Hipotermia perioperatoria / Perioperative hypothermia

Perioperative hypothermia is a common complication of general anesthesia, but it can also occur in patients undergoing regional anesthesia. It signifiicantly increases perioperative morbidity and mortality. Complications such as increased incidence of surgical site infection, delayed healing, coagulation abnormalities, increased surgical bleeding, perioperative cardiac events, decreased metabolism of drugs involved in anesthesia and a great discomfort in the immediate postoperative period (due to shivering), have been identified. The decrease in the patient's core temperature is due to a combination of physiological events related to the surgical anesthetic act. These include deterioration of the effector responses of the hypothalamus (tending to conserve heat), heat distribution between the central compartment and the periphery, and net heat loss to a generally colder environment, such as the surgical ward. Hypothermia is often an undetected complication of the anesthetic act due to the lack of regular temperature monitoring. It is not considered a basic standard of care, despite the fact that in recent years new guidelines and recommendations have emerged, which suggest its implementation in all patients in whom the duration of their surgery is expected to last longer than 1 hour. The measures aimed at keeping the patient normothermic can be classified as passive, within which the simplest is to cover the patient for as long as possible during their presence in the ward, and active, which are those that transfer heat to the body, within the which the most effective is the use of convective heat blankets. It has recently been suggested that prewarming the patient before inducing anesthesia is an efficient strategy to avoid hypothermia, decreasing temperature differences between core and peripheral tissues. However, the effectiveness of this measure remain to be evaluated with prospective, randomized trials. In the context of the emergency patient, although hypothermia shows the same characteristics as in the elective patient, it becomes more relevant in three clinical settings: patient with major burns, patient in hemorrhagic shock and the polytraumatized patient. In these scenarios, keeping the patient normothermic will prevent a series of serious complications, which can strongly affect mortality.

La hipotermia perioperatoria es una complicación frecuente de la anestesia general, pero que también se puede presentar en pacientes sometidos a anestesia regional. Se relaciona con un aumento significativo de la morbilidad y mortalidad perioperatorias, donde se han identificado complicaciones como aumento de la incidencia de infección del sitio quirúrgico, retardo de la cicatrización, alteraciones de la coagulación, aumento del sangrado quirúrgico, de los eventos cardiacos perioperatorios, disminución del metabolismo de drogas implicadas en la anestesia y sensación de gran incomodidad del paciente en el posoperatorio inmediato, por la presencia de calosfríos. La disminución de la temperatura central del paciente se debe a un combinación de eventos fisiológicos relacionados con el acto anestésico quirúrgico, con deterioro de las respuestas efectoras del hipotálamo tendientes a conservar calor, fenómenos distributivos de calor entre el compartimiento central y la periferia del propio paciente y pérdida de calor neta hacia un medio ambiente en general más frío, como lo es el pabellón quirúrgico. El hecho de que la hipotermia sea muchas veces considerada una complicación no detectada del acto anestésico, se debe a que aún la monitorización regular de la temperatura no se considera un estándar básico de cuidado, pese a que en los últimos años han surgido nuevas guías y recomendaciones, que sugieren que ésta sea implementada en todo paciente en que se proyecte una duración de la cirugía mayor a 1 hora. Las medidas tendientes a mantener al paciente normotérmico, pueden ser clasificadas en pasivas, dentro de las cuales la más simple es cubrir al paciente el mayor tiempo posible durante su presencia en pabellón y activas, que son aquellas que transfieren calor al cuerpo, dentro de las cuales la más efectiva es el uso de mantas de calor convectivo. Recientemente, se ha sugerido que una de las estrategias eficientes para evitar la HPO es el precalentamiento del paciente, que permite que sus tejidos periféricos estén a mayor temperatura al momento de inducir la anestesia, sin embargo, la efectividad de esta medida debe ser evaluada con estudios prospectivos y aleatorizados más concluyentes. La hipotermia en el contexto del paciente de urgencia, si bien presenta las mismas características que en el paciente electivo, cobra mayor relevancia en tres escenarios clínicos: el gran quemado, el paciente en hemorrágico y el paciente politraumatizado, escenarios en que mantener al paciente normotérmico, implicará evitar una serie de complicaciones graves, que pueden incidir fuertemente en la mortalidad.

Livedo reticularis by hypothermia during anesthesia for dental treatment in Down's syndrome patient / Livedo reticular por hipotermia durante anestesia para tratamento odontológico em paciente com síndrome de Down

Abstract Background: Livedo reticularis is a benign dermatological condition characterized by ischemic areas permeated by erythematous-cyanotic areas in a lacy pattern, and may be transient or permanent and is frequently associated with body exposure to cold. Cutaneous arterial vasospasm promotes ischemia, and venous dilation of the congested areas occurs by tissue hypoxia or autonomic dysfunction. Patients with Down's syndrome, due to their physiological peculiarities, constitute a representative part of those who require dental care under general anesthesia, and livedo reticularis has a reported incidence of 8-12% in Down's syndrome patients. Objectives: To describe the physiological livedo reticularis in a Down's syndrome patient, with the onset during the anesthetic-surgical procedure. Case report: 5-year-old female patient with Down's syndrome, admitted for dental treatment under balanced general anesthesia with sevoflurane, fentanyl, and atracurium. Transoperative hypothermia occurred with axillary temperature reaching 34.5 °C after 30 min after the beginning of anesthesia. At the end of the procedure, red-purplish skin lesions interspersed with areas of pallor were observed exclusively on the ventromedial aspect of the right forearm, with no systemic signs suggestive of allergic reactions. The established diagnosis was physiological livedo reticularis. There was a total fading of the lesions within 5 days. Conclusion: This report evidences the need for thermal control of patients undergoing anesthesia, as well as the manifestation of livedo reticularis as a consequence of transoperative hypothermia.

Resumo Justificativa: O livedo reticular representa quadro dermatológico benigno, caracterizado por áreas isquêmicas permeadas por áreas eritematocianóticas em padrão rendilhado, pode ser transitório ou permanente e frequentemente é associado à exposição corporal ao frio. O vasoespasmo arterial cutâneo promove a isquemia e a dilatação venosa das áreas congestas e ocorre por hipóxia tecidual ou por disfunção autonômica. Os portadores da síndrome de Down, devido às suas peculiaridades fisiológicas, constituem uma representativa parcela daqueles que necessitam de atendimento odontológico sob anestesia geral e o livedo reticular tem incidência relatada de 8% a 12% em pacientes com síndrome de Down. Objetivos: Descrever quadro de livedo reticular fisiológico em paciente portador de síndrome de Down, com aparecimento durante o ato anestésico-cirúrgico. Relato do caso: Paciente de cinco anos, sexo feminino, síndrome de Down, admitida para tratamento odontológico sob anestesia geral balanceada, com emprego de sevoflurano, fentanil e atracúrio. Houve ocorrência de hipotermia transoperatória, a temperatura axilar atingiu 34,5 ºC após 30 minutos do início da anestesia. Ao término do procedimento, notaram-se lesões cutâneas vermelho-arroxeadas, intercaladas com áreas de palidez, exclusivamente na face ventromedial do antebraço direito, sem sinais sistêmicos sugestivos de reações alérgicas. O diagnóstico firmado foi de livedo reticular fisiológico. Houve esmaecimento total das lesões em cinco dias. Conclusão: O relato apresentado evidencia a necessidade de controle térmico de pacientes submetidos a anestesias, bem como registra manifestação de livedo reticular em consequência de hipotermia transoperatória.

Variación de la temperatura central durante la cirugía colorrectal laparoscópica / Cangas in central temperature during laparoscopic colorectal surgery

Introducción: La hipotermia es una complicación que se produce con frecuencia en el posoperatorio de la cirugía laparoscópica. Múltiples factores potencian la disminución de la temperatura corporal por efecto directo del gas. Objetivo: Determinar las variaciones de la temperatura corporal en la intervención colorrectal laparoscópica y su influencia en la hipotermia intraoperatoria. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo en pacientes con anestesia general para procedimiento laparoscópico colorrectal electivo con el propósito de identificar la incidencia y variaciones de la temperatura corporal. El estudio se realizó en el hospital Hermanos Ameijeiras entre enero de 2014 y enero de 2017. Resultados: De los 88 pacientes, 78,4 por ciento tenían entre 51 y 60 años. El sexo masculino, los pacientes con sobrepeso y la clasificación ASA II presentaron mayor frecuencia. La temperatura basal media fue de 36,4 oC. Luego de 30 min disminuyó a 35,5 oC, a la hora 35,4 oC, a 90 min 35,1 oC y al finalizar 34,9 oC. Del total, presentaron hipotermia intraoperatoria no intencionada 78,4 por ciento. En ninguno se constató hipotermia severa. El tiempo quirúrgico promedio fue de 183,1 min. Se verificaron 49 complicaciones asociadas a hipotermia. Conclusiones: Se identificaron las variaciones de la temperatura corporal en la intervención colorrectal laparoscópica y la tendencia de generar hipotermia durante el procedimiento quirúrgico(AU)

Introduction: Hypothermia is a complication that frequently occurs in the postoperative period of laparoscopic surgery. Multiple factors boost the decrease in body temperature due to the direct effect of gas. Objective: To determine the variations in body temperature in laparoscopic colorectal surgery and its influence on intraoperative hypothermia. Methods: A descriptive, longitudinal and prospective study was carried out with patients, using general anesthesia for elective laparoscopic colorectal procedures and with the purpose of identifying the incidence and variations of body temperature. The study was carried out at the Hermanos Ameijeiras Hospital, between January 2014 and January 2017. Results: Among the 88 patients, 78.4 percent were at ages 51-60 years. Male sex, overweight patients and ASA-II classification were more frequent. The average basal temperature was 36.4ºC. After 30 min, it decreased to 35.5ºC; after one hour, to 35.4 ºC; after 90 min, 35.1ºC; and at the end, to 34.9 ºC. From the total, 78.4 percent presented unintentional intraoperative hypothermia. None of them had severe hypothermia. The average surgical time was 183.1 min. There were 49 complications associated with hypothermia. Conclusions: Variations in body temperature were identified in the laparoscopic colorectal intervention, as well as the tendency to generate hypothermia during the surgical procedure(AU)

Compromiso de conciencia y bradicardia / Unconciousness and bradycardia

Resumen: Mujer de 71 años, institucionalizada con antecedentes de esquizofrenia y tabaquismo. Consulta en el servicio de urgencias tras ser encontrada a la intemperie comprometida de conciencia. Al llegar la ambulancia se constata mal perfundida, bradipsíquica y bradicárdica, siendo trasladada al servicio de Urgencia. A su ingreso el ECG mostró bradicardia sinusal con trastorno de la conducción intraventricular y prolongación del intervalo QT. Los exámenes de laboratorio al ingreso resultaron dentro de límites normales. La historia clínica y los trazados electrocardiográficos son presentados, siendo discutidos junto al manejo médico.

Abstracts: A 71year old woman, institutionalized with a history of schizophrenia and smoking. She was transported to a local emergency room after being found laying outside unconscious. She was hypoperfused, bradypsychic and bradycardic, being transferred to the emergency service. On admission, the ECG showed sinus bradycardia with intraventricular conduction delay and QT prolongation. Laboratory tests were normal. Clinical history, physical examination and ECG tracings are presented and management is discussed.

Onda de Osborn asociada a hipotermia sin bradicardia presente. A propósito de un caso / Osborn´s wave associated to hypothermia without the presence of bradycardia. A propos of a case

La onda J de Osborn es una deflexión que se inscribe en el electrocardiograma (ECG) entre el complejo QRS y el inicio del segmento ST. La onda J tiene una alta sensibilidad y especificidad en la hipotermia, aunque no es patognomónica. Se han descrito casos en la hemorragia subaracnoidea, la hipercalcemia, la isquemia cardíaca aguda y la hipotermia severa. Se presenta el caso de un paciente masculino, alcohólico, encontrado en situación de bajo nivel de conciencia por sobredosificación de alcohol, que desarrolló un cuadro de hipotermia con la presencia de una onda de Osborn en el electrocardiograma sin bradicardia asociada (AU).

The Osborn´s J wave is a deflection inscribed in the electrocardiogram (ECG) between the QRS complex and the beginning of the ST segment. The J wave shows a high sensibility and specificity in the hypothermia, although it is not patognomonic. Cases have been described in subarachnoid hemorrhage, hypercalcemia, acute cardiac ischemia and severe hypothermia. The case of an alcoholic, male patient is presented. He was found in a situation of a low awareness level due to alcohol overdoses, and developed hypothermia with the presence of an Osborn´s wave in the electrocardiogram without associated bradycardia (AU).

Hipotermia terapéutica: programa para prevención del daño neurológico de la encefalopatía hipóxico isquémica en Buenos Aires / THERAPEUTIC HYPOTHERMIA: A MODEL TO PREVENT NEUROLOGIC DAMAGE BY ISCHEMIC HIPOXIC ENCEPHALOPATHY

Introducción: La hipotermia terapéutica (HT) es el estándar de cuidado para la encefalopatía hipóxico-isquémica (EHI). El servicio de neonatología implemento el programa de HT en el marco de la red perinatal de la Ciudad de Buenos Aires (RPCABA). Objetivos: Describir la implementación del programa de hipotermia en RPCABA. Reportar la mortalidad, complicaciones y efectos adversos asociados al tratamiento. Métodos: La implementación del programa se realizó en etapas: 1) 2009- 2010 Capacitación y entrenamiento en el uso del equipamiento. 2) 2010 hasta la actualidad: Tratamiento y seguimiento para los pacientes con EHI moderada o grave. Resultados: Hasta Marzo de 2017, 65 neonatos recibieron HT (7 con hipotermia corporal total y los 58 restantes hipotermia activa selectiva), 49 paciente fueron clasificados según la Escala Sarnat & Sarnat como EHI moderada y 16 como EHI grave. Conclusiones: Fue factible implementar el programa en nuestra unidad, auditarlo para mejorarlo y sostenerlo en el tiempo. El sistema de traslado pudo responder ante la activación del "código de hipotermia", cumpliendo tiempos, sosteniendo el tratamiento y el monitoreo adecuado. Creemos necesario mejorar la identificación de neonatos con diagnóstico de EHI en RPCABA. Se necesita nueva capacitación para evitar el subdiagnóstico de esta patología en los centros de nivel 2

Therapeutic hypothermia (TH) is nowadays the gold standard of care for the treatment of hypoxic- ischemic encephalopathy (HIE) in developed countries. The term encephalopathy refers to a diffuse disturbance of brain function, resulting in behavioral changes, altered consciousness or seizures. The brain is particularly vulnerable to even brief interruptions of blood flow or oxygen supply. If the brain´s oxygen supply is insufficient, consciousness is lost rapidly. If oxygenation is restored immediately, consciousness returns without sequelae. However, if oxygen deprivation lasts longer than 1 or 2 minutes, signs of an encephalopathy may persists for hours or permanently. Total ischemic anoxia lasting longer than about 4 minutes usually results in severe irreversible brain damage. The aim of the present report was to describe the implementation of the hypothermia program in a model for the perinatal system at the City of Buenos Aires, with the equipment Cool Cap® for selective hypothermia, and the equipment CFM Olympic 6000® and CFM OMB from Medix® by Natus®, these two to monitoreate the cerebral function. The results obtained are referred, with special consideration to mortality, complications and adverse effects associated with the treatment.

Terapia do controle da temperatura pós-parada cardiorrespiratório / Temperature control therapy after cardiorespiratory

O processo fisiopatológico secundário à parada cardiorrespiratória (PCR) com retorno da circulação espontânea (RCE), determina a síndrome pós-PCR, com lesão cerebral, disfunção miocárdica e reperfusão, em resposta à isquemia orgânica. A terapia do controle da temperatura (TCT) oferece mecanismos neuroprotetores, limitação da lesão miocárdica e redução da resposta inflamatória sistêmica. Dúvidas existem em relação aos benefícios, início e duração da TCT, porém, há evidências que apoiam a melhora da sobrevida e do prognóstico neurológico em populações selecionadas. Recomenda-se a TCT por 24 horas, com controle da temperatura na faixa de 32 °C a 36 °C para adultos que sobrevivem à PCR extra-hospitalar e permanecem em coma com ritmos iniciais de fibrilação/taquicardia ventricular, o que também é sugerido para os sobreviventes de PCR extra-hospitalar com ritmo inicial não chocável e de PCR intra-hospitalar em qualquer ritmo inicial. O início do resfriamento deve ser feito o mais precocemente possível, depreferência, até 12 horas após o RCE. O controle da temperatura corpórea deve ser incorporado aos cuidados dos pacientes críticos pós-PCR, a fim de reduzir as taxas de mortalidade e de sequelas neurológicas...

The secondary pathophysiological process to cardiorespiratory arrest (CRA) with return of spontaneous circulation (ROSC), determines the post-cardiorespiratory arrest syndrome with brain injury, myocardial reperfusion and dysfunction in response to systemic ischemia. The temperature control therapy (TCT) provides neuroprotective mechanisms, limitation of myocardial injury and reduction of systemic inflammatory response. There are still some questions regarding the benefits, timing and duration of TCT, however, there is evidence supporting improved survival and neurological outcome in selected populations. TCT is recommended for 24 hours, with temperature control in the range of 32 to 36 °C for comatose adults who survive after out-of-hospital cardiorespiratory arrest with initial rates of fibrillation/ ventricular tachycardia, which is also suggested for extra-hospital cardiorespiratory arrest survivors with early pace not shockable and intra-hospital cardiorespiratory arrest in any initial rate. The beginning of the cooling should be done as early as possible, ideally up to12 hours after ROSC. The control of body temperature should be incorporated into the careof the post-CRA critically ill patients in order to reduce mortality and neurological sequelae...

Complicações pós-operatórias relacionadas à hipotermia intraoperatória

Introdução: A hipotermia é um evento comum no período intraoperatório, em que acarreta consequências na recuperação do paciente, sendo um dos diagnósticos de enfermagem de maior frequência no pós-operatório. As complicações decorrentes da hipotermia afetam diversos sistemas do organismo, como o cardíaco, respiratório, tegumentar, digestório, imunológico e também o sistema de coagulação. A redução do desconforto térmico do paciente e, principalmente, o controle das complicações associadas à hipotermia intraoperatória, devem ser realizados em todo o período perioperatório com o uso de medidas preventivas e de tratamento da hipotermia. Objetivo: Este estudo teve como objetivo analisar as complicações apresentadas pelo paciente no período de pós-operatório relacionadas com a hipotermia intraoperatória...

Introduction: Hypothermia is a common event in the intraoperative period, which leads to consequences in the patient recovery, and it is one of the most frequent postoperative nursing diagnoses. Complications resulting from hypothermia affect several body systems, such as cardiac, respiratory, integumentary, digestive, immune and also the coagulation system. The reduction of patient´s thermal discomfort and the control of complications associated with intraoperative hypothermia, must be performed throughout the perioperative period with the use of preventive measures and treatment of hypothermia. Objective: The purpose of this study was to analyze the complications presented by the patient in the postoperative period associated to intraoperative hypothermia...

Alteraciones electrocardiográficas en hipotermia severa accidental: Caso clínico y revisión de la literatura / Electrocardiographic manifestations of severe accidental hypothermia: Report of one case

We report a 77-year-old female patient who was admitted to the Emergency Department with impairment of consciousness, hypotension, bradycardia and hypothermia. She required endotracheal intubation and transfer to Intensive Care Unit (ICU). Computed tomography of the brain showed no lesions. Electrocardiogram showed abnormalities suggestive of severe hypothermia (bradycardia, marked elevation of J point associated with ST depression, a negative T wave in V2 to V6 and prolongation of QTc), which was confirmed with a pulmonary artery catheter. Myxedema coma, infections and neurological diseases were discarded. The cause of severe hypothermia was unclear, and the probable source was suspected to be accidental. After intensive treatment the patient improved, achieving normalization of electrocardiographic changes, recovery of organic functions and she was discharged home after 22 days.

Hypothermia-induced acute kidney injury in an elderly patient

Hypothermia, defined as an unintentional decline in the core body temperature to below 35degrees C, is a life-threatening condition. Patients with malnutrition and diabetes mellitus as well as those of advanced age are at high risk for accidental hypothermia. Due to the high mortality rates of accidental hypothermia, proper management is critical for the wellbeing of patients. Accidental hypothermia was reported to be associated with acute kidney injury (AKI) in over 40% of cases. Although the pathogenesis remains to be elucidated, vasoconstriction and ischemia in the kidney were considered to be the main mechanisms involved. Cases of AKI associated with hypothermia have been reported worldwide, but there have been few reports of hypothermia-induced AKI in Korea. Here, we present a case of hypothermia-induced AKI that was treated successfully with rewarming and supportive care.

Factores predictores e implicancias de la hipotermia perioperatoria en el Hospital Nacional Dos de Mayo / Factors predictors and implications of peri-operative hypothermia in National Hospital Dos de Mayo

Objetivos: Caracterizar los factores predictores conocidos de la hipotermia perioperatoria, construyendo un score para identificar los pacientes de alto riesgo a desarrollar complicaciones. Métodos: Se estudiaron 200 pacientes (hipotermia-116 pacientes y normotermia-84 pacientes) en los meses de setiembre-noviembre del 2012, excluyéndose 7 pacientes de acuerdo a los criterios de inclusión y exclusión; posteriormente se dividió la población dos grupos (diseño - 127 pacientes, validación - 66 pacientes), relacionándose con los factores predictores (edad, sexo, peso, talla, ASA, tiempo anestésico, tiempo quirúrgico, temperatura/humedad ambiental, extensión de la intervención, zona quirúrgica, tipo de anestesia), a través de un análisis bivariable, tanto de las variables cuantitativas (t de Student) como cualitativas (Chi cuadrado), incluyendo solo a los factores con p<0,10 para la realización de un modelo multivariable obteniendo un modelo predictivo, a través de la curva ABC-ROC. Resultados: En el grupo diseño el ABC-ROC del modelo completo fue 0.96 (0.97 a 1.00) y la del modelo abreviado ABC-ROC 0.94 (0.90 a 0.97). En el grupo validación el ABC-ROC del modelo completo fue 0.94 (0.86 a 1.00) y la del modelo abreviado ABC-ROC 0.92 (0.87 a 0.98). Conclusiones: El punto de corte del modelo mediante la curva ABC ROC fue de 7, obteniéndose como factores predictores temperatura corporal, tiempo de cirugía y zona quirúrgica.

Objectives: To characterize the known predictors of perioperative hypothermia, building a score to identify patients at high risk of developing complications. Methods: We studied 200 patients (hypotherrnia-norrnotherrnia-116 patients and 84 patients) in the months of September-November 2012, excluding 7 patients according to the inclusion and exclusion criteria, then the population was divided two groups (design - 127 patients, validation - 66 patients), relating to the predictors (age, sex, weight, height, ASA, anesthetic time, surgical time, temperature / humidity, extent of surgery, surgical site, type of anesthesia), to through a bivariate analysis, both quantitative variables (Student t test) and qualitative (Chi squared), including only those factors with p<0.10 for the realization of a multivariable model predictive model obtained through the ABC-ROC curve. Results: In group ABC-ROC design of the full model was 0.96 (0.97 to 1.00) and the abbreviated model ABC-ROC 0.94 (0.90 to 0.97). In the validation group ABC-ROC of the full model was 0.94 (0.86 to 1.00) and the abbreviated model ABC-ROC 0.92 (0.87 to 0.98). Conclusions: The model cutoff by ROC curve was 7 predictors obtained as body temperature, duration of surgery and surgical site.

Normotermia perioperatoria / Peri-operative normothermia

Introducción: La hipotermia perioperatoria inadvertida es un desafío para la seguridad del paciente quirúrgico y puede tener un impacto negativo en su recuperación. Materiales y métodos: Se realizó aleatoriamente una encuesta personalizada a anestesiólogos federados que asistieron al Congreso Argentino de Anestesiología realizado en Salta, Argentina, en septiembre de 2007, a fin de obtener un panorama sobre las estrategias de manejo de la temperatura en pacientes bajo anestesia en su medio de trabajo (monitorización, calentamiento activo, métodos de soporte). Resultados: Sobre 92 encuestas realizadas, 85 correspondieron a anestesiólogos argentinos, de los cuales 20 eran jefes de servicio de anestesiología, 59 médicos de planta y 6 residentes de anestesiología. Del total de los profesionales en estudio, 37,6 por ciento trabaja en la Ciudad Autónoma de Buenos Aires, 25,9 por ciento en la provincia de Buenos Aires, 5,9 por ciento en la provincia de Córdoba, 5,9 por ciento en la provincia de Salta, 4,7 por ciento en la provincia de Jujuy, 3,5 por ciento en la provincia de Chaco, 3,5 por ciento en la provincia de Santa Fe, 2,4 por ciento en la provincia de Corrientes, 2,4 por ciento en la provincia de Neuquén, 2,4 por ciento en la provincia de Tucumán, 1,2 por ciento en la provincia de Chubut, 1,2 por ciento en la provincia de Mendoza, 1,2 por ciento en la provincia de Santa Cruz, 1,2 por ciento en la provincia de Santiago del Estero y 1,2 por ciento en la provincia de Tierra del Fuego. La media de camas hospitalarias fue de 384,5 para el grupo Ciudad Autónoma de Buenos Aires (CABA), 111,7 para el grupo Gran Buenos Aires (GBA) y 159,2 para el grupo Interior. La media de quirófanos fue de 10,6 para el grupo CABA, 4,9 para el grupo GBA y 5,1 para el grupo Interior... (TRUNCADO)

Introduction: inadvertent peri-operative hypothermia represents a challenge to the safety of the surgical patient, and can produce a negative impact on recovery. Materials & methods: A randomized personalized survey was made of federated anesthesiologists who attended the Argentine Convention in Salta, Argentina, in September 2007, so as to have an overview of strategies of temperature management in anesthetized patients in the anesthesiologist’s area (monitoring, active heat, supportive methods). Results: Of the 92 professionals surveyed, 85 were Argentine anesthesiologists, 20 were Heads of Service, 59 staff members, and 6 residents in Anesthesiology. From this total, 37,6 percent work in the Autonomous City of Buenos Aires, 25,9 percent in the Province of Buenos Aires, 5,9 percent in Cordoba, 5,9 percent in Salta, 4,7 percent in Jujuy, 3,5 percent in Chaco, 3,5 percent in Santa Fe, 2,4 percent in Neuquén, 2,4 percent in Tucumán, 1,2 percent in Chubut, 1,2 percent in Mendoza, 1,2 percent in Santa Cruz, 1,2 percent in Santiago del Estero, and 1,2 percent in Tierra del Fuego. The average of hospital beds was 384,5 for Buenos Aires City, 111,7 for Greater Buenos Aires and 159,2 for the group of provinces. The average of operating rooms was 10,6 for Buenos Aires City, 4,9 for Greater Buenos Aires, and 5,1 for the group of provinces. Temperature monitoring was used by 63,5 percent of the professionals in pediatric patients, 40 percent in geriatric patients, 14,1 percent in pregnant patients, 50,6 percent in traumatized patients, 51,8 percent in critical patients, and 14,1 percent in all patients. Nasopharyngeal was the preferred location for the sensor (74,1 percent), followed by axillary and tympanic (17,6 percent), skin (14,1 percent), and rectal (12,9 percent) areas... (TRUNCADO)

Introdução: A hipotermia perioperatória inadvertida é um desafio para a segurança do paciente cirúrgico, e pode ter um impacto negativo na recuperação hospitalar. Materiais e métodos: Foi feita aleatoriamente uma pesquisa personalizada a anestesiologistas que participaram do Congresso Argentino de Anestesiologia realizado em Salta, Argentina, em setembro de 2007, a fim de ter um panorama das estratégias de controle da temperatura nos pacientes sob anestesia (monitoração, aquecimento ativo, métodos de suporte). Resultados: Em 92 pesquisas realizadas, 85 corresponderam a anestesiologistas argentinos, dos quais 20 eram chefes de serviço de anestesiologia, 59 médicos de planta e 6 residentes de anestesiologia. Do total dos profissionais do estudo, 37,6 por cento trabalhavam na Ciudad Autónoma de Buenos Aires, 25,9 por cento na província de Buenos Aires, 5,9 por cento na província de Córdoba, 5,9 por cento na província de Salta, 4,7 por cento na província de Jujuy, 3,5 por cento na província de Chaco, 3,5 por cento na província de Santa Fe, 2,4 por cento na província de Corrientes, 2,4 por cento na província de Neuquén, 2,4 por cento na província de Tucumán, 1,2 por cento na província de Chubut, 1,2 por cento na província de Mendoza, 1,2 por cento na província de Santa Cruz, 1,2 por cento na província de Santiago del Estero e 1,2 por cento na província de Tierra del Fuego. A média de leitos hospitalares foi de 384,5 no grupo Ciudad Autónoma de Buenos Aires (CABA), 111,7 no grupo Gran Buenos Aires (GBA) e 159,2 no grupo Interior. A média de salas de operações foi de 10,6 no grupo CABA, 4,9 no grupo GBA e 5,1 no grupo Interior. Em relação à monitoração, 63,5 por cento disseram realizá-la em pacientes pediátricos, 40 por cento em pacientes idosos, 14,1 por cento em grávidas, 50,6 por cento em traumatizados, 51,8 por cento em pacientes críticos e 14,1 por cento em todos os pacientes... (TRUNCADO)

Hipotermia como fator de risco para infecção de sítio cirúrgico: conhecimento dos profissionais de enfermagem de nível médio / Hypothermia as a risk factor for surgical wound infection: the nurse assistant's knowledge / Hipotermia como factor de riesgo para infeccion de sitio quirurgico: conocimiento de los auxiliares de enfermeria

A equipe de enfermagem tem papel fundamental na prevenção da hipotermia no cliente cirúrgico para o controle e a prevenção de complicações, sendo a principal a infecção de sítio cirúrgico, que diminui custos para a instituiçãoe melhora a qualidade da assistência para o cliente. O objetivo com esta pesquisa foi analisar o conhecimento do profissional de enfermagem de nível médio sobre a relação do controle da hipotermia para a prevenção da infecção desítio cirúrgico. Realizou-se um estudo descritivo de caráter exploratório no centro cirúrgico de um hospital filantrópico no interior de São Paulo, do qual participaram 21 colaboradores de ambos os sexos, profissionais de enfermagem. Para a coleta de dados, foi utilizado um formulário de questões como instrumento norteador. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Paulista. No estudo, evidenciou-se que 85,7% demonstraram não ter conhecimento de que a hipotermia é um fator de risco para infecção de sítio cirúrgico, mostrando a necessidade de o profissional de enfermagem possuir amplo conhecimento na área em que atua, já que os avanços da tecnologia, descobertas científicas são constantes e a reciclagem e a atualização tornam-se imprescindíveis. São fundamentais ações estratégicas para transformar a organização das práticas de saúde e práticas pedagógicas, o que implica um trabalho articulado entre o sistema de saúde e as instituições formadoras para a construção do conhecimento, no qual a teoria e a prática se fundem, proporcionando segurança e qualidade para a assistência ao cliente cirúrgico. Para isso o profissional enfermeiro deve atuar efetivamente como supervisor e líder, repassando novos conhecimentos e informações relevantes a toda sua equipe.

The nursing team plays a fundamental role in preventing and controlling hypothermia in a surgical patient. Such control is essential to avoid complications, such as the surgical wound infection. It helps to reduce costs and improve the quality in patient care. This study aims to analyze the nursing assistants’ knowledge about the relationship between the control of hypothermia and the surgical site infection prevention. We conducted a descriptive exploratory study in the surgical center of a philanthropic hospital in the State of São Paulo. 21 nursing professionals of both sexes participated in the survey. A questionnaire was used as data collection method. The study was approved by the Research Ethics Committee of the Universidade Paulista. The results indicated that 85.7% of the nursing assistants were not aware that hypothermia is a risk factor for surgical wound infection what stresses the need for the nursing professionals to possess an extensive knowledge in the area. Advances in technology and scientific discoveries are constant and refreshment and update courses become indispensable. In this context strategic actions are fundamental to transform healthcare organization and teaching practices. Their implementation would require an articulated work between the health system and the nursing training schools, where theory and practice could merge to provide safetyand quality to the surgical patient. For this the professional nurse has to act effectively as a supervisor and leader, transmitting knowledge and relevant information to his/her team.

El equipo de enfermería tiene un papel fundamental en la prevención de la hipotermia del cliente quirúrgico para control y prevención de complicaciones, principalmente de la infección de sitio quirúrgico. Esto ayuda a disminuir costos y mejorar la calidad de la atención al cliente. La presente investigación fue realizada con la finalidad de evaluar el conocimiento de los auxiliares de enfermería sobre la relación enre el control de la hipotermia y la prevención parainfección de sitio quirúrgico. Se trata de un estudio descriptivo exploratorio llevado a cabo en el centro quirúrgico de un hospital filantrópico del interior de São Paulo. Participaron 21 profesionales de enfermería de ambos sexos. Para la recogida de datos fue utilizado un cuestionario estructurado. El estudio fue aprobado por el Comité de Ética en Investigación de la Universidad Paulista. Los resultados señalan que el 85,7% de los auxiliares de enfermería nosabe que la hipotermia es un factor de riesgo para infección de sitio quirúrgico lo cual refuerza la necesidad de que dichos profesionales adquieran amplio conocimiento sobre su área de actuación. Los avances tecnológicos y los descubrimientos científicos son algo constante y, por ello, es indispensable que los profesionales se reciclen y estén actualizados permanentemente. Las acciones estratégicas son fundamentales para transformar la organización de las prácticas de salud y las prácticas pedagógicas, lo cual significa que el sistema de salud trabaje de forma articulada con las instituciones a cargo de la construcción del conocimiento. Es así como teoría y práctica se funden para proporcionar seguridad y calidad de atención al cliente quirúrgico. Para ello, el enfermero profesional debe actuar efectivamente como supervisor y jefe, trasmitiendo conocimiento e información relevante a su equipo.

Avaliação de hipotermia na sala de recuperação pós-anestésica em pacientes submetidos a cirurgias abdominais com duração maior de duas horas / Hypothermia evaluation in post-anesthetic recovery room after abdominal surgeries longer than 2 hours

Introdução: Hipotermia não intencional é caracterizada por temperatura sanguínea central inferior a 36°C e pode estar presente em 53-85% dos adultos que chegam à Sala de Recuperação Pós-anestésica (SRPA). Objetivos: Avaliar a hipotermia na SRPA em pacientessubmetidos a cirurgias abdominais com duração maior de duas horas, no Hospital Nossa Senhora da Conceição, em Tubarão – SC. Métodos: Foi realizado um estudo transversal no qualpacientes submetidos a cirurgias abdominais com duração maior de duas horas, tiveram as temperaturas axilaresmonitoradas antes e depois da cirurgia e no momento da alta da SRPA. As variáveis utilizadas foram gênero,faixa etária, etnia, peso, altura, tipo de cirurgia, especialidade, tempo de cirurgia e tempo de permanência naSRPA. Resultados: A média de temperatura após a cirurgia foi de 34,5°C, já a média da alta da SRPA foi de35,7°C. Pacientes acima de 40 anos apresentaram uma média de 1,0°C menor em relação ao grupo com idadeinferior ao final da cirurgia. O grupo de pacientes com menos de 70 Kg obteve uma temperatura média menor após a cirurgia quando comparado ao outro grupo. Cirurgias com mais de 180 minutos e tempo na SRPA superiora 180 minutos apresentaram menor temperatura média posterior. Conclusões: A média de temperatura após a cirurgia foi classificada em hipotermia de grau leve. Característicasdo paciente como peso menor que 70Kg, idade maior de 40 anos e cirurgias prolongadas estiveram associadas a uma menor temperatura pós-operatória.

Introduction: Non intentional hypothermia is characterized by central blood temperature lower than 36ºC,and is present in 53-85% of adults upon arrival at the post-anesthetic recovery room. Objective: To analyze hypothermia in the post-anestheticroom, in patients submitted to abdominal surgery with duration of over two hours, in the Nossa Senhora da Conceição Hospital, in Tubarão – SC. Methods: A cross sectional study was realized.Patients submitted to abdominal surgeries with over two hours of duration, had their axillaries temperatures monitored, before and after of the surgery, and at the timeof discharge of the post-anesthetic recovery room. The variables used were, gender, age group, ethnicity, weight, height, type of surgery, and time spent in the post- anesthetic recovery room. Results: The average body temperature after surgery was 34.5°C while the average body temperature atthe post-anesthetic recovery room was 35.7°C. Patients over 40 years old presented an average temperature0.5°C lower when compared to the group less than this age, at the end of the surgery. The group of patientsweighting less than 70 Kg obtained a lower average temperatureafter surgery when compared to the other group. Surgeries longer than 180 minutes and patients that remainedmore than 180 minutes in the post-anesthetic recovery room presented lower average temperatures. Conclusion: The average temperature after surgery was classified as low level hypothermia. Patients characteristicssuch as weight lower than 70 Kg, age over 40 years old and prolonged surgeries were associated with lower post-operative temperature.

approach to minimize perioperative hypothermia and its complications

During general anesthesia there is marked decrease in energy expenditure and heat generation, in addition, central thermoregulatory function is impaired Postoperatively, hypothermicpatients are uncomfortable and at risk of developing several hypothermic related complications such as shivering, ischemic cardiac events and decreased resistance to wound infections. We investigated the effect of I V infusion of a balanced mixture of ammo acids in prevention of perioperative hypothermia and its complications. Forty patients undergoing major abdominal surgery were randomly assigned to either an amino acid [a a] group or a control group. Patients in the a. a group received mixture of 19 amino acids I' V at a rate of 100 ml/h given 1h before induction and continuing for 3h after induction. The control group received Ringer's solution. During the perioperative period we recorded heart rate, arterial blood pressure, SO2, end tidal CO2 and rectsl core temperature Plasma norepinephrine was assayed before induction and after surgery On recovery the patients were observed for shivering and were asked about cold feeling. The mean duration of stay in PACU and hospital stay duration were recorded The surgical wounds were evaluated The mean core body temperature at the end of surgery and at the discharge from the PACU were significantly lower in the control group than the a a group The mean heart rate and arterial blood pressure were significantly higher in the control group. The incidence of postoperative shivering and cold feeling was higher in the control group than the a a group. The mean plasma concentration of norepinephrine was significantly higher in the control groupr. The mean duration of stay in the PACU and duration ofthe hospital stay were significantly longer in the control group than the a.a. group. In conclusion it was found that the infusion of amino acids to anesthetized patients will induce thermogenesis preventing perioperative hypothermia and significantly decreases the sympathetically mediated dynamic and hormonal response to hypothermia during recovery from anesthesia It decreases also significantly the postoperative shivering and cold feeling of the patient. Amino acid infusion enhances also recovery and shortens the hospital stay

Hypothermia in Iranian newborns. Incidence, risk factors and related complications

To determine the incidence rate and factors associated with hypothermia in Iranian newborns and to discover the effect of hypothermia on neonatal morbidity and mortality. We selected a random sample of 1952 neonates using a multistage sampling technique from February 2004 to February 2005 in University Teaching Hospitals in Iran. We measured repeatedly at different time points the rectal temperature of these newborns. At each time of measurement, those with rectal temperature <36OC were considered as hypothermic. The obtained results showed that approximately one third of newborns became hypothermic immediately after birth. In addition, the regression analysis revealed that low birth weights, prematures, low apgar scores, infants of multiple pregnancies and those who received cardiopulmonary resuscitation had higher risk for being hypothermic. It was also found that hypothermia increases the risk of metabolic acidosis, jaundice, respiratory distress, hypoglycemia, pulmonary hemorrhage and death, regardless of the newborn's weight and gestational age. There is an urgent need to train mothers and all levels of neonatal care staff to control this health problem in our country