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Colorectal Surgery Patients With Immediate Postoperative Normothermia
Core temperatures outside the normal range pose a risk in all patients undergoing surgery.
According to the Clinical Guidelines for the Prevention of Unplanned Perioperative Hypothermia by the American Society of Perianesthesia Nurses (ASPAN, 2001), published research has correlated impaired wound healing, adverse cardiac events, altered drug metabolism, and coagulopathies with unplanned perioperative hypothermia. A study by Kurtz, et al (1996), found that incidence of culture-positive surgical site infections among those with mild perioperative hypothermia was three times higher than the normothermic perioperative patients. In this study, mild perioperative hypothermia was associated with delayed wound closure and prolonged hospitalization. In a meta-analysis of outcomes and costs, Mahoney and Odom (1999), demonstrated that hypothermia is associated with a significant increase in adverse outcomes, including an increased incidence of infections. The authors also concluded that hypothermia is associated with an increased chance of blood products administration, myocardial infarction, and mechanical ventilation. These adverse outcomes resulted in prolonged hospital stays and increased healthcare expenditures.
American Society of Perianesthesia Nurses. Clinical Guidelines for the prevention of unplanned perioperative hypothermia.2001 PMID: 00000F.
Frank SM, Raja SN, Bulaco, C, et al: Relative contributions of core and cutaneous temperature to thermal comfort and autonomic responses in humans. J Appl Physiol. 86:1588-1593,1999. PMID: 10233122.
Mahoney C, Odom J: Maintaining Intraoperative normothermia: a meta-analysis of outcomes with costs. AANA Journal. 67:155-164, 1999. PMID: 10488289.
Hooper V: Perioperative thermoregulation: A survey of clinical practices. Paper presented at the Consensus Conference on Perioperative Thermoregulation, ASPAN, Bethesda, MD, 1998. PMID: 15096446.
Frank SM, Beattie C, Christopherson R, et al: Epidural versus general anesthesia, ambient operating room temperature, and patient age as predictors of inadvertent hypothermia. Anesthesiology. 77:252-257, 1992. PMID: 1642343.
Carli F, Emery P, Freemantle C: Effect of intraoperative normothermia on postoperative protein metabolism in elderly patients undergoing hip arthroplasty. Br J Anaesth. 63:276-282,1989. PMID: 2803885.
Bennett J, Ramachandra V, Webster J, et al: Prevention of hypothermia during hip surgery: Effect of passive compared with active skin surface warming. Br J Anaesth. 73:180-183, 1994. PMID: 7917732.
Kurz A, Sessler DI, Lenhardt R: Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med. 334:1209-1215, 1996 [Accompanied by an editorial; 334:1263-1264.] PMID: 8606715.
Sessler DI: Current concepts: Mild intraoperative hypothermia. N Engl J Med. 336:1730-1737, 1997. PMID: 9180091.
Brauer A, Perl T, Uyanik Z, et al: Perioperative thermal insulation: minimally clinically important differences? Br J Anaesth. 2004 Jun;92(6):836-840. Epub 2004 Apr 19.
Sessler DI. A proposal for new temperature monitoring and thermal management guidelines. Anesthesiology. 1998; 89 (5):1298-1300.
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