Article

Inadvertent Perioperative Hypothermia During Orthopedic Surgery

Publish date: July 12, 2018

Chandrakanth Boddu, MD

Joseph Cushner

Giles R. Scuderi, MD

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Inadvertent perioperative hypothermia, defined as an involuntary drop in core body temperature to <35°C (95°F), is a condition associated with significant morbidity and mortality.
Maintenance of core body temperature >36°C is now a measured standard of perioperative care.
Overall, in the last 2 decades, the incidence of inadvertent perioperative hypothermia has decreased, mainly due to aggressive intraoperative management.
Active patient warming by conduction devices occurs by direct physical contact with the device, which is set at a higher temperature, whereas heat transfer from the convection device to the patient occurs by a physical medium such as forced air or circulating water that moves in between the device and the patient.
Active patient warming is superior to passive heat retention methods.

References

Brown DJ, Brugger H, Boyd J, Paal P. Accidental Hypothermia. N Engl J Med. 2012;367(20):1930-1938. doi:10.1056/NEJMra1114208.
Uzoigwe CE, Khan A, Smith RP, et al. Hypothermia and low body temperature are common and associated with high mortality in hip fracture patients. Hip Int. 2014; 24(3):237-242. doi:10.5301/hipint.5000124.
Johansen A, Wakeman R, Boulton C, Plant F, Roberts J, Williams A. National Hip Fracture Database: National Report 2013. London, UK: National Hip Fracture Database, Royal College of Physicians; 2013.
Karalapillai D, Story DA, Calzavacca, Licari E, Liu YL, Hart GK. Inadvertent hypothermia and mortality in postoperative intensive care patients: retrospective audit of 5050 patients. Anaesthesia. 2009;64(9):968-972. doi:10.1111/j.1365-2044.2009.05989.x.
Horosz B, Malec-Milewska M. Inadvertent intraoperative hypothermia. Anaesthesiol Intensive Ther. 2013;45(1):38-43. doi:10.5603/AIT.2013.0009.
Steelman VM, Perkhounkova YS, Lemke JH. The gap between compliance with the quality performance measure "perioperative temperature management” and normothermia. J Healthc Qual. 2014;37(6):333-341. doi:10.1111/jhq.12063.
National Institute for Health and Clinical Excellence. Inadvertent Perioperative Hypothermia: The Management of Inadvertent Perioperative Hypothermia in Adults. London, UK: National Institute for Health and Clinical Excellence; 2008.
Carlino W. Damage control resuscitation from major haemorrhage in polytrauma. Eur J Orthop Surg Traumatol. 2014;24(2):137-141. doi:10.1007/s00590-013-1172-7.
Billeter AT, Hohmann SF, Druen D, Cannon R, Polk HC Jr. Unintentional perioperative hypothermia is associated with severe complications and high mortality in elective operations. Surgery. 2014;156(5):1245-1252. doi:10.1016/j.surg.2014.04.024.
Kim YS, Jeon YS, Lee JA, et al. Intra-operative warming with a forced-air warmer in preventing hypothermia after tourniquet deflation in elderly patients. J Int Med Res. 2009;37(5):1457-1464. doi:10.1177/147323000903700521.
Parodi D, Tobar C, Valderrama J, et al. Hip arthroscopy and hypothermia. Arthroscopy. 2012;28(7):924-928. doi:10.1016/j.arthro.2011.12.012.
Kurz A, Sessler DI, Christensen R, Dechert M. Heat balance and distribution during the core-temperature plateau in anesthetized humans. Anesthesiology. 1995;83(3):491-499.
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.
American Society of PeriAnesthesia Nurses. Clinical guideline for the prevention of unplanned perioperative hypothermia. J Perianesth Nurs. 2001;16(5):305-314.
Inaba K, Berg R, Barmparas G, et al. Prospective evaluation of ambient operating room temperature on the core temperature of injured patients undergoing emergent surgery. J Trauma Acute Care Surg. 2012;73(6):1478-1483. doi:10.1097/TA.0b013e3182781db3.
Barie PS. Surgical site infections: epidemiology and prevention. Surg Infect (Larchmt). 2002;3 Suppl 1:S9-S21. doi:10.1089/sur.2002.3.s1-9.
Jeran L. Patient temperature: an introduction to the clinical guideline for the prevention of unplanned perioperative hypothermia. J Perianesth Nurs. 2001;16(5):303-304.
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.
Alderson P, Campbell G, Smith AF, Warttig S, Nicholson A, Lewis SR. Thermal insulation for preventing inadvertent perioperative hypothermia. Cochrane Database Syst Rev. 2014;6:CD009908. doi:10.1002/14651858.CD009908.pub2.
Berry D, Wick C, Magons P. A clinical evaluation of the cost and time effectiveness of the ASPAN Hypothermia Guideline. J Perianesth Nurs. 2008;23(1):24-35. doi:10.1016/j.jopan.2007.09.010.
Kimberger O, Held C, Stadelmann K et al. Resistive polymer versus forced-air warming: comparable heat transfer and core rewarming rates in volunteers. Anesth Analg. 2008;107(5):1621-1626. doi:10.1213/ane.0b013e3181845502.
Brandt S, Oguz R, Hüttner H, et al. Resistive-polymer versus forced-air warming: comparable efficacy in orthopedic patients. Anesth Analg. 2010;110(3):834-838. doi:10.1213/ANE.0b013e3181cb3f5f.
Legg AJ, Hammer AJ. Forced-air patient warming blankets disrupt unidirectional airflow. Bone Joint J. 2013;95-B(3):407-410. doi:10.1302/0301-620X.95B3.29121.
Dasari KB, Albrecht M, Harper M. Effect of forced-air warming on the performance of operating theatre laminar flow ventilation. Anaesthesia. 2012;67(3):244-249. doi:10.1111/j.1365-2044.2011.06983.x.
Belani KG, Albrecht M, McGovern PD, Reed M, Nachtsheim C. Patient warming excess heat: the effects on orthopedic operating room ventilation performance. Anesth Analg. 2013;117(2):406-411. doi:10.1213/ANE.0b013e31825f81e2.
Legg AJ, Cannon T, Hammer AJ. Do forced air patient-warming devices disrupt unidirectional downward airflow? J Bone Joint Surg Br. 2012;94(2):254-256. doi:10.1302/0301-620X.94B2.27562.
Albrecht M, Gaithier RL, Belani K, Litchy M, Leaper D. Forced-air warming blowers: An evaluation of filtration adequacy and airborne contamination emissions in the operating room. Am J Infect Control. 2011;39(4):321-328. doi:10.1016/j.ajic.2010.06.011.
Reed M, Kimberger O, McGovern PD, Albrecht MC. Forced-air warming design: evaluation of intake filtration, internal microbial buildup, and airborne-contamination emissions. AANA J. 2013;81(4):275-280.
McGovern PD, Albercht M, Belani KG, et al. Forced-air warming and ultra-clean ventilation do not mix: an investigation of theatre ventilation, patient warming and joint replacement infection in orthopaedics. J Bone Joint Surg Br.2011;93(11):1537-1544. doi:10.1302/0301-620X.93B11.27124.

References

Brown DJ, Brugger H, Boyd J, Paal P. Accidental Hypothermia. N Engl J Med. 2012;367(20):1930-1938. doi:10.1056/NEJMra1114208.
Uzoigwe CE, Khan A, Smith RP, et al. Hypothermia and low body temperature are common and associated with high mortality in hip fracture patients. Hip Int. 2014; 24(3):237-242. doi:10.5301/hipint.5000124.
Johansen A, Wakeman R, Boulton C, Plant F, Roberts J, Williams A. National Hip Fracture Database: National Report 2013. London, UK: National Hip Fracture Database, Royal College of Physicians; 2013.
Karalapillai D, Story DA, Calzavacca, Licari E, Liu YL, Hart GK. Inadvertent hypothermia and mortality in postoperative intensive care patients: retrospective audit of 5050 patients. Anaesthesia. 2009;64(9):968-972. doi:10.1111/j.1365-2044.2009.05989.x.
Horosz B, Malec-Milewska M. Inadvertent intraoperative hypothermia. Anaesthesiol Intensive Ther. 2013;45(1):38-43. doi:10.5603/AIT.2013.0009.
Steelman VM, Perkhounkova YS, Lemke JH. The gap between compliance with the quality performance measure "perioperative temperature management” and normothermia. J Healthc Qual. 2014;37(6):333-341. doi:10.1111/jhq.12063.
National Institute for Health and Clinical Excellence. Inadvertent Perioperative Hypothermia: The Management of Inadvertent Perioperative Hypothermia in Adults. London, UK: National Institute for Health and Clinical Excellence; 2008.
Carlino W. Damage control resuscitation from major haemorrhage in polytrauma. Eur J Orthop Surg Traumatol. 2014;24(2):137-141. doi:10.1007/s00590-013-1172-7.
Billeter AT, Hohmann SF, Druen D, Cannon R, Polk HC Jr. Unintentional perioperative hypothermia is associated with severe complications and high mortality in elective operations. Surgery. 2014;156(5):1245-1252. doi:10.1016/j.surg.2014.04.024.
Kim YS, Jeon YS, Lee JA, et al. Intra-operative warming with a forced-air warmer in preventing hypothermia after tourniquet deflation in elderly patients. J Int Med Res. 2009;37(5):1457-1464. doi:10.1177/147323000903700521.
Parodi D, Tobar C, Valderrama J, et al. Hip arthroscopy and hypothermia. Arthroscopy. 2012;28(7):924-928. doi:10.1016/j.arthro.2011.12.012.
Kurz A, Sessler DI, Christensen R, Dechert M. Heat balance and distribution during the core-temperature plateau in anesthetized humans. Anesthesiology. 1995;83(3):491-499.
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.
American Society of PeriAnesthesia Nurses. Clinical guideline for the prevention of unplanned perioperative hypothermia. J Perianesth Nurs. 2001;16(5):305-314.
Inaba K, Berg R, Barmparas G, et al. Prospective evaluation of ambient operating room temperature on the core temperature of injured patients undergoing emergent surgery. J Trauma Acute Care Surg. 2012;73(6):1478-1483. doi:10.1097/TA.0b013e3182781db3.
Barie PS. Surgical site infections: epidemiology and prevention. Surg Infect (Larchmt). 2002;3 Suppl 1:S9-S21. doi:10.1089/sur.2002.3.s1-9.
Jeran L. Patient temperature: an introduction to the clinical guideline for the prevention of unplanned perioperative hypothermia. J Perianesth Nurs. 2001;16(5):303-304.
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.
Alderson P, Campbell G, Smith AF, Warttig S, Nicholson A, Lewis SR. Thermal insulation for preventing inadvertent perioperative hypothermia. Cochrane Database Syst Rev. 2014;6:CD009908. doi:10.1002/14651858.CD009908.pub2.
Berry D, Wick C, Magons P. A clinical evaluation of the cost and time effectiveness of the ASPAN Hypothermia Guideline. J Perianesth Nurs. 2008;23(1):24-35. doi:10.1016/j.jopan.2007.09.010.
Kimberger O, Held C, Stadelmann K et al. Resistive polymer versus forced-air warming: comparable heat transfer and core rewarming rates in volunteers. Anesth Analg. 2008;107(5):1621-1626. doi:10.1213/ane.0b013e3181845502.
Brandt S, Oguz R, Hüttner H, et al. Resistive-polymer versus forced-air warming: comparable efficacy in orthopedic patients. Anesth Analg. 2010;110(3):834-838. doi:10.1213/ANE.0b013e3181cb3f5f.
Legg AJ, Hammer AJ. Forced-air patient warming blankets disrupt unidirectional airflow. Bone Joint J. 2013;95-B(3):407-410. doi:10.1302/0301-620X.95B3.29121.
Dasari KB, Albrecht M, Harper M. Effect of forced-air warming on the performance of operating theatre laminar flow ventilation. Anaesthesia. 2012;67(3):244-249. doi:10.1111/j.1365-2044.2011.06983.x.
Belani KG, Albrecht M, McGovern PD, Reed M, Nachtsheim C. Patient warming excess heat: the effects on orthopedic operating room ventilation performance. Anesth Analg. 2013;117(2):406-411. doi:10.1213/ANE.0b013e31825f81e2.
Legg AJ, Cannon T, Hammer AJ. Do forced air patient-warming devices disrupt unidirectional downward airflow? J Bone Joint Surg Br. 2012;94(2):254-256. doi:10.1302/0301-620X.94B2.27562.
Albrecht M, Gaithier RL, Belani K, Litchy M, Leaper D. Forced-air warming blowers: An evaluation of filtration adequacy and airborne contamination emissions in the operating room. Am J Infect Control. 2011;39(4):321-328. doi:10.1016/j.ajic.2010.06.011.
Reed M, Kimberger O, McGovern PD, Albrecht MC. Forced-air warming design: evaluation of intake filtration, internal microbial buildup, and airborne-contamination emissions. AANA J. 2013;81(4):275-280.
McGovern PD, Albercht M, Belani KG, et al. Forced-air warming and ultra-clean ventilation do not mix: an investigation of theatre ventilation, patient warming and joint replacement infection in orthopaedics. J Bone Joint Surg Br.2011;93(11):1537-1544. doi:10.1302/0301-620X.93B11.27124.

Inadvertent Perioperative Hypothermia During Orthopedic Surgery

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