and post-anesthesia care unit. RESULTS: The incidence of intraoperative and postoperative hypothermia were not significantly different (P > 0.05). However, the temperatures were higher in the 30 minute group from the post-warming time to 90 minutes after anesthetic induction (P < 0.05). CONCLUSIONS: Ten minutes of pre-warming has the same effectiveness as 30 minutes of pre-warming for preventing inadvertent perioperative hypothermia. It is a preferable choice for the patients scheduled for surgery less than 120 minutes under general anesthesia.
Subject(s)
Humans , Anesthesia, General , Body Temperature , Hypothermia , Incidence , Perioperative Period , Prospective Studies , ShiveringABSTRACT
BACKGROUND: Hypothermia (< 36°C) is common during arthroscopic shoulder surgery. It is known that 30 to 60 minutes of prewarming can prevent perioperative hypothermia by decreasing body heat redistribution. However, the effect of short-term prewarming (less than 30 minutes) on body temperature in such surgery has not been reported yet. Therefore, the aim of this prospective study was to investigate the effect of short-term prewarming for less than 30 minutes using forced-air warming device on body temperature during interscalene brachial plexus block (ISBPB) procedure in arthroscopic shoulder surgery before general anesthesia. METHODS: We randomly assigned patients scheduled for arthroscopic shoulder surgery to receive either cotton blanket (not pre-warmed, group C, n = 26) or forced-air warming device (pre-warmed, group F, n = 26). Temperature was recorded every 15 minutes from entering the operating room until leaving post-anesthetic care unit (PACU). Shivering and thermal comfort scale were evaluated during their stay in the PACU. RESULTS: There were significant differences in body temperature between group C and group F from 30 minutes after induction of general anesthesia to 30 minutes after arrival in the PACU (P < 0.05). The median duration of prewarming in group F was 14 min (range: 9-23 min). There was no significant difference in thermal comfort scale or shivering between the two groups in PACU. CONCLUSIONS: Our results showed that short-term prewarming using a forced-air warming device during ISBPB in arthroscopic shoulder surgery had beneficial effect on perioperative hypothermia.
Subject(s)
Humans , Anesthesia, General , Body Temperature , Brachial Plexus Block , Hot Temperature , Hypothermia , Operating Rooms , Prospective Studies , Shivering , ShoulderABSTRACT
BACKGROUND: Hypothermia (< 36°C) is common during arthroscopic shoulder surgery. It is known that 30 to 60 minutes of prewarming can prevent perioperative hypothermia by decreasing body heat redistribution. However, the effect of short-term prewarming (less than 30 minutes) on body temperature in such surgery has not been reported yet. Therefore, the aim of this prospective study was to investigate the effect of short-term prewarming for less than 30 minutes using forced-air warming device on body temperature during interscalene brachial plexus block (ISBPB) procedure in arthroscopic shoulder surgery before general anesthesia. METHODS: We randomly assigned patients scheduled for arthroscopic shoulder surgery to receive either cotton blanket (not pre-warmed, group C, n = 26) or forced-air warming device (pre-warmed, group F, n = 26). Temperature was recorded every 15 minutes from entering the operating room until leaving post-anesthetic care unit (PACU). Shivering and thermal comfort scale were evaluated during their stay in the PACU. RESULTS: There were significant differences in body temperature between group C and group F from 30 minutes after induction of general anesthesia to 30 minutes after arrival in the PACU (P < 0.05). The median duration of prewarming in group F was 14 min (range: 9-23 min). There was no significant difference in thermal comfort scale or shivering between the two groups in PACU. CONCLUSIONS: Our results showed that short-term prewarming using a forced-air warming device during ISBPB in arthroscopic shoulder surgery had beneficial effect on perioperative hypothermia.
Subject(s)
Humans , Anesthesia, General , Body Temperature , Brachial Plexus Block , Hot Temperature , Hypothermia , Operating Rooms , Prospective Studies , Shivering , ShoulderABSTRACT
Intraoperative active warming in daycare surgery may be least popular compared to major elective surgeries due to the lesser risk of perioperative hypothermia. This prospective, single blind, randomized, controlled trial in daycare breast lumpectomy was done to evaluate the routine use of intraoperative forced-air warmer in the presence of other warming modalities in prevention of perioperative hypothermia. Fifty patients were randomized into two groups; Group 1 received forced-air warmer and Group 2 received a standard cotton thermal blanket. Both groups received circulating-water mattress. Intraoperatively, all patients received pre-warmed intravenous fluid with an in-line warmer. Ear and ambient temperature was recorded using infrared ear thermometer and digital thermo-hygrometer respectively. Measurement was done before induction, every 15 minutes intraoperatively, upon arrival in recovery room and 30 mins later, postoperatively. All patients were normothermic prior to induction of anaesthesia. During the initial half an hour post-induction, both groups mean core temperature decreased at approximately 0.5˚C. Both showed no statistical difference in mean core temperature (0.04 ˚C) within the initial half an hour. The next half an hour, both groups had approximately 0.2˚C decrement but this time, Group 2 had a slightly higher mean core temperature than Group 1 which maintained until the end of surgery. Overall, within the initial one hour postinduction of GA, there was a drop of 0.7˚C and 0.6°C in Group 1 and Group 2 respectively, however the difference in final mean core temperature between the two groups was 0.05°C and it was not statistically significant (p value < 0.05). None of the patients experienced intraoperative hypothermia (< 36˚C) and all remained in the normothermic range with no shivering or sense of feeling cold, postoperatively. The results of the present study found no significant difference in the changes of final core temperature with or without the usage of intraoperative forced-air warmer in the presence of other warming measures in daycare breast lumpectomy.