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Vawda DO, King C, Toit LD, Dyer RA, Masuku NJ, Bishop DG. Agreement between three noninvasive temperature monitoring devices during spinal anaesthesia for caesarean delivery: a prospective observational study. J Clin Monit Comput 2024:10.1007/s10877-024-01154-1. [PMID: 38687415 DOI: 10.1007/s10877-024-01154-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/14/2024] [Indexed: 05/02/2024]
Abstract
Hypothermia during obstetric spinal anaesthesia is a common and important problem, yet temperature monitoring is often not performed due to the lack of a suitable, cost-effective monitor. This study aimed to compare a noninvasive core temperature monitor with two readily available peripheral temperature monitors during obstetric spinal anaesthesia. We undertook a prospective observational study including elective and emergency caesarean deliveries, to determine the agreement between affordable reusable surface temperature monitors (Welch Allyn SureTemp® Plus oral thermometer and the Braun 3-in-1 No Touch infrared thermometer) and the Dräger T-core© (using dual-sensor heat flux technology), in detecting thermoregulatory changes during obstetric spinal anaesthesia. Predetermined clinically relevant limits of agreement (LOA) were set at ± 0.5 °C. We included 166 patients in our analysis. Hypothermia (heat flux temperature < 36 °C) occurred in 67% (95% CI 49 to 78%). There was poor agreement between devices. In the Bland-Altman analysis, LOA for the heat flux monitor vs. oral thermometer were 1.8 °C (CI 1.7 to 2.0 °C; bias 0.5 °C), for heat flux monitor vs. infrared thermometer LOA were 2.3 °C (CI 2.1 to 2.4 °C; bias 0.4 °C) and for infrared vs. oral thermometer, LOA were 2.0 °C (CI 1.9 to 2.2 °C; bias 0.1 °C). Error grid analysis highlighted a large amount of clinical disagreement between methods. While monitoring of core temperature during obstetric spinal anaesthesia is clinically important, agreement between monitors was below clinically acceptable limits. Future research with gold-standard temperature monitors and exploration of causes of sensor divergence is needed.
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Affiliation(s)
- D O Vawda
- Department of Anaesthesia, School of Clinical Medicine, College of Health Sciences, Grey's Hospital, University of KwaZulu-Natal, Pietermaritzburg, 3201, South Africa
| | - Christopher King
- Department of Anesthesiology, Washington University School of Medicine in St Louis, MO, USA
| | - L du Toit
- Department of Anesthesiology, Washington University School of Medicine in St Louis, MO, USA
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - R A Dyer
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - N J Masuku
- Department of Anaesthesia, School of Clinical Medicine, College of Health Sciences, Grey's Hospital, University of KwaZulu-Natal, Pietermaritzburg, 3201, South Africa
| | - D G Bishop
- Department of Anaesthesia, School of Clinical Medicine, College of Health Sciences, Grey's Hospital, University of KwaZulu-Natal, Pietermaritzburg, 3201, South Africa.
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Eisenkraft A, Goldstein N, Fons M, Tabi M, Sherman AD, Ben Ishay A, Merin R, Nachman D. Comparing body temperature measurements using the double sensor method within a wearable device with oral and core body temperature measurements using medical grade thermometers-a short report. Front Physiol 2023; 14:1279314. [PMID: 38033330 PMCID: PMC10685445 DOI: 10.3389/fphys.2023.1279314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction: Body temperature is essential for diagnosing, managing, and following multiple medical conditions. There are several methods and devices to measure body temperature, but most do not allow continuous and prolonged measurement of body temperature. Noninvasive skin temperature sensor combined with a heat flux sensor, also known as the "double sensor" technique, is becoming a valuable and simple method for frequently monitoring body temperature. Methods: Body temperature measurements using the "double sensor" method in a wearable monitoring device were compared with oral and core body temperature measurements using medical grade thermometers, analyzing data from two prospective clinical trials of different clinical scenarios. One study included 45 hospitalized COVID-19 patients in which oral measurements were taken using a hand-held device, and the second included 18 post-cardiac surgery patients in which rectal measurements were taken using a rectal probe. Results: In study 1, Bland-Altman analysis showed a bias of -0.04°C [0.34-(-0.43)°C, 95% LOA] with a correlation of 99.4% (p < 0.001). In study 2, Bland-Altman analysis showed a bias of 0.0°C [0.27-(-0.28)°C, 95% LOA], and the correlation was 99.3% (p < 0.001). In both studies, stratifying patients based on BMI and skin tone showed high accordance in all sub-groups. Discussion: The wearable monitor showed high correlation with oral and core body temperature measurements in different clinical scenarios.
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Affiliation(s)
- Arik Eisenkraft
- Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Force Medical Corps, Jerusalem, Israel
- Biobeat Technologies Ltd., Petah Tikva, Israel
| | | | - Meir Fons
- Biobeat Technologies Ltd., Petah Tikva, Israel
| | | | | | | | - Roei Merin
- Biobeat Technologies Ltd., Petah Tikva, Israel
| | - Dean Nachman
- Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Force Medical Corps, Jerusalem, Israel
- Heart Institute, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
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Périard JD, Eijsvogels TMH, Daanen HAM. Exercise under heat stress: thermoregulation, hydration, performance implications, and mitigation strategies. Physiol Rev 2021; 101:1873-1979. [PMID: 33829868 DOI: 10.1152/physrev.00038.2020] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A rise in body core temperature and loss of body water via sweating are natural consequences of prolonged exercise in the heat. This review provides a comprehensive and integrative overview of how the human body responds to exercise under heat stress and the countermeasures that can be adopted to enhance aerobic performance under such environmental conditions. The fundamental concepts and physiological processes associated with thermoregulation and fluid balance are initially described, followed by a summary of methods to determine thermal strain and hydration status. An outline is provided on how exercise-heat stress disrupts these homeostatic processes, leading to hyperthermia, hypohydration, sodium disturbances, and in some cases exertional heat illness. The impact of heat stress on human performance is also examined, including the underlying physiological mechanisms that mediate the impairment of exercise performance. Similarly, the influence of hydration status on performance in the heat and how systemic and peripheral hemodynamic adjustments contribute to fatigue development is elucidated. This review also discusses strategies to mitigate the effects of hyperthermia and hypohydration on exercise performance in the heat by examining the benefits of heat acclimation, cooling strategies, and hyperhydration. Finally, contemporary controversies are summarized and future research directions are provided.
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Affiliation(s)
- Julien D Périard
- University of Canberra Research Institute for Sport and Exercise, Bruce, Australia
| | - Thijs M H Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hein A M Daanen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Balki I, Khan JS, Staibano P, Duceppe E, Bessissow A, Sloan EN, Morley EE, Thompson AN, Devereaux B, Rojas C, Rojas C, Siddiqui N, Sessler DI, Devereaux PJ. Effect of Perioperative Active Body Surface Warming Systems on Analgesic and Clinical Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Anesth Analg 2020; 131:1430-1443. [PMID: 33079867 DOI: 10.1213/ane.0000000000005145] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Inadvertent perioperative hypothermia is a common complication of surgery, and active body surface warming (ABSW) systems are used to prevent adverse clinical outcomes. Prior data on certain outcomes are equivocal (ie, blood loss) or limited (ie, pain and opioid consumption). The objective of this study was to provide an updated review on the effect of ABSW on clinical outcomes and temperature maintenance. METHODS We conducted a systematic review of randomized controlled trials evaluating ABSW systems compared to nonactive warming controls in noncardiac surgeries. Outcomes studied included postoperative pain scores and opioid consumption (primary outcomes) and other perioperative clinical variables such as temperature changes, blood loss, and wound infection (secondary outcomes). We searched Ovid MEDLINE daily, Ovid MEDLINE, EMBASE, CINHAL, Cochrane CENTRAL, and Web of Science from inception to June 2019. Quality of evidence (QoE) was rated according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Subgroup analysis sought to determine the effect of preoperative + intraoperative warming versus intraoperative warming alone. Metaregression evaluated the effect of year of publication, use of neuromuscular blockers, anesthesia, and surgery type on outcomes. RESULTS Fifty-four articles (3976 patients) were included. Pooled results demonstrated that ABSW maintained normothermia compared to controls, during surgery (30 minutes postinduction [mean difference {MD}: 0.3°C, 95% confidence interval {CI}, 0.2-0.4, moderate QoE]), end of surgery (MD: 1.1°C, 95% CI, 0.9-1.3, high QoE), and up to 4 hours postoperatively (MD: 0.3°C, 95% CI, 0.2-0.5, high QoE). ABSW was not associated with difference in pain scores (<24 hours postoperatively, moderate to low QoE) or perioperative opioid consumption (very low QoE). ABSW increased patient satisfaction (MD: 2.2 points, 95% CI, 0.9-3.6, moderate QoE), reduced blood transfusions (odds ratio [OR] = 0.6, 95% CI, 0.4-1.0, moderate QoE), shivering (OR = 0.2, 95% CI, 0.1-0.4, high QoE), and wound infections (OR = 0.3, 95% CI, 0.2-0.7, high QoE). No significant differences were found for fluid administration (low QoE), blood loss (very low QoE), major adverse cardiovascular events (very low QoE), or mortality (very low QoE). Subgroup analysis and metaregression suggested increased temperature benefit with pre + intraoperative warming, use of neuromuscular blockers, and recent publication year. ABSW seemed to confer less temperature benefit in cesarean deliveries and neurosurgical/spinal cases compared to abdominal surgeries. CONCLUSIONS ABSW is effective in maintaining physiological normothermia, decreasing wound infections, shivering, blood transfusions, and increasing patient satisfaction but does not appear to affect postoperative pain and opioid use.
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Affiliation(s)
- Indranil Balki
- From the Department of Anesthesia, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - James S Khan
- From the Department of Anesthesia, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Phillip Staibano
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Emmanuelle Duceppe
- Department of Medicine, Centre hospitalier de l'Université de Montréal, l'Université de Montréal, Montreal, Quebec, Canada
| | - Amal Bessissow
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Erin N Sloan
- Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erin E Morley
- Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra N Thompson
- Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Breagh Devereaux
- Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Camila Rojas
- Department of Anesthesia, Clinica Universidad de Los Andes, Universidad de Los Andes, Bogota, Colombia
| | - Naveed Siddiqui
- Department of Anesthesia, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Daniel I Sessler
- (DIS) Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
| | - P J Devereaux
- Department of Health Research Methods, Evidence and Impact
- Population Health Research Institute, and
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Tachibana S, Chida Y, Yamakage M. Using the Bair Hugger™ temperature monitoring system in neck and chest regions: a pilot study. JA Clin Rep 2019; 5:32. [PMID: 32026018 PMCID: PMC6966991 DOI: 10.1186/s40981-019-0252-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 04/29/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Temperature monitoring in the perioperative periods is important in order to avoid both hyperthermia and hypothermia. In our pilot study, we evaluated the usefulness of Bair Hugger™ temperature monitoring system (BHTMS), a forehead deep temperature monitoring system, in the neck and chest under general anesthesia. METHODS After approval from the Sapporo Medical University Research Ethics Board, 30 female patients scheduled for laparoscopic surgery were enrolled in this study. Patients were divided into three groups, depending on the attachment regions of BHTMS sensor. Temperatures obtained from the three regions and each esophageal temperature (TEso) were monitored and analyzed. RESULTS A Bland-Altman plot showed that the mean bias between temperature obtained from the neck and TEso was + 0.05 °C above TEso (2SD ± 0.35 °C), and that between temperature obtained from the chest and TEso was - 0.55 °C above TEso (2SD ± 0.55 °C). CONCLUSION By using the BHTMS sensor in the neck region, it is possible to monitor core body temperature seamlessly and with high reliability. These results may suggest that the use of BHTMS has high versatility in measuring perioperative core body temperature. TRIAL REGISTRATION This study was approved by the Sapporo Medical University Research Ethics Board (2015: No. 262-149) and registered with UMIN Clinical Trial Registry ( UMIN000016802 Registered 15 March 2015).
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Affiliation(s)
- Shunsuke Tachibana
- Department of Anesthesiology, Sapporo Medical University, School of Medicine, Sapporo, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Yutaro Chida
- Department of Anesthesiology, Sapporo Medical University, School of Medicine, Sapporo, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University, School of Medicine, Sapporo, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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Botros JM, Mahmoud AMS, Ragab SG, Ahmed MAA, Roushdy HMS, Yassin HM, Bolus ML, Goda AS. Comparative study between Dexmedetomidine and Ondansteron for prevention of post spinal shivering. A randomized controlled trial. BMC Anesthesiol 2018; 18:179. [PMID: 30501612 PMCID: PMC6267838 DOI: 10.1186/s12871-018-0640-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 11/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background Regional anesthesia could affect the homeostatic system functions resulting frequently in perioperative hypothermia and consequently shivering. The objective of this trial was to evaluate the efficacy of dexmedetomidine and ondansetron to reduce the incidence and severity of shivering after intrathecal blocks. Methods This randomized placebo-controlled trial included 120 patients allocated equally in three groups. All patients were anesthetized by standard intrathecal blocks for surgical procedure at lower half of the body and received one of the study drugs intravenously (IV) according to the group assignments. Group S patients (placebo) were administered saline, Group O (ondansetron) were given 8 mg ondansetron, and Group D (dexmedetomidine) were given 1 μg/kg of dexmedetomidine. Shivering incidence and scores, sedation scores, core body temperature, hemodynamic variables, and incidence of complications (nausea, vomiting, hypotension, bradycardia, over-sedation, and desaturation) were recorded. Results The incidence and 95% confidence interval (95% CI) of shivering in group S 57.5% (42.18–72.82%) was significantly higher than that of both group O 17.5% (5.73–29.27%), P < 0.001 and group D 27.5% (13.66–41.34%), P = 0.012. However, the difference in the incidence of shivering between group O and group D was comparable, P = 0.425. The sedation scores were significantly higher in group D than those of both group S and group O, P < 0.001. Sedation scores between group S and group O were comparable, P = 0.19. Incidences of adverse effects were comparable between the three groups. Conclusion Prophylactic administrations of dexmedetomidine or ondansetron efficiently decrease the incidence and severity of shivering after spinal anesthesia as compared to placebo without significant difference between their efficacies when compared to each other. Trial registration Pan African Clinical Trial Registry (PACTR) under trial number (PACTR201710002706318). 18-10-2017. ‘retrospectively registered’.
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Scholten R, Leijtens B, Kremers K, Snoeck M, Koëter S. The incidence of mild hypothermia after total knee or hip arthroplasty: A study of 2600 patients. J Orthop 2018; 15:408-411. [PMID: 29881165 DOI: 10.1016/j.jor.2018.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/25/2018] [Accepted: 03/16/2018] [Indexed: 01/28/2023] Open
Abstract
Hypothermia is associated with a higher risk of perioperative complications and occurs frequently after total joint arthroplasty (TJA). The incidence of hypothermia following total joint arthroplasty was assessed with its risk factors and its correlation with PJI. Correlation of hypothermia with age, gender, BMI, type of arthroplasty surgery, type of anesthesia, operation time, blood loss, date of surgery and PJI was evaluated in 2600 patients. Female gender and spinal anesthesia increased the risk for hypothermia whereas an increased BMI and surgery duration correlated decreased the risk of hypothermia. The incidence of hypothermia decreased over time without a correlation with PJI.
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Affiliation(s)
- Ruben Scholten
- Department of Orthopedics, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands
| | - Borg Leijtens
- Department of Orthopedics, RadboudUMC, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Keetie Kremers
- Department of Orthopedics, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands
| | - Marc Snoeck
- Department of Anesthesia, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands
| | - Sander Koëter
- Department of Orthopedics, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands
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Onitsuka S, Nakamura D, Onishi T, Arimitsu T, Takahashi H, Hasegawa H. Ice slurry ingestion reduces human brain temperature measured using non-invasive magnetic resonance spectroscopy. Sci Rep 2018; 8:2757. [PMID: 29426888 PMCID: PMC5807509 DOI: 10.1038/s41598-018-21086-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/29/2018] [Indexed: 11/09/2022] Open
Abstract
We previously reported that ice slurry ingestion reduced forehead skin temperature, thereby potentially reducing brain temperature (Tbrain). Therefore, in the current study, we investigated the effect of ice slurry ingestion on Tbrain using proton magnetic resonance spectroscopy, which is a robust, non-invasive method. Eight male participants ingested 7.5 g/kg of either a thermoneutral drink (37 °C; CON) or ice slurry (-1 °C; ICE) for about 5 min following a 15-min baseline period. Then, participants remained at rest for 30 min. As physiological indices, Tbrain, rectal temperature (Tre), mean skin temperature, nude body mass, and urine specific gravity were measured. Subjective thermal sensation (TS) and thermal comfort (TC) were measured before and after the experiment. Tbrain and Tre significantly reduced after ingestion of ICE compared with after ingestion of CON, and there was a significant correlation between Tbrain and Tre. The other physiological indices were not significantly different between beverage conditions. TS and TC were significantly lower with ICE than with CON (p < 0.05). These results indicate that ice slurry ingestion can cool the brain, as well as the body's core.
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Affiliation(s)
- Sumire Onitsuka
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Higashihiroshima, 739-8521, Japan.,Japan Society for the Promotion of Science, Tokyo, 102-0083, Japan
| | | | | | - Takuma Arimitsu
- College of Sport and Health Science, Ritsumeikan University, Kusatsu, 525-8577, Japan
| | | | - Hiroshi Hasegawa
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Higashihiroshima, 739-8521, Japan.
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Salazar F, Doñate M, Boget T, Bogdanovich A, Basora M, Torres F, Fàbregas N. Intraoperative warming and post-operative cognitive dysfunction after total knee replacement. Acta Anaesthesiol Scand 2011; 55:216-22. [PMID: 21226864 DOI: 10.1111/j.1399-6576.2010.02362.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Post-operative cognitive dysfunction (POCD) can affect 30% of orthopedic surgery patients. We hypothesized that perioperative temperature has an impact on POCD. METHODS We included 150 patients over 65 years of age scheduled for total knee replacement under spinal anesthesia. They were randomized to receive standard care (sheet cover) or active warming. Neurocognitive assessment (11 subtests) was performed pre-operatively and at day 4 (three subtests) and 3 months (10 subtests). A control group of 55 nonsurgical patients took the same tests at equivalent times. POCD was defined as an individual score decrease of more than 2 standard deviations (SDs) below the baseline on at least two subtests or 2 SDs in the combined z-score, in both cases using control-adjusted changes. RESULTS Tympanic temperature declined below 35 °C in 88% of standard-care patients; 25.3% of warmed patients had a temperature ≥36 °C. On day 4, 3.2% of standard-care patients and 19.4% of warmed patients had POCD (P=0.0058). At 3 months, there were no between-group differences (standard care, 14.3%; warmed, 6.5%) (P=0.2440). CONCLUSIONS Perioperative warming was associated with a higher incidence of cognitive dysfunction at 4 days after total knee replacement in patients >65 years of age.
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Affiliation(s)
- F Salazar
- Department of Anesthesia, Hospital Clinic, Universitat de Barcelona, Spain.
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Lim CL, Byrne C, Lee JKW. Human Thermoregulation and Measurement of Body Temperature in Exercise and Clinical Settings. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2008. [DOI: 10.47102/annals-acadmedsg.v37n4p347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This review discusses human thermoregulation during exercise and the measurement of body temperature in clinical and exercise settings. The thermoregulatory mechanisms play important roles in maintaining physiological homeostasis during rest and physical exercise. Physical exertion poses a challenge to thermoregulation by causing a substantial increase in metabolic heat production. However, within a non-thermolytic range, the thermoregulatory mechanisms are capable of adapting to sustain physiological functions under these conditions. The central nervous system may also rely on hyperthermia to protect the body from “overheating.” Hyperthermia may serve as a self-limiting signal that triggers central inhibition of exercise performance when a temperature threshold is achieved. Exposure to sub-lethal heat stress may also confer tolerance against higher doses of heat stress by inducing the production of heat shock proteins, which protect cells against the thermolytic effects of heat. Advances in body temperature measurement also contribute to research in thermoregulation. Current evidence supports the use of oral temperature measurement in the clinical setting, although it may not be as convenient as tympanic temperature measurement using the infrared temperature scanner. Rectal and oesophagus temperatures are widely accepted surrogate measurements of core temperature (Tc), but they cause discomfort and are less likely to be accepted by users. Gastrointestinal temperature measurement using the ingestible temperature sensor provides an acceptable level of accuracy as a surrogate measure of Tc without causing discomfort to the user. This form of Tc measurement also allows Tc to be measured continuously in the field and has gained wider acceptance in the last decade.
Key words: Core temperature, Gastrointestinal temperature, Ingestible temperature sensor, Thermoregulation
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Affiliation(s)
- Chin Leong Lim
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore
| | - Chris Byrne
- School of Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Jason KW Lee
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore
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Abelha FJ, Castro MA, Neves AM, Landeiro NM, Santos CC. Hypothermia in a surgical intensive care unit. BMC Anesthesiol 2005; 5:7. [PMID: 15938757 PMCID: PMC1180426 DOI: 10.1186/1471-2253-5-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2005] [Accepted: 06/06/2005] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Inadvertent hypothermia is not uncommon in the immediate postoperative period and it is associated with impairment and abnormalities in various organs and systems that can lead to adverse outcomes. The aim of this study was to estimate the prevalence, the predictive factors and outcome of core hypothermia on admission to a surgical ICU. METHODS All consecutive 185 adult patients who underwent scheduled or emergency noncardiac surgery admitted to a surgical ICU between April and July 2004 were admitted to the study. Tympanic membrane core temperature (Tc) was measured before surgery, on arrival at ICU and every two hours until 6 hours after admission. The following variables were also recorded: age, sex, body weight and height, ASA physical status, type of surgery, magnitude of surgical procedure, anesthesia technique, amount of intravenous fluids administered during anesthesia, use of temperature monitoring and warming techniques, duration of the anesthesia, ICU length of stay, hospital length of stay and SAPS II score. Patients were classified as either hypothermic (Tc < or = 35 degrees C) or normothermic (Tc> 35 degrees C). Univariate analysis and multiple regression binary logistic with an odds ratio (OR) and its 95% Confidence Interval (95%CI) were used to compare the two groups of patients and assess the relationship between each clinical predictor and hypothermia. Outcome measured as ICU length of stay and mortality was also assessed. RESULTS Prevalence of hypothermia on ICU admission was 57.8%. In univariate analysis temperature monitoring, use of warming techniques and higher previous body temperature were significant protective factors against core hypothermia. In this analysis independent predictors of hypothermia on admission to ICU were: magnitude of surgery, use of general anesthesia or combined epidural and general anesthesia, total intravenous crystalloids administrated and total packed erythrocytes administrated, anesthesia longer than 3 hours and SAPS II scores. In multiple logistic regression analysis significant predictors of hypothermia on admission to the ICU were magnitude of surgery (OR 3.9, 95% CI, 1.4-10.6, p = 0.008 for major surgery; OR 3.6, 95% CI, 1.5-9.0, p = 0.005 for medium surgery), intravenous administration of crystalloids (in litres) (OR 1.4, 95% CI, 1.1-1.7, p = 0.012) and SAPS score (OR 1.0, 95% CI 1.0-1.7, p = 0.014); higher previous temperature in ward was a significant protective factor (OR 0.3, 95% CI 0.1-0.7, p = 0.003). Hypothermia was neither a risk factor for hospital mortality nor a predictive factor for staying longer in ICU. CONCLUSION The prevalence of patient hypothermia on ICU arrival was high. Hypothermia at time of admission to the ICU was not an independent factor for mortality or for staying longer in ICU.
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Affiliation(s)
- Fernando J Abelha
- Department of Anesthesia and Intensive Care, Hospital de São João, Porto, Portugal
| | - Maria A Castro
- Department of Anesthesia and Intensive Care, Hospital de São João, Porto, Portugal
| | - Aida M Neves
- Department of Anesthesia and Intensive Care, Hospital de São João, Porto, Portugal
| | - Nuno M Landeiro
- Department of Anesthesia and Intensive Care, Hospital de São João, Porto, Portugal
| | - Cristina C Santos
- Biostatistics and Medical Informatics Department, Faculty of Medicine at the University of Porto, Portugal
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Selldén E, Rimeika D, Settergren G. Thermogenic effect of amino acids not demonstrated in heart surgery with cardiopulmonary bypass. Acta Anaesthesiol Scand 2005; 49:35-40. [PMID: 15675979 DOI: 10.1111/j.1399-6576.2005.00550.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In abdominal surgery and in healthy volunteers, amino acids increased thermogenesis. In this double-blind study we investigated if a similar effect would ensue in heart surgery and accelerate the rewarming process postoperatively. METHODS Thirty-four patients undergoing coronary artery bypass grafting or aortic valve replacement were randomized into two groups, and received either 500 ml of amino acids or Ringer's solution intravenously during 4 h. The infusion was started approximately 30 min before the end of a cardiopulmonary bypass (CPB), performed at a temperature of 34 degrees C with rewarming to 36-37 degrees C. The lowest pulmonary artery (PA) temperature after the CPB and the time interval until the temperature reached 37 degrees C were recorded. Oxygen uptake was calculated from cardiac output (thermodilution) and the pulmonary av-difference of oxygen after induction of anaesthesia, at the end of surgery, and 1 and 2 h after the CPB. RESULTS Demographic data, medication including beta-blockers, CPB data and case mix were similar. The lowest temperature after the CPB was 35.9 +/- 0.1 degrees C in the amino acid group and 35.6 +/- 0.2 degrees C in the control group, and the increase per hour was 0.6 +/- 0.1 degrees C and 0.6 +/- 0.0 degrees C, respectively, with no differences between the groups. During the infusion, oxygen uptake was higher in the amino acid group, 115 +/- 4 ml m(-2), than in the controls, 102 +/- 3 ml m(-2) (P < 0.05). No adverse effects of the infusions were noted. CONCLUSION The lack of a thermal effect of the amino acids in the heart surgery was most probably due to the temperature gradients between the different body compartments, and also may have been due to the use of beta-blockers.
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Affiliation(s)
- E Selldén
- Department of Surgical Sciences, Karolinska Institute, Division of Anaesthesia and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden.
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