Dataset Information

Perioperative Temperature Management in Children: What Matters?

ABSTRACT: Inadvertent perioperative hypothermia is common and associated with increased risk of perioperative complications. Adult data drives most guidelines for pediatric perioperative temperature management and does not consistently demonstrate effectiveness in children. This study aims to identify risk factors for hypothermia and determine the effectiveness of current interventions in the pediatric population.

Methods

We carried out a prospective observational study in children undergoing anesthesia in our tertiary pediatric unit. We included 869 patients (<16 y) undergoing emergency/elective surgeries over 2 months. Our team recorded the incidence of hypothermia (tympanic core temperature < 36°C) within 15 minutes of arrival to the postanesthetic care unit. We collected data such as patient demographic, surgical, anesthetic (including monitoring and warming measures used), and operating theater (OT) temperature. We performed statistical analysis to identify risk factors associated with hypothermia.

Results

Postoperative hypothermia incidence was 12.3% (107/869). The mean core temperature on arrival to the postanesthetic care unit was 36.6°C (+SD 0.45) in normothermic patients versus 35.6°C (+SD 0.34) in hypothermic patients. Multivariable analysis identified starting ambient OT temperature [odds ratio (OR) = 0.83, confidence interval (CI): 0.71-0.96; P = 0.010], intraoperative temperature monitoring (OR = 0.49, CI: 0.28-085; P = 0.011), use of occlusive dressing (OR = 0.35, CI: 0.15-0.85; P = 0.020), and active forced-air warming (OR = 0.42, CI: 0.25-0.70; P = 0.001) as factors independently protective of postoperative hypothermia. Hypothermia occurred less frequently with emergency vs. elective procedures (OR 0.43, CI: 0.21-0.91; P = 0.026).

Conclusions

Routine core temperature monitoring and active forced-air warming are useful measures to prevent hypothermia. Additionally, occlusive covers and controlling ambient OT temperature are cost-effective and safe methods to reduce inadvertent hypothermia.

SUBMITTER: Lee SY

PROVIDER: S-EPMC8487781 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundAnesthesia leads to impairments in central and peripheral thermoregulatory responses. Inadvertent perioperative hypothermia is hence a common perioperative complication, and is associated with coagulopathy, increased surgical site infection, delayed drug metabolism, prolonged recovery, and shivering. However, surveys across the world have shown poor compliance to perioperative temperature management guidelines. Therefore, we evaluated the prevalent practices and attitudes to perioperative temperature management in the Asia-Pacific region, and determined the individual and institutional factors that lead to noncompliance.MethodsA 40-question anonymous online questionnaire was distributed to anesthesiologists and anesthesia trainees in six countries in the Asia-Pacific (Singapore, Malaysia, Philippines, Thailand, India and South Korea). Participants were polled about their current practices in patient warming and temperature measurement across the preoperative, intraoperative and postoperative periods. Questions were also asked regarding various individual and environmental barriers to compliance.ResultsIn total, 1154 valid survey responses were obtained and analyzed. 279 (24.2%) of respondents prewarm, 508 (44.0%) perform intraoperative active warming, and 486 (42.1%) perform postoperative active warming in the majority of patients. Additionally, 531 (46.0%) measure temperature preoperatively, 767 (67.5%) measure temperature intraoperatively during general anesthesia, and 953 (82.6%) measure temperature postoperatively in the majority of patients. The availability of active warming devices in the operating room (p < 0.001, OR 10.040), absence of financial restriction (p < 0.001, OR 2.817), presence of hospital training courses (p = 0.011, OR 1.428), and presence of a hospital SOP (p < 0.001, OR 1.926) were significantly associated with compliance to intraoperative active warming.ConclusionsCompliance to international perioperative temperature management guidelines in Asia-Pacific remains poor, especially in small hospitals. Barriers to compliance were limited temperature management equipment, lack of locally-relevant standard operating procedures and training. This may inform international guideline committees on the needs of developing countries, or spur local anesthesiology societies to publish their own national guidelines.