Prevention of perioperative hypothermia in plastic surgery

Abstract

While inadvertent perioperative hypothermia has received serious attention in many surgical specialties, few discussions of hypothermia have been published in the plastic surgery literature. This article reviews the physiology of thermoregulation, describes how both general and regional anesthesia alter the normal thermoregulatory mechanisms, indicates risk factors particularly associated with hypothermia, and discusses the most effective current methods for maintaining normothermia. Hypothermia is typically defined as a core body temperature of </=36 degrees C (</=96.8 degrees F), though patient outcomes are reportedly better when a temperature of >/=36.5 degrees C is maintained. Unless preventive measures are instituted, inadvertent hypothermia occurs in 50% to 90% of surgical patients, even those undergoing relatively short procedures lasting one to one-and-a-half hours. During either general or regional anesthesia, a patient's natural behavioral and autonomic responses to cold are unavailable or impaired, and the combination of general and neuraxial anesthesia produces the highest risk for inadvertent perioperative hypothermia. Unless hypothermia is prevented, the restoration of normothermia can take more than 4 hours once anesthesia is stopped. Consequences of hypothermia are serious and affect surgical outcomes in plastic surgery patients. Potential complications include morbid cardiac events, coagulation disorders and blood loss, increased incidence of surgical wound infection, postoperative shivering, longer hospital stays, and increased costs associated with surgery. Measures for preventing hypothermia are emphasized in this article, especially those proven most effective in prospective and controlled clinical studies. Perhaps the most important step in maintaining normothermia is to prewarm patients in the preoperative area with forced-air heating systems. Intraoperative warming with forced-air and fluid warming are also essential. Other strategies include maintaining an ambient operating room temperature of approximately 73 degrees F (22.8 degrees C), covering as much of the body surface as possible, and aggressively treating postoperative shivering. None of these measures can be adequately employed unless a patient's core body temperature is monitored throughout the perioperative period. Prevention of perioperative hypothermia is neither difficult nor expensive. Proper preventive measures can reduce the risk of complications and adverse outcomes, and eliminate hours of needless pain and misery for our patients.

Risk factors for hypothermia in patients under general anesthesia: Is there a drawback of laminar airflow operating rooms? A prospective cohort study

“…A decade ago, Abelha FJ et al also revealed that 57.8% of patients who underwent non-cardiac surgeries developed mild hypothermia postoperatively in the Surgical Intensive Care Unit [3]. Furthermore, 50% 90% of patients who underwent certain short-term surgeries (lasting 1~1.5 h) would develop hypothermia if no preventive measurements were taken [4].…”

Prevention of Hypothermia by Infusion of Warm Fluid During Abdominal Surgery

“…1 Hypothermia continues to occur frequently in the perioperative setting. 1,2 Perioperative hypothermia may result from the disorganization in thermoregulation caused by anesthesia, the type or dimension of the surgery, and the surgical environment.…”

Pearls and Perils of Caring for the Postbariatric Body Contouring Patient

“…Hypothermia increases the risk of cardiac events, coagulation disorders, infection, and wound healing problems. [40][41][42][43] Expeditious time management reduces exposure. Forced warming blankets under and on top of the patient may be used and initiated in the preoperative area, and the temperature of the operating room should be elevated as needed.…”