Incidence of Postoperative Hypothermia in Obstetric and Gynecologic Patients at Ramathibodi Hospital

Main Article Content

Jittima Jiarpinitnun
Wichai Ittichaikulthol
Rojnarin Komonhirun

Abstract

Background: Inadvertent postoperative hypothermia is common among anesthetized patients in the operating room. Although prophylaxis guideline has been applied to every patient, hypothermia still occurred and continued to increase in PACU (Post anesthesia care unit).
Objective: To identify the incidence and to assess the risk of postoperative hypothermia in obstetric and gynecologic patients at Ramathibodi Hospital.
Methods: After ethical approval, a prospective observational study was conducted on obstetric and gynecologic patients undergoing surgery under anesthesia during October 2012 to December 2012. The hypothermia was defined as a core temperature of below 36.0 °C. Outcomes were analyzed and compared between G1: < 35.0 °C group and G2: 35.0 - 36.0 °C group. The possible factors of postoperative hypothermia were collected by using research data sheet. Tympanic membrane temperature was recorded on admission to PACU and before discharge.
Results: The 919 patients were in this study, a subgroup of 456 patients had body temperature of lower than 36.0 °C (49.62%). The G1 group comprised 37 patients (8.11%) and G2 group comprised 419 patients (97.89%). Of these, mean age was 37.94 ± 12.66 years, mean body weight was 62.83 ± 12.27 kg, mean operating room temperature was 20.97 ± 1.53 °C and the mean operation time was 91.90 ± 60.98 min. Parameters associated with hypothermia were caesarean section, laparoscopic surgery and operating room temperature (P = 0.019, 0.003, and 0.014, respectively). The risk factors significantly associated with < 35.0 °C were laparoscopic and operating room temperature of below 20.0 °C.
Conclusions: The incidence of postoperative hypothermia in obstetric and gynecologic patients at Ramathibodi Hospital was 49.62%. The risk factors associated with postoperative hypothermia with the temperature of below 35.0 °C were laparoscopic surgery and operating room temperature of below 20.0 °C.

Article Details

How to Cite
1.
Jiarpinitnun J, Ittichaikulthol W, Komonhirun R. Incidence of Postoperative Hypothermia in Obstetric and Gynecologic Patients at Ramathibodi Hospital. Rama Med J [Internet]. 2014 Jun. 30 [cited 2024 Mar. 29];37(2):53-62. Available from: https://he02.tci-thaijo.org/index.php/ramajournal/article/view/95465
Section
Original Articles

References

Lenhardt R, Marker E, Goll V, et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology. 1997;87(6):1318-1323.

Rohrer MJ, Natale AM. Effect of hypothermia on the coagulation cascade. Crit Care Med. 1992;20(10):1402-1405.

Horn EP, Schroeder F, Gottschalk A, et al. Active warming during cesarean delivery. Anesth Analg. 2002;94(2):409-414.

Frank SM, Higgins MS, Breslow MJ, et al. The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia. A randomized clinical trial. Anesthesiology. 1995;82(1):83-93.

Frank SM. Consequences of hypothermia. Curr Anaesth Crit Care. 2001;12:79-86.

Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996;334(19):1209-1215.

Scott EM, Buckland R. A systematic review of intraoperative warming to prevent postoperative complications. AORN J. 2006;83(5):1090-1113.

Galvão CM, Marck PB, Sawada NO, Clark AM. A systematic review of the effectiveness of cutaneous warming systems to prevent hypothermia. J Clin Nurs. 2009;18(5):627-636. doi:10.1111/j.1365-2702.2008.02668.x.

Kurz A, Sessler DI, Narzt E, et al. Postoperative hemodynamic and thermoregulatory consequences of intraoperative core hypothermia. J Clin Anesth. 1995;7(5):359-366.

Wong PF, Kumar S, Bohra A, Whetter D, Leaper DJ. Randomized clinical trial of perioperative systemic warming in major elective abdominal surgery. Br J Surg. 2007;94(4):421-426.

Vaughan MS, Vaughan RW, Cork RC. Postoperative hypothermia in adults: relationship of age, anesthesia, and shivering to rewarming. Anesth Analg. 1981;60(10):746-751.

Kean M. A patient temperature audit within a theatre recovery unit. Br J Nurs. 2000;9(3):150-156.

Leibowitz AB, Atchabahiab A. Hypothermia. In: Reed Ap, Yudkowitz FS, editors. Clinical cases in Anesthesia. 3rd ed. Philadelphia: Elsevier Churchill Livingstone. 2005:513-516.

Fox J. Chilling facts. Nurs Times. 1993;89:76-80.

El-Gamal N, Elkassabany N, Frank SM, et al. Age-related thermoregulatory differences in a warm operating room environment (approximately 26 degrees C). Anesth Analg. 2000;90(3):694-698.

Cattaneo CG, Frank SM, Hesel TW, El-Rahmany HK, Kim LJ, Tran KM. The accuracy and precision of body temperature monitoring methods during regional and general anesthesia. Anesth Analg. 2000;90(4):938-945.

Erickson RS, Yount ST. Effect of aluminized covers on body temperature in patients having abdominal surgery. Heart Lung. 1991;20(3):255-264.

Kiekkas P, Poulopoulou M, Papahatzi A, Souleles P. Effects of hypothermia and shivering on standard PACU monitoring of patients. AANA J. 2005;73(1):47-53.

Moslemi-Kebria M, El-Nashar SA, Aletti GD, Cliby WA. Intraoperative hypothermia during cytoreductive surgery for ovarian cancer and perioperative morbidity. Obstet Gynecol. 2012;119(3):590-596. doi:10.1097/AOG.0b013e3182475f8a.

Bräuer A, Quintel M. Forced-air warming: technology, physical background and practical aspects. Curr Opin Anaesthesiol. 2009;22(6):769-774. doi:10.1097/ACO.0b013e328331d134.

Cork RC, Vaughan RW, Humphrey LS. Precision and accuracy of intraoperative temperature monitoring. Anesth Analg. 1983;62(2):211-214.

Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109(2):318-338. doi:10.1097/ALN.0b013e31817f6d76.

Apfelbaum JL, Silverstein JH, Chung FF, et al. Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology. 2013;118(2):291-307. doi:10.1097/ALN.0b013e31827773e9.

Morris RH. Operating room temperature and the anesthetized, paralyzed patient. Arch Surg. 1971;102(2):95-97. doi:10.1001/archsurg.1971.01350020005002.

Poveda VB. Intraoperative hypothermia in patients undergoing elective surgery. Acta Paul Enferm. 2009;22:361-366. doi:10.1590/S0103-21002009000400002.

American Society of Peri-Anesthesia Nurses. Clinical guideline for the prevention of unplanned perioperative hypothermia. J Perianesth Nurs. 2001;16:305-314.

Yokoyama K, Suzuki M, Shimada Y, Matsushima T, Bito H, Sakamoto A. Effect of administration of pre-warmed intravenous fluids on the frequency of hypothermia following spinal anesthesia for Cesarean delivery. J Clin Anesth. 2009;21(4):242-248. doi:10.1016/j.jclinane.2008.12.010.

Goyal P, Kundra S, Sharma S, Grewal A, Kaul TK, Singh M R. Efficacy of intravenous fluid warming for maintenance of core temperature during lower segment cesarean section under spinal anesthesia. J Obstet Anaesth Crit Care. 2011;1:73-77.

Camus Y, Delva E, Cohen S, Lienhart A. The effects of warming intravenous fluids on intraoperative hypothermia and postoperative shivering during prolonged abdominal surgery. Acta Anaesthesiol Scand. 1996;40(7):779-782.

Woolnough M, Allam J, Hemingway C, Cox M, Yentis SM. Intra-operative fluid warming in elective caesarean section: a blinded randomised controlled trial. Int J Obstet Anesth. 2009;18(4):346-351. doi:10.1016/j.ijoa.2009.02.009.

Goldberg MJ, Roe CF. Temperature changes during anesthesia and operations. Arch Surg. 1966;93(2):365-369.

Ozaki M, Sessler DI, Matsukawa T, et al. The threshold for thermoregulatory vasoconstriction during nitrous oxide/sevoflurane anesthesia is reduced in the elderly. Anesth Analg. 1997;84(5):1029-1033.

Sessler DI. Perioperative heat balance. Anesthesiology. 2000;92(2):578-596.

Pisitsak C, Virankabutra T, Deewong K. Pornprasertsuk M. Incidence and factor of postoperative hypothermia. The Thai Journal of Anesthesiology. 2011;37:93-103.

Butwick AJ, Lipman SS, Carvalho B. Intraoperative forced air-warming during cesarean delivery under spinal anesthesia does not prevent maternal hypothermia. Anesth Analg. 2007;105(5):1413-1419.