Protocol-driven prevention of perioperative hypothermia in the pediatric neurosurgical population

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Perioperative hypothermia (PH) is a preventable, pathological, and iatrogenic state that has been shown to result in increased surgical blood loss, increased surgical site infections, increased hospital length of stay, and patient discomfort. Maintenance of normothermia is recommended by multiple surgical quality organizations; however, no group yet provides an ergonomic, evidence-based protocol to reduce PH for pediatric neurosurgery patients. The authors’ aim was to evaluate the efficacy of a PH prevention protocol in the pediatric neurosurgery population.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A prospective, nonrandomized study of 120 pediatric neurosurgery patients was performed. Thirty-eight patients received targeted warming interventions throughout their perioperative phases of care (warming group—WG). The remaining 82 patients received no extra warming care during their perioperative period (control group—CG). Patients were well matched for age, sex, and preparation time intraoperatively. Hypothermia was defined as &lt; 36°C. The primary outcome of the study was maintenance of normothermia preoperatively, intraoperatively, and postoperatively.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>WG patients were significantly warmer on arrival to the operating room (OR) and were 60% less likely to develop PH (p &lt; 0.001). Preoperative forced air warmer use both reduced the risk of PH at time 0 intraoperatively and significantly reduced the risk of any PH intraoperatively (p &lt; 0.001). All patients, regardless of group, experienced a drop in core temperature until a nadir occurred at 30 minutes intraoperatively for the WG and 45 minutes for the CG. At every time interval, from preoperatively to 120 minutes intraoperatively, CG patients were between 2 and 3 times more likely to experience PH (p &lt; 0.001). All patients were warm on arrival to the postanesthesia care unit regardless of patient group.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Preoperative forced air warmer use significantly increases the average intraoperative time 0 temperature, helping to prevent a fall into PH at the intraoperative nadir. Intraoperatively, a strictly and consistently applied warming protocol made intraoperative hypothermia significantly less likely as well as less severe when it did occur. Implementation of a warming protocol necessitated only limited resources and an OR culture change, and was well tolerated by OR staff.</jats:p></jats:sec>

Airway Management of a Patient With a Giant Frontoethmoidal Encephalocele: A Pediatric Case Report

“…The main targets related to anesthesia management include the prevention of intracranial pressure increases, correct positioning to account for the long duration of the procedure, overlaying of surgical drapes over the child’s entire body, proper padding of pressure points, protection of the eyes, and easy access to intravenous lines and breathing circuits [ 11 ]. Maintaining normovolemia and consequent hemodynamic stability is a fundamental aspect, as is normothermia, as pediatric patients present a particularly high risk of perioperative hypothermia due to increased heat loss from the head, a high surface area-to-body mass ratio, and less effective thermoregulatory mechanisms [ 12 ]. Follow-up care in a pediatric intensive care unit is required for close ventilatory and hemodynamic monitoring and early detection of possible postoperative complications, such as seizures and infection [ 11 ].…”

Perioperative active warming strategies in children: a protocol for a multicentre, prospective, randomized controlled trial

“…This relationship is especially true for infants, who generate heat through brown adipose tissue metabolism instead of shivering in low-temperature environments. This metabolism is innervated by sympathetic nerves and inhibited during general anaesthesia, further increasing the risk of IPH ( 17 – 19 ). Therefore, it is imperative to undertake appropriate warming measures for children during the perioperative period.…”

A Pilot Quality Improvement Project to Reduce Intraoperative MRI Hypothermia in Neurosurgical Patients

“…3 Pediatric patients tend to cool due to less body fat and greater body surface area per weight than adults. Typically, air warming, 4 full-body draping, and room temperature control maintain optimal thermoregulation during pediatric neurosurgery. 3…”

“…3 Pediatric patients tend to cool due to less body fat and greater body surface area per weight than adults. Typically, air warming, 4 fullbody draping, and room temperature control maintain optimal thermoregulation during pediatric neurosurgery. 3 The addition of magnetic resonance imaging (MRI) to neurosurgical procedures, referred to as intraoperative MRI (iMRI), improves the localization of seizure foci.…”