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Survey on intraoperative temperature management in Europe

Published online by Cambridge University Press:  01 August 2007

A. Torossian
A. Torossian*
Affiliation:
University Hospital Marburg, Department of Anaesthesia and Intensive Care Medicine, Germany
*
Correspondence to: Alexander Torossian, Department of Anaesthesia and Intensive Care Medicine, University Hospital Marburg, 35043 Marburg/Germany. E-mail: alexander-torossian@t-online.de; Tel: +49 0 6421 2865980; Fax: +49 0 6421 2865555
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Summary

Background and objectives

Inadvertent perioperative hypothermia causes serious morbidity in surgical patients. However, recent reports suggest that patients might still be hypothermic after elective surgery. We thus surveyed intraoperative temperature monitoring and management practices in Europe.

Methods

Postal survey of 801 representative hospitals from 17 European countries on the same day. The questions addressed the number of surgical procedures and type of anaesthesia performed, mode and site of temperature monitoring and method of patient warming. Mean and standard error of the mean or count and percentage were calculated. The t-test or contingency table analysis with the Fisher’s exact test were used.

Results

Eight thousand and eighty-three surgical procedures were assessed from 316 responding hospitals (39.4%). Overall, patient temperature monitored in 19.4% and 38.5% of the patients were actively warmed. Under general anaesthesia, body temperature was monitored in 25% and during regional anaesthesia in 6%, P = 0.0005. Nasopharyngeal temperature was most often taken under general anaesthesia, while tympanic temperature was preferred during regional anaesthesia. Under general anaesthesia, 43% of patients were actively warmed as compared to 28% with regional anaesthesia, P = 0.0005. Forced-air warming was the method of choice for both general and regional anaesthesia.

Conclusions

Intraoperative temperature monitoring is still uncommon and hence active patient warming is not a standard of care in Europe. Awareness of perioperative hypothermia is critical to its prevention, and thus temperature monitoring is a pre-requisite. The objective is to maintain normothermia in patients throughout surgery. A European practice guideline for perioperative patient temperature management is warranted.

Keywords

BODY TEMPERATURE, intraoperative, monitoringANAESTHESIA GENERALANAESTHESIA CONDUCTIONEQUIPMENT AND SUPPLIESthermoregulation, warmingHYPOTHERMIA
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 8 , August 2007 , pp. 668 - 675
Copyright
Copyright © European Society of Anaesthesiology 2007

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References

1.Abelha, FJ, Castro, MA, Neves, AM, Landeiro, NM, Santos, CC. Hypothermia in a surgical intensive care unit. BMC Anesthesiol 2005; 5: 7.CrossRefGoogle Scholar
2.Frank, SM, Beattie, C, Christopherson, R et al. . Unintentional hypothermia is associated with postoperative myocardial ischemia. The Perioperative Ischemia Randomized Anesthesia Trial Study Group. Anesthesiology 1993; 78: 468–476.CrossRefGoogle ScholarPubMed
3.Frank, SM, Fleisher, LA, Breslow, MJ et al. . Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 1997; 277: 1127–1134.CrossRefGoogle ScholarPubMed
4.Schmied, H, Kurz, A, Sessler, DI, Kozek, S, Reiter, A. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet 1996; 347: 289–292.CrossRefGoogle ScholarPubMed
5.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: 1209–1215.CrossRefGoogle ScholarPubMed
6.Torossian, A, Ruehlmann, S, Middeke, M et al. . Mild preseptic hypothermia is detrimental in rats. Crit Care Med 2004; 32: 1899–1903.CrossRefGoogle ScholarPubMed
7.Kongsayreepong, S, Chaibundit, C, Chadpaibool, J et al. . Predictor of core hypothermia and the surgical intensive care unit. Anesth Analg 2003; 96: 826–833.Google Scholar
8.Panagiotis, K, Maria, P, Argiri, P, Panagiotis, S. Is postanesthesia care unit length of stay increased in hypothermic patients? AORN J 2005; 81: 379–392.CrossRefGoogle ScholarPubMed
9.Doufas, AG. Consequences of inadvertent perioperative hypothermia. Best Pract Res Clin Anaesthesiol 2003; 17: 535–549.CrossRefGoogle ScholarPubMed
10.Mahoney, CB, Odom, J. Maintaining intraoperative normothermia: a meta-analysis of outcomes with costs. AANA J 1999; 67: 155–163.Google ScholarPubMed
11.Smith, JJ, Bland, SA, Mullett, S. Temperature – the forgotten vital sign. Accid Emerg Nurs 2005; 13: 247–250.CrossRefGoogle ScholarPubMed
12.Sessler, DI. Complications and treatment of mild hypothermia. Anesthesiology 2001; 95: 531–543.Google Scholar
13.Gallagher, GA, McLintock, T, Booth, MG. Closing the audit loop – prevention of perioperative hypothermia: audit and reaudit of perioperative hypothermia. Eur J Anaesthesiol 2003; 20: 750–752.CrossRefGoogle ScholarPubMed
14.Kean, M. A patient temperature audit within a theatre recovery unit. Br J Nurs 2000; 9: 150–156.CrossRefGoogle ScholarPubMed
15. Crosby K, Tulloch B, Crosby R. Walnut Medical Hospital Register. 2006. http://www.walnutmedical.info.Google Scholar
16.Browner, WS, Newman, TB. Sample size and power based on the population attributable fraction. Am J Public Health 1989; 79: 1289–1294.CrossRefGoogle ScholarPubMed
17.Leslie, K, Sessler, DI. Perioperative hypothermia in the high-risk surgical patient. Best Pract Res Clin Anaesthesiol 2003; 17: 485–498.Google Scholar
18.Janczyk, RJ, Howells, GA, Bair, HA, Huang, R, Bendick, PJ, Zelenock, GB. Hypothermia is an independent predictor of mortality in ruptured abdominal aortic aneurysms. Vasc Endovascular Surg 2004; 38: 37–42.CrossRefGoogle ScholarPubMed
19.Casscells, W, Vasseghi, MF, Siadaty, MS et al. . Hypothermia is a bedside predictor of imminent death in patients with congestive heart failure. Am Heart J 2005; 149: 927–933.CrossRefGoogle ScholarPubMed
20.JrBush, HL, Hydo, LJ, Fischer, E, Fantini, GA, Silane, MF, Barie, PS. Hypothermia during elective abdominal aortic aneurysm repair: the high price of avoidable morbidity. J Vasc Surg 1995; 21: 392–400.CrossRefGoogle Scholar
21.Guest, JD, Vanni, S, Silbert, L. Mild hypothermia, blood loss and complications in elective spinal surgery. Spine J 2004; 4: 130–137.Google Scholar
22.El Gamal, N, El Kassabany, N, Frank, SM et al. . Age-related thermoregulatory differences in a warm operating room environment (approximately 26 degrees C). Anesth Analg 2000; 90: 694–698.CrossRefGoogle Scholar
23.Clergue, F, Auroy, Y, Pequignot, F, Jougla, E, Lienhart, A, Laxenaire, MC. French survey of anesthesia in 1996. Anesthesiology 1999; 91: 1509–1520.CrossRefGoogle ScholarPubMed
24.Peduto, VA, Chevallier, P, Casati, A. A multicenter survey on anaesthesia practice in Italy. Minerva Anestesiol 2004; 70: 473–491.Google ScholarPubMed
25.Arkilic, CF, Akca, O, Taguchi, A, Sessler, DI, Kurz, A. Temperature monitoring and management during neuraxial anesthesia: an observational study. Anesth Analg 2000; 91: 662–666.Google Scholar
26.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: 938–945.CrossRefGoogle ScholarPubMed
27.Frank, SM, El Rahmany, HK, Cattaneo, CG, Barnes, RA. Predictors of hypothermia during spinal anesthesia. Anesthesiology 2000; 92: 1330–1334.CrossRefGoogle ScholarPubMed
28.Frank, SM, Nguyen, JM, Garcia, CM, Barnes, RA. Temperature monitoring practices during regional anesthesia. Anesth Analg 1999; 88: 373–377.CrossRefGoogle ScholarPubMed
29.Kamada, Y, Miyamoto, N, Yamakage, M, Tsujiguchi, N, Namiki, A. Utility of an infrared ear thermometer as an intraoperative core temperature monitor. Masui 1999; 48: 1121–1125.Google ScholarPubMed
30.Rotello, LC, Crawford, L, Terndrup, TE. Comparison of infrared ear thermometer derived and equilibrated rectal temperatures in estimating pulmonary artery temperatures. Crit Care Med 1996; 24: 1501–1506.CrossRefGoogle ScholarPubMed
31.Brauer, A, Weyland, W, Kazmaier, S et al. . Efficacy of postoperative rewarming after cardiac surgery. Ann Thorac Cardiovasc Surg 2004; 10: 171–177.Google ScholarPubMed
32.Kabbara, A, Goldlust, SA, Smith, CE, Hagen, JF, Pinchak, AC. Randomized prospective comparison of forced air warming using hospital blankets versus commercial blankets in surgical patients. Anesthesiology 2002; 97: 338–344.CrossRefGoogle ScholarPubMed
33.Casati, A, Baroncini, S, Pattono, R et al. . Effects of sympathetic blockade on the efficiency of forced-air warming during combined spinal-epidural anesthesia for total hip arthroplasty. J Clin Anesth 1999; 11: 360–363.Google Scholar
34.Zhao, J, Luo, AL, Xu, L, Huang, YG. Forced-air warming and fluid warming minimize core hypothermia during abdominal surgery. Chin Med Sci J 2005; 20: 261–264.Google Scholar
35.Kehlet, H, Wilmore, DW. Fast-track surgery. Br J Surg 2005; 92: 3–4.CrossRefGoogle ScholarPubMed
36. The Association of Anaesthetists of Great Britain and Ireland. Recommendations for standards of monitoring during anaesthesia and recovery. 2000. http://www.aagbi.org/PDF/Absolute.pdf.Google Scholar
37.Montanini, S, Martinelli, G, Torri, G et al. . Recommendations on perioperative normothermia. Working Group on Perioperative Hypothermia, Italian Society for Anesthesia, Analgesia, Resuscitation, and Intensive Care. Minerva Anestesiol 2001; 67: 157–158.Google Scholar