Guidelines of the Polish Society of Anaesthesiology and Intensive Therapy regarding prevention of inadvertent intraoperative hypothermia

Horosz, Bartosz; Adamiec, Artur; Malec-Milewska, Małgorzata; Misiołek, Hanna

doi:10.5114/ait.2021.111871

Cited by 6 publications

(7 citation statements)

References 68 publications

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“…However, when the samples were collected an hour after the seizure (i.e., during the post-ictal state), significant TrkB signaling was observed, which was similar to the samples from animals subjected to continuous isoflurane anesthesia (Figure A). Our previous research has shown both states to be characterized by prominent sedation and suppression of cortical EEG activity. , According to previous research, both anesthesia and recovery from excitatory stimuli , are also characterized by hypothermia, suggesting that these states share some features at the face value. These findings prompted us to investigate the physiological correlates of recovery from a flurothyl seizure and ongoing anesthesia using a nontargeted metabolomics screen (Figure B,E, Supplementary File B).…”

Section: Resultsmentioning

confidence: 89%

Linking Hypothermia and Altered Metabolism with TrkB Activation

Alitalo,

González-Hernández,

Rosenholm

et al. 2023

ACS Chem. Neurosci.

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Many mechanisms have been proposed to explain acute antidepressant drug-induced activation of TrkB neurotrophin receptors, but several questions remain. In a series of pharmacological experiments, we observed that TrkB activation induced by antidepressants and several other drugs correlated with sedation, and most importantly, coinciding hypothermia. Untargeted metabolomics of pharmacologically dissimilar TrkB activating treatments revealed effects on shared bioenergetic targets involved in adenosine triphosphate (ATP) breakdown and synthesis, demonstrating a common perturbation in metabolic activity. Both activation of TrkB signaling and hypothermia were recapitulated by administration of inhibitors of glucose and lipid metabolism, supporting a close relationship between metabolic inhibition and neurotrophic signaling. Drug-induced TrkB phosphorylation was independent of electroencephalography slow-wave activity and remained unaltered in knock-in mice with the brain-derived neurotrophic factor (BDNF) Val66Met allele, which have impaired activity-dependent BDNF release, alluding to an activation mechanism independent from BDNF and neuronal activity. Instead, we demonstrated that the active maintenance of body temperature prevents activation of TrkB and other targets associated with antidepressants, including p70S6 kinase downstream of the mammalian target of rapamycin (mTOR) and glycogen synthase kinase 3β (GSK3β). Increased TrkB, GSK3β, and p70S6K phosphorylation was also observed during recovery sleep following sleep deprivation, when a physiological temperature drop is known to occur. Our results suggest that the changes in bioenergetics and thermoregulation are causally connected to TrkB activation and may act as physiological regulators of signaling processes involved in neuronal plasticity.

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Section: Resultsmentioning

confidence: 89%

Linking Hypothermia and Altered Metabolism with TrkB Activation

Alitalo,

González-Hernández,

Rosenholm

et al. 2023

ACS Chem. Neurosci.

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“…Using RT irrigation fluids affects not only the temperature of the area of thrombus formation, but also the core body temperature. Intraoperative hypothermia is a common complication during surgery that is associated with higher morbidity and mortality (34) and increased rates of blood transfusion and coagulation disturbances (35). Although the core body temperature of the mice was not measured, we attempted to prevent hypothermia by using a heating pad in both of our models.…”

Section: Discussionmentioning

confidence: 99%

Effect of Irrigation Fluid Composition on Hemostasis in Mouse Bleeding Models

Alsaadi

Hassoune

Haldeman

et al. 2022

Shock

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Introduction: Intraoperative irrigation, usually with normal saline (NS), aids in bleeding identification and management. We investigated the effect of different irrigation fluids, with additives, on hemostasis using two bleeding models. Methods: C57BL/6 J mice were subjected to a tail bleed model or uncontrolled abdominal hemorrhage via liver laceration followed by abdominal cavity irrigation. We compared NS, lactated Ringer's (LR), and PlasmaLyte. We examined NS and LR at different temperatures. Normal saline or LR with calcium (Ca2+) or tranexamic acid (TXA) was studied. Results: Compared with room temperature (RT), increasing the temperature of the irrigation fluid to 37°C and 42°C reduced tail vein bleeding times substantially in both NS and LR (all P < 0.001), with no significant differences between the two fluids. At RT, LR, but not PlasmaLyte, substantially reduced bleeding times in comparison to NS (P < 0.0001). Liver injury blood loss was lower with LR (P < 0.01). Normal saline supplemented with 2.7 mEq/L of Ca2+ decreased bleeding time and blood loss volume (P < 0.001 and P < 0.01, respectively) to similar levels as LR. Normal saline with 150 mg/mL of TXA markedly reduced bleeding time (P < 0.0001), and NS with 62.5 mg/mL TXA decreased blood loss (P < 0.01). Conclusion: Whereas Ca2+- and TXA-supplemented NS reduced bleeding, LR remained superior to all irrigation fluid compositions. As LR contains Ca2+, and Ca2+-supplemented NS mirrored LR in response, Ca2+ presence in the irrigation fluid seems key to improving solution's hemostatic ability. Because warming the fluids normalized the choice of agents, the data also suggest that Ca2+-containing fluids such as LR may be more suitable for hemostasis when used at RT.

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“…179 Intraoperative hypothermia is associated with adverse outcomes such as increased bleeding, more wound infection, and increased cardiac events. 180 Furthermore, intraoperative hypothermia prolongs the duration of anesthetic agents and delays postanesthesia recovery. 179,181 In a prospective cohort study, intraoperative hypothermia (<36°C) was an independent risk factor of the emergence of delirium.…”

Section: Avoiding Intraoperative Hypotension and Hypothermiamentioning

confidence: 99%

“…Hypothermia is common during general anesthesia and surgery 179 . Intraoperative hypothermia is associated with adverse outcomes such as increased bleeding, more wound infection, and increased cardiac events 180 . Furthermore, intraoperative hypothermia prolongs the duration of anesthetic agents and delays postanesthesia recovery 179,181 .…”

Section: Prevention For Perioperative Ncdsmentioning

confidence: 99%