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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 1 مورد

Consequences of mild perioperative hypothermia

Consequences of mild perioperative hypothermia
Consequence Author N Difference in Tcore (°C) Normothermic Hypothermic P
Surgical wound infection Kurz et al.[1] 200 1.9 6% 19% <0.01
Deep or organ-space infection Sessler et al.[2] 5056 1.5 7.2% 6.3% 0.25
Myocardial injury and death Sessler et al.[2] 5056 1.5 9.9% 9.6% 0.69
Transfusion requirement Sessler et al.[2] 5056 1.5 10.2% 9.5% 0.41
Hospital readmission Sessler et al.[2] 5056 1.5 6.5% 5.5% 0.13
Duration of hospitalization Kurz et al.[1] 200 1.9 12.1±4.4 days 14.7±6.5 days <0.01
Duration of hospitalization Sessler et al.[2] 5056 1.5 8 (CI: 6, 12) 8 (CI: 6, 12) 0.45
Ventricular ectopy Frank et al.[3] 300 1.3 2% 8% <0.05
Urinary excretion of nitrogen Carli et al.[4] 12 1.5 728+254 mmol per day 1240+558 mmol per day <0.05
Duration of vecuronium Heier et al.[5] 20 2.0 28±4 minutes 62±8 minutes <0.001
Duration of atracurium Leslie et al.[6] 6 3.0 44±4 minutes 68±7 minutes <0.05
Plasma propofol concentration Leslie et al.[6] 6 3.0 100% 128% <0.05
Duration of postanesthetic recovery Lenhardt et al.[7] 150 1.9 53±36 minutes 94±65 minutes <0.001
Change in plasma norepinephrine Frank et al.[8] 9 1.3 –0.6±1.0 mcg/mL 46±5 mcg/mL <0.05
Thermal discomfort Kurz et al.[9] 74 2.6 50±10 mm VAS 18±9 mm VAS <0.001
Only prospective, randomized human trials are included; subjective responses were evaluated by observers blinded to treatment group and core temperature. Different outcomes from some studies are shown on separate lines. VAS is a 100 mm long visual analog scale (0 mm = intense cold, 100 mm = intense heat). Studies of blood loss and transfusion requirement are excluded since they are summarized in a meta-analysis.[10] Dozens of studies, not shown, demonstrate that hypothermia provokes postoperative shivering.
N: total number of subjects; difference in Tcore: difference in core temperature between the normothermic and hypothermic groups; VAS: visual analog scale.
References:
  1. Kurz A, Sessler DI, Lenhardt RA, Study of wound infections and temperature group. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 1996; 334:1209.
  2. Sessler DI, Pei L, Li K, et al. Aggressive intraoperative warming versus routine thermal management during non-cardiac surgery (PROTECT): a multicentre, parallel group, superiority trial. Lancet 2022; 399:1799.
  3. Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: a randomized clinical trial. JAMA 1997; 277:1127.
  4. Carli F, Emery PW, Freemantle CA. Effect of peroperative normothermia on postoperative protein metabolism in elderly patients undergoing hip arthroplasty. Br J Anaesth 1989; 63:276.
  5. Heier T, Caldwell JE, Sessler DI, Miller RD. Mild intraoperative hypothermia increases duration of action and spontaneous recovery of vecuronium blockade during nitrous oxide-isofl urane anesthesia in humans. Anesthesiology 1991; 74:815.
  6. Leslie K, Sessler DI, Bjorksten AR, Moayeri A. Mild hypothermia alters propofol pharmacokinetics and increases the duration of action of atracurium. Anesth Analg 1995; 80:1007.
  7. Lenhardt R, Marker E, Goll V, et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology 1997; 87:1318.
  8. Frank SM, Higgins MS, Fleisher LA, et al. Adrenergic, respiratory, and cardiovascular effects of core cooling in humans. Am J Physiol 1997; 272: R557.
  9. Kurz A, Sessler DI, Narzt E, et al. Postoperative hemodynamic and thermoregulatory consequences of intraoperative core hypothermia. J Clin Anesth 1995; 7: 359.
  10. Rajagopalan S, Mascha E, Na J, Sessler DI. The effects of mild perioperative hypothermia on blood loss and transfusion requirement: a meta-analysis. Anesthesiology 2008; 108:71.

Original table modified for this publication. From: Sessler DI. Perioperative thermoregulation and heath balance. Lancet 2016; 387:2655. Table used with the permission of Elsevier Inc. All rights reserved.

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