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Yuan X, Liu Q, Zhou H, Ni L, Yin X, Zhang X, Du M, Du X. Development and Validation of a Predictive Model for Intraoperative Hypothermia in Elderly Patients Undergoing Craniocerebral Tumor Resection: A Retrospective Cohort Study. World Neurosurg 2024; 184:e593-e602. [PMID: 38325704 DOI: 10.1016/j.wneu.2024.01.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/31/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Timely identification of elderly patients who are at risk of developing intraoperative hypothermia (IH) is imperative to enable appropriate interventions. This study aimed to develop a nomogram for predicting the risk of IH in elderly patients undergoing resection of craniocerebral tumor, and to validate its effectiveness. METHODS Elderly patients who underwent craniocerebral tumor resection at a large tertiary hospital in eastern China between January 2019 and December 2022 were included (n = 988). The study population was divided into a training set and a validation set by time period. Risk factors identified through the Least Absolute Shrinkage and Selection Operator method and logistic regression analysis were used to establish the nomogram. The model was validated internally by Bootstrap method and externally by validation set through receiver operating characteristic curve analysis, Hosmer-Lemeshow test, and decision curve analysis. RESULTS A total of 273 (27.6%) patients developed IH. Duration of anesthesia (P < 0.001), blood loss (P < 0.001), preoperative temperature (P < 0.001), tumor location (P < 0.001), age (P < 0.05), and mean arterial pressure (P < 0.05) were identified as independent risk factors for IH. A nomogram integrating these 6 factors was constructed. The area under the curve was 0.773 (95% confidence interval: 0.735-0.811) (70.5% specificity and 75.0% sensitivity), indicating good predictive performance. The decision curve analysis demonstrated the clinical benefit of using the nomogram. CONCLUSIONS Our model showed good performance in identifying elderly patients who are at high risk of developing IH during craniocerebral tumor resection. The nomogram can help inform timely preventive interventions.
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Affiliation(s)
- Xi Yuan
- Department of Anesthesiology and Surgery, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Qing Liu
- Department of Anesthesiology and Surgery, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Huixian Zhou
- Department of Anesthesiology and Surgery, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Liangyan Ni
- Department of Anesthesiology and Surgery, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Xuequn Yin
- Department of Anesthesiology and Surgery, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Xinmei Zhang
- Department of Anesthesiology and Surgery, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Meilan Du
- Department of Anesthesiology and Surgery, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Xiaohong Du
- Department of Anesthesiology and Surgery, the First Affiliated Hospital of Soochow University, Soochow, China.
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Yin L, Wang H, Yin X, Hu X. Impact of intraoperative hypothermia on the recovery period of anesthesia in elderly patients undergoing abdominal surgery. BMC Anesthesiol 2024; 24:124. [PMID: 38561683 PMCID: PMC10983640 DOI: 10.1186/s12871-024-02509-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND This study aimed to investigate the impact of intraoperative hypothermia on the recovery period of anesthesia in elderly patients undergoing abdominal surgery. METHODS A prospective observational study was conducted based on inclusion and exclusion criteria. A total of 384 elderly patients undergoing abdominal surgery under general anesthesia were enrolled in a grade A tertiary hospital in Chengdu, Sichuan Province from October 2021 and October 2022. After anesthesia induction, inflatable warming blankets were routinely used for active heat preservation, and nasopharyngeal temperature was monitored to observe the occurrence of intraoperative hypothermia. Patients were divided into hypothermia group and nonhypothermia group according to whether hypothermia occurred during the operation. Anesthesia recovery time and the incidence of adverse events or unwanted events during anesthesia recovery between the two groups were compared. RESULTS The numbers (percentage) of 384 patients who underwent abdominal surgery developed intraoperative hypothermia occurred in 240 (62.5%) patients, all of whom had mild hypothermia. There were statistically significant differences between mild hypothermia after active warming and nonhypothermia in the occurrence of shivering (χ2 = 5.197, P = 0.023) and anesthesia recovery time (Z = -2.269, P = 0.02) in elderly patients undergoing abdominal surgery during anesthesia recovery, and there were no statistically significant differences in hypoxemia, nausea or vomiting, hypertension, hypokalemia, hypocalcemia, analgesic drug use,postoperative wound infection or postoperative hospitalization days. CONCLUSIONS The incidence of intraoperative mild hypothermia after active warming was high in elderly patients who underwent abdominal surgery. Mild hypothermia increased the incidence of shivering and prolonged anesthesia recovery time in elderly patients undergoing abdominal surgery.
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Affiliation(s)
- Lu Yin
- Department of Anesthesiology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Heng Wang
- Department of Anesthesiology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Xiaorong Yin
- Department of Anesthesiology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Xiuying Hu
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China.
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Yang H, Gu S, Fan J, Li W. Factors Influencing the Occurrence of Intraoperative Hypothermia in Patients Undergoing General Anesthesia Intervention: A Study in a Tertiary Care Hospital. Med Sci Monit 2024; 30:e943463. [PMID: 38509664 DOI: 10.12659/msm.943463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Intraoperative and postoperative hypothermia of patients can be caused by the use of anesthetic drugs and the complicated and time-consuming procedures of interventional surgery. This retrospective study included 184 patients to investigate the incidence and factors associated with hypothermia during intraoperative anesthesia in a single center in China between January and October 2023. MATERIAL AND METHODS A convenient sampling method was used to select 184 patients who underwent general anesthesia intervention in a tertiary hospital in Sichuan Province from January to October 2023 as the study population. The independent factors influencing the occurrence of intraoperative hypothermia were analyzed. A survey was conducted to collect 5 demographic factors, 4 preoperative-related factors, and 10 surgically related factors. According to the occurrence of intraoperative hypothermia, the independent influencing factors of unplanned hypothermia during perioperative period were further analyzed. RESULTS Among 184 patients, 64 (34.78%) experienced perioperative unplanned hypothermia, of which 5 (7.81%) cases occurred before the start of surgery, 7 (10.94%) occurred before the start of surgery after anesthesia, and 52 (81.25%) occurred during surgery. Logistic regression analysis showed that body temperature at the beginning of surgery (P<0.001), set operating room temperature (P<0.001), duration of anesthesia (P=0.006), and age (P=0.001) were independent influencing factors for unplanned hypothermia during perioperative period. CONCLUSIONS The incidence of intraoperative hypothermia is high in patients undergoing general anesthesia interventions. Age, duration of anesthesia, set operating room temperature, and body temperature at the beginning of the operation were independent influencing factors for the occurrence of unplanned hypothermia during the perioperative period.
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Affiliation(s)
- Huiqiong Yang
- Interventional Radiology Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Sang Gu
- Interventional Radiology Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Juan Fan
- Interventional Radiology Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Wei Li
- Interventional Radiology Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
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Ma Z, Ma P, Huang N, Li C, Cao Y, Chen J. Incidence of Unintentional Intraoperative Hypothermia and Its Risk Factors in Oral and Maxillofacial Surgery: A Prospective Study. J Perianesth Nurs 2023; 38:876-880. [PMID: 37565936 DOI: 10.1016/j.jopan.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/04/2022] [Accepted: 01/21/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Unintentional intraoperative hypothermia is a common complication in patients who undergo open surgery, increasing the risk of adverse outcomes. However, few studies have focused on intraoperative hypothermia during oral and maxillofacial surgery. Our study aimed to analyze the prevalence and risk factors of hypothermia in patients who underwent oral and maxillofacial surgery. DESIGN A prospective cohort study was conducted on 128 patients who underwent oral and maxillofacial surgery. METHODS This prospective study was conducted at West China Hospital of Stomatology between December 2020 and May 2021, and each patient was followed for at least 1-month postoperatively. Patients who underwent oral and maxillofacial surgery under general anesthesia, with at least 1-month follow-up were analyzed. The primary variable was intraoperative hypothermia, defined as core body temperature less than 36°C, measured using a tympanic thermometer during the surgery. We performed univariate and multivariate logistic regression analyses to identify the risk factors of unintentional intraoperative hypothermia. FINDINGS The mean age of the 128 patients was 31.0 ± 20.9 years, and there was a male predominance (53.1%), with male to female ratio of 1.13:1. Thirty-one patients (24.2%) developed hypothermia intraoperatively. Older age (OR = 1.068, 95% CI: 1.028-1.110, P = .001), lower weight (OR = 0.878, 95% CI: 0.807-0.955, P = .002), greater blood loss (OR = 1.003, 95% CI: 1.000-1.006, P = .034), and undergoing cancer surgery (OR = 0.210, 95% CI: 0.067-0.656, P = .007) were associated with intraoperative hypothermia. CONCLUSIONS Unintentional intraoperative hypothermia is common in patients who undergo surgery for oral cancer. Warming interventions to prevent intraoperative hypothermia for high-risk patients (older, lower weight, or more intraoperative bleeding) should be considered. Meanwhile, with careful nursing and rehabilitation instructions, intraoperative hypothermia does not lead to serious perioperative complications.
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Affiliation(s)
- Zhongkai Ma
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, PR China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Pingchuan Ma
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, PR China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Nengwen Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, PR China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Chunjie Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, PR China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Yubin Cao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, PR China; Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Jing Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, PR China; Department of Operating Room, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China.
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Zhao B, Zhu Z, Qi W, Liu Q, Zhang Q, Jiang L, Wang C, Weng X. Construction and validation of a risk prediction model for intraoperative hypothermia in elderly patients undergoing total hip arthroplasty. Aging Clin Exp Res 2023; 35:2127-2136. [PMID: 37490260 PMCID: PMC10520156 DOI: 10.1007/s40520-023-02500-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
AIMS To construct and validate an intraoperative hypothermia risk prediction model for elderly patients undergoing total hip arthroplasty (THA). METHODS We collected data from 718 patients undergoing THA in a tertiary hospital from January 2021 to December 2022. Of these patients, 512 were assigned to the modeling group from January 2021 to April 2022, and 206 participants were assigned to the validation group from May 2022 to December 2022. A logistic regression analysis was performed to construct the model. The area under the curve (AUC) was used to test the model's predictive ability. RESULTS The incidence rate of intraoperative hypothermia was 51.67%. The risk factors entered into the risk prediction model were age, preoperative hemoglobin level, intraoperative blood loss, postoperative hemoglobin level, and postoperative systolic blood pressure. The model was constructed as follows: logit (P) = - 10.118 + 0.174 × age + 1.366 × 1 (preoperative hemoglobin level) + 0.555 × 1 (postoperative hemoglobin level) + 0.009 × 1 (intraoperative blood loss) + 0.066 × 1 (postoperative systolic blood pressure). Using the Hosmer-Lemeshow test, the P value was 0.676 (AUC, 0.867). The Youden index, sensitivity, and specificity were 0.602, 0.790, and 0.812, respectively. The incidence rates of intraoperative hypothermia in the modeling and validation groups were 53.15% and 48.06%, respectively. The correct practical application rate was 89.81%. This model had good application potential. CONCLUSIONS This risk prediction model has good predictive value and can accurately predict the occurrence of intraoperative hypothermia in patients who undergo THA, which provides reliable guidance for clinical work and has good clinical application value.
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Affiliation(s)
- Bin Zhao
- Department of Anesthesiology and SICU, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China
| | - Zhe Zhu
- Department of Anesthesiology and SICU, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China
| | - Wenwen Qi
- Department of Psychogeriatric, School of Medicine, Shanghai Mental Health Center, Shanghai Jiao Tong University, South Wanping Road 600, Shanghai, 200030, China
| | - Qiuli Liu
- Department of Anesthesiology and SICU, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China
| | - Qi Zhang
- Department of Emergency, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China
| | - Liping Jiang
- Department of Nursing, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China.
| | - Chenglong Wang
- Department of Orthopaedic Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China.
| | - Xiaojian Weng
- Department of Anesthesiology and SICU, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China.
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Güven B, İbrahimoğlu Ö, Kuş İ. Inadvertent Perioperative Hypothermia in Ambulatory Surgery Patients: Incidence, Risk Factors, and Prevention Initiatives. J Perianesth Nurs 2023; 38:792-798. [PMID: 37269277 DOI: 10.1016/j.jopan.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Although the number and complexity of ambulatory surgical interventions has grown considerably over the years, it has not been fully established whether hypothermia still poses a risk for these interventions. In this study, we aimed to determine the incidence, risk factors, and methods applied to prevent perioperative hypothermia in ambulatory surgery patients. DESIGN A descriptive research design was used. METHODS The study was conducted with 175 patients between May 2021 and March 2022 in the outpatient units of a training and research hospital in Mersin, Turkey. Data were collected using the Patient Information and Follow-up Form. FINDINGS The incidence of perioperative hypothermia was 20% in ambulatory surgery patients. Hypothermia developed in 13.7% of the patients at the 0th minute at the PACU, and 96.6% of the patients were not warmed intraoperatively. We noted a statistically significant relationship between perioperative hypothermia and advanced age (≥60 years), high American Society of Anesthesiologists' (ASA) class, and low hematocrit values. In addition, we determined that the female gender, presence of chronic diseases, general anesthesia, and a long operation time were other risk factors for hypothermia in the perioperative period. CONCLUSIONS The incidence of hypothermia during ambulatory surgeries is lower than that in inpatient surgeries. The warming rate of ambulatory surgery patients, which is quite low, can be improved by increasing the awareness of the perioperative team and following the guidelines.
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Affiliation(s)
- Betül Güven
- Faculty of Health Sciences-Nursing, Bezmialem Vakıf University, Istanbul, Turkey.
| | - Özlem İbrahimoğlu
- Faculty of Health Science-Nursing, Istanbul Medeniyet University, İstanbul, Turkey
| | - İlknur Kuş
- Mersin City Training and Research Hospital, Mersin, Turkey
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Tian YN, Gao WY, Tian XR, Wang ZW. Comparative Efficacy of Six Active Warming Systems for Intraoperative Warming in Adult Patients Undergoing Laparoscopic Surgery: A Systematic Review and Network Meta-Analysis. Ther Hypothermia Temp Manag 2023; 13:92-101. [PMID: 36449377 DOI: 10.1089/ther.2022.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Intraoperative hypothermia is very common and harmful in adult patients undergoing laparoscopic surgery. A variety of active warming systems has received close attention and has been researched by related scholars. However, the relative efficacy of these systems and which active warming system is preferred for such patients remain unclear. The aim of this study was to compare and rank six active warming systems regarding intraoperative warming efficacy in adult patients undergoing laparoscopic surgery. Following the PRISMA 2020 guidelines, relevant randomized controlled trials (RCTs) on the efficacy of different active warming systems in warming adult patients undergoing laparoscopic surgery were searched from five English databases and three Chinese databases. The quality of the studies was assessed using the Cochrane Risk of Bias tool (RoB2). The outcome was the final intraoperative core temperature. We estimated direct effects by using pairwise meta-analysis, estimated relative effects and ranking with the consistency model to conduct an NetworkMeta-Analysis (NMA). We used GRADE (Grading of Recommendations Assessment, Development, and Evaluation) to assess the certainty of the evidence. Sensitivity analysis was performed to test the robustness of the results. This study is registered with PROSPERO, with number CRD42022309057. In total, 19 RCTs involving 6 active warming systems and comprising 1364 patients were included in this NMA. The NMA once again confirmed the validity of forced-air warming (FAW) systems compared with other active warming systems, and further showed that underbody FAW was associated with more remarkable warming efficacy in different types of FAW systems. NMA was used to perform an exhaustive comparison of the warming efficacy of six active warming systems and indicated that underbody FAW was most likely to be the most effective warming system in adult patients undergoing laparoscopic surgery; however, considering the sparsity of the network, our results should be cautiously interpreted. Furthermore, a large number of high-quality RCTs comparing the warming efficacy of different competitive active warming systems are needed.
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Affiliation(s)
- Yan-Ni Tian
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Wei-Yin Gao
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiao-Rong Tian
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhi-Wen Wang
- School of Nursing, Peking University, Beijing, China
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Wang YC, Huang HH, Lin PC, Wang MJ, Huang CH. Hypothermia is an independent risk factor for prolonged ICU stay in coronary artery bypass surgery: an observational study. Sci Rep 2023; 13:4626. [PMID: 36944855 PMCID: PMC10030842 DOI: 10.1038/s41598-023-31889-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/20/2023] [Indexed: 03/23/2023] Open
Abstract
Maintenance of normothermia is a critical perioperative issue. The warming process after hypothermia tends to increase oxygen demand, which may lead to myocardial ischemia. This study explored whether hypothermia was an independent risk factor for increased morbidity and mortality in patients receiving CABG. We conducted a retrospective observational study of CABG surgeries performed from January 2018 to June 2019. The outcomes of interest were mortality, surgical site infection rate, ventilator dependent time, intensive care unit (ICU) stay, and hospitalization duration. Data from 206 patients were analysed. Hypothermic patients were taller (p = 0.012), had lower left ventricular ejection fraction (p = 0.016), and had off-pump CABG more frequently (p = 0.04). Our analysis noted no incidence of mortality within 30 days. Hypothermia was not associated with higher surgical site infection rate or longer intubation time. After adjusting for sex, age, cardiopulmonary bypass duration, left ventricular ejection fraction, and EuroSCORE II, higher EuroSCORE II (p < 0.001; odds ratio 1.2) and hypothermia upon ICU admission (p = 0.04; odds ratio 3.8) were independent risk factors for prolonged ICU stay. In addition to EuroSCORE II, hypothermia upon ICU admission was an independent risk factor for prolonged ICU stay in patients receiving elective CABG.
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Affiliation(s)
- Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University College of Medicine and National University Hospital, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, 10002
| | - Hsing-Hao Huang
- Department of Anesthesiology, National Taiwan University College of Medicine and National University Hospital, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, 10002
| | - Pei-Ching Lin
- Department of Anesthesiology, National Taiwan University College of Medicine and National University Hospital, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, 10002
| | - Ming-Jiuh Wang
- Department of Anesthesiology, National Taiwan University College of Medicine and National University Hospital, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, 10002
- National Taiwan University Cancer Center, No. 57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City, 106, Taiwan
| | - Chi-Hsiang Huang
- Department of Anesthesiology, National Taiwan University College of Medicine and National University Hospital, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, 10002.
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Risk factors and prediction model for inadvertent intraoperative hypothermia in patients undergoing robotic surgery: a retrospective analysis. Sci Rep 2023; 13:3687. [PMID: 36878972 PMCID: PMC9988985 DOI: 10.1038/s41598-023-30819-1] [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: 09/20/2022] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
This study explored the risk factors and established a prediction model for intraoperative hypothermia (IOH) in patients undergoing robotic surgery. We conducted a retrospective survey of patients undergoing elective robotic surgery at the China-Japan Union Hospital of Jilin University during June 2020-October 2021 using institutional medical records. Intraoperative core temperatures and potential influencing factors were collected, and regression analyses were used to assess the risk factors for IOH and establish a prediction model for the incidence of IOH. Overall, 833 patients who underwent robotic surgery were included in the final analysis; IOH was observed in 344 patients (incidence, 0.41; 95% confidence interval [CI] 0.38-0.45). A higher body mass index (BMI) and baseline core temperature were protective factors for IOH. A final prediction model for IOH was developed based on the determining factors with an area under the receiver operating characteristic curve of 0.85 under fivefold cross validation (95% CI 0.83-0.88). Accordingly, a lower BMI and baseline core temperature, thoracic surgeries, morning surgeries, and surgeries with longer durations were risk factors for IOH during robotic surgeries. Our prediction model has an excellent discrimination ability for predicting IOH in robotic surgeries.
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Kol E, Ince S, Erdoğan A, Karsli B, Keskin H, Özgür N. The Effectiveness of Active External Warming of Patient Concurrently With Ice Application on the Incision Site on Post-Thoracotomy Pain and Analgesic Consumption. Clin Nurs Res 2023; 32:323-336. [PMID: 35726475 DOI: 10.1177/10547738221101729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The aim of study is to investigate the effects of active external warming of patient concurrently with application of ice to incision site on thoracotomy pain and analgesic consumption. The research is a quasi-experimental design with control and study groups. The study was conducted in 2018 and 2019. A total of 70 patients were included in the study: 35 in the control group and 35 in the study group. The mean verbal pain scale values were significantly lower in the intervention group (2.85 point) than in the control group (4.57 point; p < .001). Opioid consumption rate was high in control group patients (77.1% tramadol 30 mg; 45.7% morphine sulfate 5 mg) In contrast, the rate of opioid consumption was lower in patients in the intervention group (40% tramadol 30 mg; 17% morphine sulfate 5 mg). Active external warming and ice application on the incision area, could reduce the intensity of thoracotomy pain.
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Affiliation(s)
- Emine Kol
- Department of Fundamentals Nursing, Akdeniz University Faculty of Nursing, Antalya, Turkey
| | - Serpil Ince
- Department of Fundamentals Nursing, Akdeniz University Faculty of Nursing, Antalya, Turkey
| | - Abdullah Erdoğan
- Department of Thoracic Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Bilge Karsli
- Department of Anesthesiology and Reanimation, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Hakan Keskin
- Department of Thoracic Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Nazmiye Özgür
- Department of surgical medicine, Akdeniz University Faculty of Medicine, Antalya, Turkey
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Yan Y, Geng J, Cui X, Lei G, Wu L, Wang G. Thoracic Paravertebral Block Decreased Body Temperature in Thoracoscopic Lobectomy Patients: A Randomized Controlled Trial. Ther Clin Risk Manag 2023; 19:67-76. [PMID: 36713292 PMCID: PMC9880011 DOI: 10.2147/tcrm.s392961] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/12/2023] [Indexed: 01/21/2023] Open
Abstract
Purpose Thoracic paravertebral block (TPVB) may be highly beneficial for thoracoscopic lobectomy patients, but it may increase the risk of hypothermia. Apart from its anesthetic-reducing effects, this randomized controlled trial aimed to investigate the hypothermic effect of TPVB, and thus optimize its clinical use. Patients and methods Adult patients were randomly allocated to two groups: TPVB + general anesthesia (GA) group or GA group. In the TPVB+GA group, the block was performed after GA induction by an experienced but unrelated anesthesiologist. Both the lower esophageal and axillary temperature were recorded at the beginning of surgery (T0) and every 15 min thereafter (T1-T8), and the end of surgery (Tp). The primary outcome was the lower esophageal temperature at Tp. The secondary outcomes included lower esophageal temperature from T0-T8 and axillary temperature from T0-Tp. The total propofol, analgesics, and norepinephrine consumption and the incidence of adverse events were also recorded. Results Forty-eight patients were randomly allocated to the TPVB+GA (n=24) and GA (n=24) groups. The core temperature at the end of the surgery was lower in the TPVB+GA group than the GA group (35.90±0.30°C vs 36.35±0.33°C, P<0.001), with a significant difference from 45 min after the surgery began until the end of the surgery (P<0.05). In contrast, the peripheral temperature showed a significant difference at 60 min after the surgery began till the end (P<0.05). TPVB+GA exhibited excellent analgesic and sedative-sparing effects compared to GA alone (P<0.001), though it increased norepinephrine consumption due to hypotension (P<0.001). Conclusion Although thorough warming strategies were used, TPVB combined with GA remarkably reduced the body temperature, which is an easily neglected side effect. Further studies on the most effective precautions are needed to optimize the clinical use of TPVB.
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Affiliation(s)
- Yanhong Yan
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jiao Geng
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xu Cui
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Guiyu Lei
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Lili Wu
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Guyan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China,Correspondence: Guyan Wang, Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomingxiang, Beijing, 100730, People’s Republic of China, Tel +86-13910985139, Fax +86-10-58268017, Email
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Yan L, Tan J, Chen H, Xiao H, Zhang Y, Yao Q, Li Y. A Nomogram for Predicting Unplanned Intraoperative Hypothermia in Patients With Colorectal Cancer Undergoing Laparoscopic Colorectal Procedures. AORN J 2023; 117:e1-e12. [PMID: 36573748 DOI: 10.1002/aorn.13845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/09/2022] [Accepted: 07/18/2022] [Indexed: 12/29/2022]
Abstract
Unplanned intraoperative hypothermia is a complication that can lead to a variety of negative outcomes, such as cardiovascular events. We aimed to develop and validate an intraoperative hypothermia risk prediction nomogram for patients with colorectal cancer undergoing laparoscopic colorectal procedures. We conducted a prospective cohort study with 1,091 patients (ie, 765 in the training cohort, 326 in the validation cohort) from October 2020 to November 2021. We included six predictors in the nomogram model: body mass index, diabetes diagnosis, ambient temperature, ambient humidity, duration of surgery, and use of a forced-air warmer. The model performed well, and the area under the curve was 0.855. These results, together with an external validation value, mean that health care professionals can use the nomogram to calculate the intraoperative hypothermia risk for patients undergoing laparoscopic colorectal procedures and make clinical decisions based on the results.
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13
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Li L, Lu Y, Yang LL, Xu W, Yu JK. Construction and validation of postoperative hypothermia prediction model for patients undergoing joint replacement surgery. J Clin Nurs 2022. [PMID: 35995762 DOI: 10.1111/jocn.16503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/19/2022] [Accepted: 08/06/2022] [Indexed: 11/29/2022]
Abstract
AIM To construct and validate a postoperative hypothermia prediction model for patients undergoing joint replacement surgery. BACKGROUND Postoperative hypothermia is one of the harmful perioperative complications in patients undergoing joint replacement surgery. The previous studies mainly focused on intraoperative hypothermia prediction models. The prediction model for postoperative hypothermia in patients with joint replacement surgery was understudied. DESIGN Cohort study. METHODS We collected data from 503 participants undergoing joint replacement surgery in a tertiary hospital from January 2019 to December 2021. Of those, 404 cases were assigned to the modelling and 99 to the validation groups. Logistic regression was used to construct the model. The AUC was used to test the predictive effect of the model. Finally, 99 cases were used to verify the application effect of the model. A TRIPOD checklist was used to guide the reporting of this study. RESULTS The factors entered into the prediction model were age, intraoperative hypothermia, BMI, heat preservation measures and platelet (PLT). The model was constructed as follows: Logit (P) = .537 + 3.669 × 1 (intraoperative hypothermia) + .030 × age - .289 × BMI + 2.857 × 1 (intraoperative insulation measures) + .003 × PLT. Hosmer-Lemeshow test, p = .608, the area under the receiver operating characteristic curve (AUC) was .861. The Youden index was .530, the sensitivity was .599 and the specificity was .93. The incidence of postoperative hypothermia in the modelling group was 42.93% (173/404), and that in the verification group was 43.43% (43/99), χ2 = .012, p = .912. The correct practical application rate was 87.88%. This model has a good application effect. CONCLUSION The current prediction model provided a reference for clinical screening of patients with high-risk hypothermia after joint replacement surgery. RELEVANCE TO CLINICAL PRACTICE Clinical nurses can use the developed prediction model to predict the occurrence of postoperative hypothermia and provide a reference for the preventive measure.
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Affiliation(s)
- Leilei Li
- Operating Room, The Fourth Affiliated Hospital of School of Medicine, Zhejiang University, Yiwu, ZhejiangProvince, China
| | - Yubing Lu
- Operating Room, The Fourth Affiliated Hospital of School of Medicine, Zhejiang University, Yiwu, ZhejiangProvince, China
| | - Li Li Yang
- Nursing Department, the Fourth Affiliated Hospital of School of Medicine, Zhejiang University, Yiwu, Zhejiang, China
| | - Wei Xu
- Operating Room, The Fourth Affiliated Hospital of School of Medicine, Zhejiang University, Yiwu, ZhejiangProvince, China
| | - Jing Kai Yu
- Operating Room, The Fourth Affiliated Hospital of School of Medicine, Zhejiang University, Yiwu, ZhejiangProvince, China
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14
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Salazar Maya ÁM. Nursing Care during the Perioperative within the Surgical Context. INVESTIGACION Y EDUCACION EN ENFERMERIA 2022; 40:e02. [PMID: 36264690 PMCID: PMC9714984 DOI: 10.17533/udea.iee.v40n2e02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The study describes basic nursing care during the perioperative. Introduces the origins of perioperative nursing, general care that must be practiced with patient in this context. During the preoperative, care related with risk assessment and preparation of patient from the emotional and physical point of view are important. The trans-operative is related with the anesthesia used, surgical position, preparation of the skin, maintenance of normothermia, among many others. The postoperative depends on the type of anesthesia and surgical procedure, emphasizing on airway permeability, hemodynamic stability, pain, and symptomatology being presented by patients until they are stable and suitable for transfer to another service or their home.
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15
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Li H, Liu Z, Han C. Clinical value of prophylactic transcatheter arterial chemoembolization treatment in patients with hepatocellular carcinoma. Am J Transl Res 2022; 14:3225-3232. [PMID: 35702096 PMCID: PMC9185034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the feasibility of surgical resection combined with prophylactic transcatheter arterial chemoembolization (TACE) in reducing the recurrence and improving the survival rate of patients with hepatocellular carcinoma (HCC). METHODS In this retrospective study, 76 patients with HCC treated in our hospital from February 2016 to December 2018 were enrolled. Among them, 31 patients who received radical surgery alone were enrolled as the control group, and 45 patients who received prophylactic TACE within 6 months after radical surgery were enrolled as the study group. All cases were followed up for 36 months. The recurrence rate, survival rate, and median survival time of patients at 1, 2, and 3 years after surgery were compared between the two groups. Patients in the study group were divided into subgroup A (interventional therapy within 1 month), subgroup B (interventional therapy within 1-2 months), subgroup C (interventional therapy within 2-3 months), and subgroup D (interventional therapy within 3-6 months). The recurrence rate within 1 year was compared among the four subgroups. Finally, the clinical indicators affecting the recurrence of HCC were analyzed. RESULTS The recurrence rate at 1, 2 and 3 years after surgery in the study group was lower than that in the control group (all P<0.05). The survival rate at 1, 2 and 3 years after surgery in the study group was higher than that in the control group (all P<0.05). The median survival time of patients in the study group was slightly higher than that in the control group, with no significant difference (P>0.05). The 1-year recurrence rate of patients in subgroups A and B was significantly lower than that in subgroups C and D (P<0.05). The incomplete envelope, tumor diameter ≥5 cm, and combined cirrhosis were the main causes of recurrence of HCC (P<0.05). CONCLUSION Prophylactic TACE significantly reduced the postoperative recurrence rate and improved the survival rate of patients with HCC. The optimal treatment efficacy was associated with interventional therapy within 1-2 months after surgery, while incomplete envelope, tumor diameter ≥5 cm, and combined cirrhosis were the high-risk factors for HCC recurrence.
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Affiliation(s)
- Hui Li
- Hepatobiliary Surgery, Xingtai People’s HospitalXingtai 054000, Hebei, China
| | - Zhihu Liu
- Hepatobiliary Surgery, Xingtai People’s HospitalXingtai 054000, Hebei, China
| | - Cuiping Han
- CT Room, Xingtai People’s HospitalXingtai 054000, Hebei, China
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Garutti I, Cabañero A, Vicente R, Sánchez D, Granell M, Fraile CA, Real Navacerrada M, Novoa N, Sanchez-Pedrosa G, Congregado M, Gómez A, Miñana E, Piñeiro P, Cruz P, de la Gala F, Quero F, Huerta LJ, Rodríguez M, Jiménez E, Puente-Maestu L, Aragon S, Osorio-Salazar E, Sitges M, Lopez Maldonado MD, Rios FT, Morales JE, Callejas R, Gonzalez-Bardancas S, Botella S, Cortés M, Yepes MJ, Iranzo R, Sayas J. Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:208-241. [PMID: 35585017 DOI: 10.1016/j.redare.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/04/2021] [Indexed: 06/15/2023]
Abstract
In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyzes, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.
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Affiliation(s)
- I Garutti
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - A Cabañero
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - R Vicente
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - D Sánchez
- Servicio de Cirugía Torácica, Hospital Clínic, Barcelona, Spain
| | - M Granell
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, Spain
| | - C A Fraile
- Servicio de Cirugía Torácica, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Real Navacerrada
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - N Novoa
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca (CAUS), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - G Sanchez-Pedrosa
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Congregado
- Servicio de Cirugía Torácica, Hospital Virgen de la Macarena, Sevilla, Spain
| | - A Gómez
- Unitat de Rehabilitació Cardiorespiratòria, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Miñana
- Servicio de Anestesia y Reanimación, Hospital de la Ribera, Alzira, Valencia, Spain
| | - P Piñeiro
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P Cruz
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F de la Gala
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F Quero
- Servicio de Cirugía Torácica, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - L J Huerta
- Servicio de Cirugía Torácica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Rodríguez
- Servicio de Cirugía Torácica, Clínica Universidad de Navarra, Madrid, Spain
| | - E Jiménez
- Fisioterapia Respiratoria, Hospital Universitario A Coruña, La Coruña, Spain
| | - L Puente-Maestu
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - S Aragon
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, Spain
| | - E Osorio-Salazar
- Servicio de Anestesia y Reanimación, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Sitges
- Bloc Quirúrgic i Esterilització, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | | | - F T Rios
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - J E Morales
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, Spain
| | - R Callejas
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, Spain
| | - S Gonzalez-Bardancas
- Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario A Coruña, La Coruña, Spain
| | - S Botella
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - M Cortés
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M J Yepes
- Servicio de Anestesia y Reanimación, Clínica Universidad de Navarra, Navarra, Pamplona, Spain
| | - R Iranzo
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - J Sayas
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Yan L, Yao L, Zhao Q, Xiao M, Li Y, Min S. Risk Prediction Models for Inadvertent Intraoperative Hypothermia: A Systematic Review. J Perianesth Nurs 2021; 36:724-729. [PMID: 34663532 DOI: 10.1016/j.jopan.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/27/2021] [Accepted: 02/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSES Inadvertent intraoperative hypothermia (core temperature <36°C) is a common surgical complication with several adverse events. Hypothermia prediction models can be a tool for providing the healthcare staff with information on the risk of inadvertent hypothermia. Our systematic review aimed to identify, demonstrate, and evaluate the available intraoperative hypothermia risk prediction models in surgical populations. DESIGN This study is a systematic review of literature. METHODS We systematically searched multiple databases (Ovid MEDLINE, Web of Science, Embase, and Cochrane Center Register of Controlled Trials). Two reviewers independently examined abstracts and the full text for eligibility. Data collection was guided by the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS checklist), and methodological quality and applicability were assessed by the Prediction model Risk Of Bias ASsessment Tool (PROBAST). FINDINGS A total of 3,672 references were screened, of which eight articles were included in this study. All the models had a high risk of bias since most of them lacked model validation. Also, they failed to report the model performance and final model presentations, which restricted their clinical application. CONCLUSIONS The researchers should present models in a more standard way and improve the existing models to increase their predictive values for clinical application.
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Affiliation(s)
- Lupei Yan
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lili Yao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuerong Li
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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18
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Chen HY, Su LJ, Wu HZ, Zou H, Yang R, Zhu YX. Risk factors for inadvertent intraoperative hypothermia in patients undergoing laparoscopic surgery: A prospective cohort study. PLoS One 2021; 16:e0257816. [PMID: 34555101 PMCID: PMC8460038 DOI: 10.1371/journal.pone.0257816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background Inadvertent intraoperative hypothermia is frequent during open surgeries; however, few studies on hypothermia during laparoscopic abdominal surgery have been reported. We aimed to investigate the incidence and risk factors for hypothermia in patients undergoing laparoscopic abdominal surgery. Methods This single-center prospective cohort observational study involved patients undergoing laparoscopic surgery between October 2018 and June 2019. Data on core body temperature and potential variables were collected. A multivariate logistic regression analysis was performed to identify the risk factors associated with hypothermia. A Cox regression analysis was used to verify the sensitivity of the results. Results In total, 690 patients were included in the analysis, of whom 200 (29.0%, 95% CI: 26%−32%) had a core temperature < 36°C. The core temperature decreased over time, and the incident hypothermia increased gradually. In the multivariate logistic regression analysis, age (OR = 1.017, 95% CI: 1.000–1.034, P = 0.050), BMI (OR = 0.938, 95% CI: 0.880–1.000; P = 0.049), baseline body temperature (OR = 0.025, 95% CI: 0.010–0.060; P < 0.001), volume of irrigation fluids (OR = 1.001, 95% CI: 1.000–1.001, P = 0.001), volume of urine (OR = 1.001, 95% CI: 1.000–1.003, P = 0.070), and duration of surgery (OR = 1.010, 95% CI: 1.006–1.015, P < 0.001) were significantly associated with hypothermia. In the Cox analysis, variables in the final model were age, BMI, baseline body temperature, volume of irrigation fluids, blood loss, and duration of surgery. Conclusions Inadvertent intraoperative hypothermia is evident in patients undergoing laparoscopic surgeries. Age, BMI, baseline body temperature, volume of irrigation fluids, and duration of surgery are significantly associated with intraoperative hypothermia.
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Affiliation(s)
- Huai-Ying Chen
- Department of Nursing, Ningde Municipal Hospital of Ningde Normal University, Ningde, China
- * E-mail:
| | - Li-Jing Su
- Department of Nursing, Ningde Municipal Hospital of Ningde Normal University, Ningde, China
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Hang-Zhou Wu
- Department of Medical Insurance, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hong Zou
- Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, China
| | - Rong Yang
- Department of Medical Record Management, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yi-Xia Zhu
- Department of Anesthesiology, Ningde Municipal Hospital of Ningde Normal University, Ningde, China
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19
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Incidence of Severe Hypothermia and Its Impact on Postoperative Surgical Complications and Time Delay to Adjunct Treatments in Breast Surgery Cancer Patients: A Case-Controlled Study. J Clin Med 2021; 10:jcm10163702. [PMID: 34441999 PMCID: PMC8397141 DOI: 10.3390/jcm10163702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/24/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: Unintended postoperative hypothermia frequently occurs upon arrival in the post anesthesia care unit (PACU). As part of our quality assurance program in anesthesia, we regularly monitor the incidence of this complication through our anesthesia information management system (AIMS). In this case-controlled retrospective study, our goal was to detect the incidence of unintended severe hypothermia in our breast surgery cancer patients, and subsequently to analyze the consequence of this complication in terms postoperative cutaneous infection, as well as its impact on further complementary treatment, such as radiotherapy and chemotherapy. Methods: This study was a retrospective analysis conducted through our AIMS system from 2015 through 2019, with extraction criteria based on year, type of surgery (breast), and temperature upon arrival in PACU. A tympanic temperature of less than 36 °C was considered to indicate hypothermia. Severe hypothermia was considered for patients having a temperature lower than 35.2 °C (hypothermic) (n = 80), who were paired using a propensity score analysis with a control group (normothermic) (n = 80) of other breast cancer surgery patients. Extracted data included time of surgery, sex, age, ASA status, and type and duration of the intervention. Results: The mean incidence of hypothermia was 21% from 2015 through 2019. The body mass index (BMI) was significantly lower in the hypothermia group before matching, 23.5 ± 4.1 vs. 26.4 ± 6.1 kg/m2 in normothermic patients (p < 0.05). The hypothermia group also had significantly fewer monitoring and active warming devices. No difference was noted for wound complications. Time to complementary chemotherapy and or radiotherapy did not differ between groups (52 ± 21 days in group hypothermia vs 49 ± 22 days in the control group). Conclusion: Severe intraoperative hypothermia remains an important quality assurance issue in our breast surgery cancer patients, but we could not detect any long-term effect of hypothermia.
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20
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Garutti I, Cabañero A, Vicente R, Sánchez D, Granell M, Fraile CA, Real Navacerrada M, Novoa N, Sanchez-Pedrosa G, Congregado M, Gómez A, Miñana E, Piñeiro P, Cruz P, de la Gala F, Quero F, Huerta LJ, Rodríguez M, Jiménez E, Puente-Maestu L, Aragon S, Osorio-Salazar E, Sitges M, Lopez Maldonado MD, Rios FT, Morales JE, Callejas R, Gonzalez-Bardancas S, Botella S, Cortés M, Yepes MJ, Iranzo R, Sayas J. Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 69:S0034-9356(21)00102-X. [PMID: 34294445 DOI: 10.1016/j.redar.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/28/2021] [Accepted: 02/04/2021] [Indexed: 11/24/2022]
Abstract
In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyses, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.
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Affiliation(s)
- I Garutti
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España; Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
| | - A Cabañero
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - R Vicente
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, España
| | - D Sánchez
- Servicio de Cirugía Torácica, Hospital Clínic, Barcelona, España
| | - M Granell
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, España
| | - C A Fraile
- Servicio de Cirugía Torácica, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - M Real Navacerrada
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, España
| | - N Novoa
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca (CAUS), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - G Sanchez-Pedrosa
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Congregado
- Servicio de Cirugía Torácica, Hospital Virgen de la Macarena, Sevilla, España
| | - A Gómez
- Unitat de Rehabilitació Cardiorespiratòria, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E Miñana
- Servicio de Anestesia y Reanimación, Hospital de La Ribera, Alzira, Valencia, España
| | - P Piñeiro
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P Cruz
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F de la Gala
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F Quero
- Servicio de Cirugía Torácica, Hospital Universitario Virgen de las Nieves, Granada, España
| | - L J Huerta
- Servicio de Cirugía Torácica, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Rodríguez
- Servicio de Cirugía Torácica, Clínica Universidad de Navarra, Madrid, España
| | - E Jiménez
- Fisioterapia Respiratoria, Hospital Universitario de A Coruña, La Coruña, España
| | - L Puente-Maestu
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - S Aragon
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, España
| | - E Osorio-Salazar
- Servicio de Anestesia y Reanimación, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - M Sitges
- Bloc Quirúrgic i Esterilització, Hospital del Mar, Parc de Salut Mar, Barcelona, España
| | | | - F T Rios
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, España
| | - J E Morales
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, España
| | - R Callejas
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, España
| | - S Gonzalez-Bardancas
- Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario A Coruña, La Coruña, España
| | - S Botella
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, España
| | - M Cortés
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, España
| | - M J Yepes
- Servicio de Anestesia y Reanimación, Clínica Universidad de Navarra, Navarra, Pamplona, España
| | - R Iranzo
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - J Sayas
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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21
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Xie L, Qian Z, Xu J. Clinical intervention effect of TACE combined with 3DCRT in patients with primary liver cancer. Am J Transl Res 2021; 13:7960-7967. [PMID: 34377276 PMCID: PMC8340196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the clinical intervention effect of transcatheter arterial chemoembolization (TACE) combined with three-dimensional conformal radiotherapy (3DCRT) in patients with primary liver cancer (PLC). METHODS A total of 110 PLC patients admitted to our hospital were selected and divided into the study group (SG, n=60, treated with TACE combined with 3DCRT) and the control group (CG, n=50, treated with TACE alone) in accordance with the different clinical intervention measures. The clinical intervention effect and the changes of tumor factors and quality of life scores were compared between the two groups before and after intervention, and the three-year survival and the incidence of adverse reactions were evaluated. RESULTS The objective response rate (ORR) and disease control rate (DCR) in the SG (78.33% and 95.00%) were higher than those in the CG (38.00% and 80.00%), whereas the carcinoembryonic antigen (CEA) and alpha fetoprotein (AFP) levels in the SG were lower than those in the CG (P < 0.05). After intervention, the quality of life score in the SG was higher than that in the CG (P < 0.05). The SG was superior to the CG in follow-up survival (P < 0.05). CONCLUSION TACE combined with 3DCRT has a high safety and leads to remarkable clinical intervention effects, marked improvement of the serological indices, better quality of life, as well as satisfactory long-term survival.
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Affiliation(s)
- Lifeng Xie
- Affiliated Jiangnan Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou Xiaoshan District Hospital of Traditional Chinese Medicine, Hangzhou Xiaoshan District Hospital of Traditional Chinese Medicine General Hospital Hangzhou 311200, Zhejiang Province, China
| | - Zhuliang Qian
- Affiliated Jiangnan Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou Xiaoshan District Hospital of Traditional Chinese Medicine, Hangzhou Xiaoshan District Hospital of Traditional Chinese Medicine General Hospital Hangzhou 311200, Zhejiang Province, China
| | - Jianchang Xu
- Affiliated Jiangnan Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou Xiaoshan District Hospital of Traditional Chinese Medicine, Hangzhou Xiaoshan District Hospital of Traditional Chinese Medicine General Hospital Hangzhou 311200, Zhejiang Province, China
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22
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Cho CK, Chang M, Sung TY, Jee YS. Incidence of postoperative hypothermia and its risk factors in adults undergoing orthopedic surgery under brachial plexus block: A retrospective cohort study. Int J Med Sci 2021; 18:2197-2203. [PMID: 33859527 PMCID: PMC8040418 DOI: 10.7150/ijms.55023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/10/2021] [Indexed: 12/02/2022] Open
Abstract
Postoperative hypothermia increases patient mortality and morbidity. However, the incidence of, and risk factors for, postoperative hypothermia in patients undergoing surgery under brachial plexus block (BPB) as the primary method of anesthesia remain unclear. This study aimed to determine the incidence of, and risk factors for, postoperative hypothermia in patients undergoing surgery under BPB. We retrospectively analyzed 660 patients aged ≥ 19 years who underwent orthopedic surgery under BPB in our hospital between October 2014 and October 2019. Postoperative hypothermia was defined as a tympanic membrane temperature < 36 °C when the patient arrived in the post-anesthesia care unit. Multivariate logistic regression analysis was performed to identify the independent risk factors for postoperative hypothermia. Postoperative hypothermia was observed in 40.6% (268/660) of patients. Independent risk factors for postoperative hypothermia were lower baseline core temperature before anesthesia (odds ratio [OR] 0.355; 95% confidence interval [CI] 0.185-0.682), alcohol abuse (OR 2.658; 95% CI 1.105-6.398), arthroscopic shoulder surgery (OR 2.007; 95% CI 1.428-2.820), use of fentanyl (OR 1.486; 95% CI 1.059-2.087), combined use of midazolam and dexmedetomidine (OR 1.816; 95% CI 1.268-2.599), a larger volume of intravenous fluid (OR 1.001; 95% CI 1.000-1.002), and longer duration of surgery (OR 1.010; 95% CI 1.004-1.017). Postoperative hypothermia is common in adult patients undergoing orthopedic surgery under BPB. The risk factors identified in this study should be considered to avoid postoperative hypothermia in these patients.
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Affiliation(s)
- Choon-Kyu Cho
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Minhye Chang
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Tae-Yun Sung
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.,Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
| | - Young Seok Jee
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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23
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Jin L, Han X, Yu Y, Xu L, Wang H, Guo K. Intraoperative thermal insulation in off-pump coronary artery bypass grafting surgery: a prospective, double blind, randomized controlled, single-center study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1220. [PMID: 33178752 PMCID: PMC7607130 DOI: 10.21037/atm-19-4571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background About 50% patients who underwent off-pump coronary artery bypass grafting (OPCAB) experienced perioperative hypothermia. Pre-warming and intraoperative infusion of amino acid injection are the most popular perioperative insulation measures in recent years, but neither of them can completely prevent intraoperative hypothermia. The objective is to investigate the effect of preoperative warming and/or intraoperative infusion of amino acid injection on body temperature in patients undergoing OPCAB. Methods A prospective, double blind, randomized controlled, single-center study. Seventy-two patients were randomly divided into 4 groups: control group, pre-warming group, amino-acid group and multi-mode group. Pre-warming and multi-mode group were pre-heated with warming blankets and forced-air warming system before induction. After that, amino-acid and multi-mode group were infused with 18-amino acid solution. The perioperative temperature and complications were monitored. Results The temperature of control and amino-acid group decreased significantly, but amino-acid group recovered to preoperative level faster. The temperature of pre-warming group was stable, and that in multi-mode group increased at 60 min after the start of surgery. There was a significant difference in temperature at each time, and no difference in the incidence of complications between the groups. Conclusions Preoperative warming and/or intraoperative infusion of amino acid injection can effectively reduce hypothermia in OPCAB surgery. Pre-warming before anesthesia is more effective, and the combination of the two methods has the best effect.
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Affiliation(s)
- Lin Jin
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaodan Han
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ying Yu
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liying Xu
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huilin Wang
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kefang Guo
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
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24
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Li Y, Liang H, Feng Y. Prevalence and multivariable factors associated with inadvertent intraoperative hypothermia in video-assisted thoracoscopic surgery: a single-center retrospective study. BMC Anesthesiol 2020; 20:25. [PMID: 31992212 PMCID: PMC6986149 DOI: 10.1186/s12871-020-0953-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/23/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Inadvertent intraoperative hypothermia increases the risk of adverse events, but its related risk factors have not been defined in video-assisted thoracoscopic surgery (VATS). This study aimed at analyzing the prevalence and factors related to inadvertent intraoperative hypothermia in adults undergoing elective VATS under general anesthesia. METHODS This was a retrospective study using data from the Peking University People's Hospital from January through December, 2018. Data were collected on age, sex, height, weight, American Society of Anesthesiologists physical status, the duration of preparation and surgery, timing of surgery, surgery types, anesthesia types, intraoperative core temperature and the length of stay (LOS) in the hospital from the electronic database in our center. Patients were covered with a cotton blanket preoperatively and the surgical draping during the operation. A circulation-water warming mattress set to 38 °C were placed under the body of the patients. Inadvertent intraoperative hypothermia was identified as a core temperature monitored in nasopharynx < 36 °C. Multivariate logistic regression analysis was used to identify independent risk factors of hypothermia. RESULTS We found that 72.7% (95% CI 70.5 to 75.0%) of 1467 adult patients who underwent VATS suffered hypothermia during surgery. The factors associated with inadvertent intraoperative hypothermia included age (OR = 1.23, 95% CI 1.11 to 1.36, p < 0.001), BMI (OR = 1.83, 95% CI 1.43 to 2.35, p < 0.001), the duration of preparation (OR = 1.01, 95% CI 1.00 to 1.02, p = 0.014), the duration of surgery (OR = 2.10, 95% CI 1.63 to 2.70, p < 0.001), timing of surgery (OR = 1.64, 95% CI 1.28 to 2.12, p < 0.001), ambient temperature in the operating room (OR = 0.67, 95% CI 0.53 to 0.85, p = 0.001) and general anesthesia combined with paravertebral block after induction of anesthesia (OR = 2.30, 95% CI 1.31 to 4.03, p = 0.004). The average LOS in the hospital in the hypothermia group and the normothemic group was 9 days and 8 days, respectively (p < 0.001). CONCLUSIONS We highlight the high prevalence of inadvertent intraoperative hypothermia during elective VATS and identify key risk factors including age, duration of surgery more than 2 h, surgery in the morning and general anesthesia combined with paravertebral block (PVB) after intubation. We also find that hypothermia did prolong the LOS in the hospital.
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Affiliation(s)
- Yinan Li
- Department of Anesthesia, Peking University People's Hospital, Beijing, 100044, China
| | - Hansheng Liang
- Department of Anesthesia, Peking University People's Hospital, Beijing, 100044, China
| | - Yi Feng
- Department of Anesthesia, Peking University People's Hospital, Beijing, 100044, China.
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25
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Álvarez J, Argente P. Unintentional hypothermia in the surgical patient. Old solutions to an old problem, or new solutions to an old problem? REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2018; 65:543-545. [PMID: 30477885 DOI: 10.1016/j.redar.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 06/09/2023]
Affiliation(s)
- J Álvarez
- Catedrático y Jefe del Servicio de Anestesiología, Reanimación y Tratamiento del Dolor. Hospital Clínico Universitario. Decano. Facultad de Medicina y Odontología. Universidad de Santiago de Compostela.
| | - P Argente
- Jefa del Servicio de Anestesiología, Reanimación y Tratamiento del Dolor. Directora del Área Quirúrgica. Hospital Universitari i y Politécnic de La Fe. Profesora Asociada de Anestesiología, Reanimación. Facultad de Medicina y Odontología. Universidad de Valencia
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