Perioperative Maintenance of Normothermia Reduces the Incidence of Morbid Cardiac Events

Frank, Steven M.; Fleisher, Lee A.; Breslow, Michael J.; Higgins, Michael S.; Olson, Krista F.; Kelly, Susan E.; Beattie, Charles

doi:10.1001/jama.1997.03540380041029

Cited by 1,066 publications

(224 citation statements)

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“…Recent studies showed that perioperative hypothermia occurs in more than 70% of patients in the perioperative phase and can lead to several complications: increase in blood loss during surgery by impairing platelet function and clotting factor enzyme function, increase in the incidence of surgical wound infection induced by peripheral vasoconstriction with a significant reduction of subcutaneous oxygen tension and an impairment in immune function, increase in heart rate and oxygen demand in the presence of shivering [23-25]. Additionally Frank et al reported a higher prevalence of myocardial ischemia and ventricular tachycardia in patients with perioperative hypothermia [26]. Otherwise during HITHOC temperature in the pleural space rises up to about 42°C with the risk of systemic hyperthermia.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of cytoreductive surgery followed by hyperthermic intrathoracic chemotherapy perfusion

Kerscher

Ried

Hofmann

et al. 2014

J Cardiothorac Surg

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BackgroundMacroscopic cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion (HITHOC) is a new multimodal approach for selected patients with primary and secondary pleural tumors, which may provide the patient with better local tumor control and increased overall survival rate.MethodsWe present a single-center study including 20 patients undergoing cytoreductive surgery and HITHOC between September 2008 and April 2013 at the University Medical Center Regensburg, Germany. Objective of the study was to describe the perioperative, anaesthetic management with special respect to pain and complication management.ResultsAnaesthesia during this procedure is characterized by increased intrathoracic airway and central venous pressure, hemodynamic alterations and the risk of systemic hypo- and hyperthermia. Securing an adequate intravascular volume is one of the primary goals to prevent decreased cardiac output as well as pulmonary edema. Transfusion of packed red blood cells (PRBC) was necessary in seven of 20 (35%) patients. Only two patients (10%) showed an impairment of coagulation in postoperative laboratory analysis. Perioperative forced diuresis is recommended to prevent postoperative renal insufficiency. Supplementary thoracic epidural analgesia in 13 patients (65%) showed a significant reduction of post-operative pain compared with peroral administration of opioid and non-opioid analgesics.ConclusionThis article summarizes important experiences of the anaesthesiological and intensive care management in patients undergoing HITHOC.

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Section: Discussionmentioning

confidence: 99%

Anaesthetic management of cytoreductive surgery followed by hyperthermic intrathoracic chemotherapy perfusion

Kerscher

Ried

Hofmann

et al. 2014

J Cardiothorac Surg

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“…Similarly our findings are consistent with other studies where the creation of a humified CO 2 atmosphere in the surgical wound cavity increased the total wound temperature by 0.5 °C [6]. Whilst such changes may appear insignificant, mild hypothermia has been associated with surgical-wound infection [22, 23], adverse effects on the coagulation system [24], platelet dysfunction [25], increased increases blood loss and allogeneic transfusion requirements [26], and increase adverse cardiac events [27], all of which can be fatal in the context of OLT. Given the long duration and complexity of liver transplantation surgery as well as a high rate of post-operative complications in this patient group, small differences in temperature may be clinically important.…”

Section: Discussionmentioning

confidence: 99%

Prevention of hypothermia in patients undergoing orthotopic liver transplantation using the humigard® open surgery humidification system: a prospective randomized pilot and feasibility clinical trial

et al. 2017

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BackgroundPerioperative thermal disturbances during orthotopic liver transplantation (OLT) are common. We hypothesized that in patients undergoing OLT the use of a humidified high flow CO2 warming system maintains higher intraoperative temperatures when compared to standardized multimodal strategies to maintain thermoregulatory homeostasis.MethodsWe performed a randomized pilot study in adult patients undergoing primary OLT. Participants were randomized to receive either open wound humidification with a high flow CO2 warming system in addition to standard care (Humidification group) or to standard care alone (Control group). The primary end point was nasopharyngeal core temperature measured 5 min immediately prior to reperfusion of the donor liver (Stage 3 − 5 min). Secondary endpoints included intraoperative PaCO2, minute ventilation and the use of vasoconstrictors.ResultsEleven patients were randomized to each group. Both groups were similar for age, body mass index, MELD, SOFA and APACHE II scores, baseline temperature, and duration of surgery. Immediately prior to reperfusion (Stage 3 − 5 min) the mean (SD) core temperature was higher in the Humidification Group compared to the Control Group: 36.0 °C (0.13) vs. 35.4 °C (0.22), p = 0.028. Repeated measured ANOVA showed that core temperatures over time during the stages of the transplant were higher in the Humidification Group compared to the Control Group (p < 0.0001). There were no significant differences in the ETCO2, PaCO2, minute ventilation, or inotropic support.ConclusionThe humidified high flow CO2 warming system was superior to standardized multimodal strategies in maintaining normothermia in patients undergoing OLT. Use of the device was feasible and did not interfere with any aspects of surgery. A larger study is needed to investigate if the improved thermoregulation observed is associated with improved patient outcomes.Trial registration ACTRN12616001631493. Retrospectively registered 25 November 2016.

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“…Hypothermia often causes shivering after anesthesia, which may increase oxygen consumption 3 to 4 times, and increases the risk of ventricular tachycardia and morbid cardiac events [1]. There is a report that body cooling might cause decreased oxygen pressure in the brain tissue when shivering started [12].…”

Section: Problems and Benefits Of Hypothermiamentioning

confidence: 99%

Amino Acids during Perioperative Period

Yokoyama¹,

Yamaoka²,

Hitosugi³

et al. 2017

OJAnes

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During anesthesia, thermoregulation is impaired and hypothermia will frequently occur in most patients. Hypothermia affects immunologic activity, bleeding tendency and the recovery from anesthesia. Therefore, it may prolong hospital stay, and increase morbidity, e.g. surgical site infections, cardiac events and multiple organ dysfunctions in trauma. External warming is often used to prevent hypothermia. However, infusion of amino acids is also valuable to prevent hypothermia due to their enhanced thermogenic action under anesthesia. During surgery, amino acids administration would maintain the body homeostasis, and counteract the disadvantageous fasting metabolism. Postoperatively, amino acids may be advantageous for the healing of the surgical wound. Thus, appropriate nutritional management, including glucose, during the perioperative period would prevent catabolism, frequently occurring after surgery. Protocols like ERAS (Enhanced Recovery After Surgery) are proposed for quick recovery after surgery. ERAS protocol recommends preoperative carbohydrate and early enteral nutrition, but does not include infusion of amino acids during the perioperative period. During prolonged surgery, patients clearly need good nutritional support. In this article, we intend to describe the problems of hypothermia briefly, and explain the mechanism of amino acids in hypothermia prevention. In addition, we address some evidences of nutritional management during the perioperative period.

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Perioperative Maintenance of Normothermia Reduces the Incidence of Morbid Cardiac Events

Abstract: In patients with cardiac risk factors who are undergoing noncardiac surgery, the perioperative maintenance of normothermia is associated with a reduced incidence of morbid cardiac events and ventricular tachycardia.

Cited by 1,066 publications

References 49 publications

Anaesthetic management of cytoreductive surgery followed by hyperthermic intrathoracic chemotherapy perfusion

Anaesthetic management of cytoreductive surgery followed by hyperthermic intrathoracic chemotherapy perfusion

Prevention of hypothermia in patients undergoing orthotopic liver transplantation using the humigard® open surgery humidification system: a prospective randomized pilot and feasibility clinical trial

Amino Acids during Perioperative Period

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