Postoperative hemodynamic and thermoregulatory consequences of intraoperative core hypothermia

A Systematic Review of Intraoperative Warming to Prevent Postoperative Complications

“…Twenty‐one studies included patients with ASA scores of 1 to 3 undergoing major surgery lasting more than one hour and/or involving a hospital stay of more than three days 11,13,16,20,24,26,27,39,42–54 . The remaining studies examined patients with ASA scores of 1 or 2 undergoing minor or intermediate procedures requiring a short (ie, sometimes less than one day) length of stay 19,55–58 …”

“…Shivering can increase oxygen demands by 400% to 500% above basal requirements; 4 , 18 this has been likened to the strain on the cardiovascular system of an Olympic athlete during an event—difficult for young people, but perhaps fatal for older adults 4 . Although relatively young and generally healthy patients may cope with this strain, 19 , 20 shivering is potentially dangerous for any patient who has limited cardiorespiratory reserves 21 , 22 . Other potential complications include cardiac arrhythmias, ischemia, and arrest; 23 , 24 morbidity (eg, organ dysfunction and failure), causing longer intensive care stays 25 and longer overall hospital stays; 13 , 25 mortality; 25 increased intraoperative blood loss and increased need for blood transfusion postoperatively; 16 , 26 wound infection caused by a reduction in skin oxygen tension; 13 pressure ulcers caused by peripheral shut down and cell hypoxia; 27 increased stay in the PACU because of the need for rewarming; 26 , 28 and reduced patient satisfaction 29 …”

Inadvertent Perioperative Hypothermia: Current Nursing Knowledge

“…The risk of surgical site infection (SSI) increases because of reduced skin oxygen tension, compromised immune status, and subcutaneous vasoconstriction 1,6,9,15 . A seminal study 16 evaluated the association of hypothermia with the risk of SSI and prolonged hospital stay resulting from delayed healing. Researchers randomly assigned patients to routine intraoperative thermal care (ie, the hypothermia group) or perioperative warming (ie, the normothermia group).…”

“…Nineteen percent of patients in the hypothermia group experienced infections, compared with only 6% of patients in the normothermia group ( P = .009), with an adjusted odds ratio for infection of 4.9 (95% confidence interval = 1.7‐14.5) for the hypothermia group. The mean duration of hospital stay was 12.1 days for the normothermia group and 14.7 days for the hypothermia group ( P = .001) 16 . Additional consequences of perioperative hypothermia include increased risk of pressure injuries, prolonged PACU stays, and lower levels of patient satisfaction because of thermal discomfort 1,9 …”

Recommended Practices for the Prevention of Unplanned Perioperative Hypothermia

“…Mild hypothermia also alters medication metabolism and increases the duration of muscle relaxant action 19 , 20 . Hypothermia extends postanesthesia recovery time 21 , 22 and prolongs hospitalization 12 , 23 . The risk of these complications is considered greater for frail, elderly patients undergoing extensive surgery than it is for young, generally healthy patients undergoing comparatively minor procedures 24 …”