sábado, 11 de julio de 2015

Hipotermia perioperatoria/Perioperative hypothermia

Prevención de hipotermia perioperatoria inadvertida
Preventing inadvertent perioperative hypothermia.
Torossian A1, Bräuer A, Höcker J, Bein B, Wulf H, Horn EP.
Dtsch Arztebl Int. 2015 Mar 6;112(10):166-72. doi: 10.3238/arztebl.2015.0166.
BACKGROUND: 25-90% of all patients undergoing elective surgery suffer from inadvertent postoperative hypothermia, i.e., a core body temperature below 36°C. Compared to normothermic patients, these patients have more frequent wound infections (relative risk [RR] 3.25, 95% confidence interval [CI] 1.35-7.84), cardiac complications (RR 4.49, 95% CI 1.00-20.16), and blood transfusions (RR 1.33, 95% CI 1.06-1.66). Hypothermic patients feel uncomfortable, and shivering raises oxygen consumption by about 40%. METHODS: This guideline is based on a systematic review of the literature up to and including October 2012 and a further one from November 2012 to August 2014. The recommendations were developed and agreed upon by representatives of five medical specialty societies in a structured consensus process. RESULTS: The patient's core temperature should be measured 1-2 hours before the start of anesthesia, and either continuously or every 15 minutes during surgery. Depending on the nature of the operation, the site of temperature measurement should be oral, naso-/oropharyngeal, esophageal, vesical, or tympanic (direct). The patient should be actively prewarmed 20-30 minutes before surgery to counteract the decline in temperature. Prewarmed patients must be actively warmed intraoperatively as well if the planned duration of anesthesia is longer than 60 minutes (without prewarming, 30 minutes). The ambient temperature in the operating room should be at least 21°C for adult patients and at least 24°C for children. Infusions and blood transfusions that are given at rates of >500 mL/h should be warmed first. Perioperatively, the largest possible area of the body surface should be thermally insulated. Emergence from general anesthesia should take place at normal body temperature. Postoperativehypothermia, if present, should be treated by the administration of convective or conductive heat until normothermia is achieved. Shivering can be treated with medications.
CONCLUSION: Inadvertent perioperative hypothermia can adversely affect the outcome of surgery and the patient's postoperative course. It should be actively prevented.
Medición de temperatura perioperatoria y manejo: ir más allá del proyecto de mejoramiento de cuidado quirúrgico
Perioperative temperature measurement and management: moving beyond the Surgical Care Improvement Project. Joshua W, Sappenfield, Caron M. Hong and Samuel M.
Journal of Anesthesiology & Clinical Science 2012
Intraoperative management of patient body temperature is a standard of care for practicing anesthesiologists. Merely complying with the Surgical Care Improvement Project (SCIP) measurement is inadequate for optimizing perioperative outcomes. Clinicians should have a sound understanding of available temperature monitoring sites, deleterious effects of hypothermia, and indications for therapeutic hypothermia. This foundation will help physicians use indicated modalities to improve patient outcomes throughout the perioperative period. The purpose of this paper is to review appropriate intraoperative temperature monitoring, the importance of maintaining normothermia, and indications for intraoperative hypothermia.
Hipotermia perioperatoria en pacientes pediátricos. Diagnóstico, prevención y manejo
Perioperative hypothermia in pediatric patients: diagnosis, prevention and management
Bajwa SJS and Swati.
Anaesth Pain & Intensive Care 2014;18(1):97-100
Hipothermia is the most common perioperative disturbance in pediatric patients. Pediatric patients are highly vulnerable to hypothermia and its associated complications, e.g. respiratory embarrassment, metabolic acidosis, hypoglycemia, hypoxemia, cardiac disturbances, coagulopathy, and a higher incidence of wound infection etc. This higher vulnerability is mainly due to increased heat loss from larger head size, thin skin, lack of subcutaneous pad of fat and limited ability of compensatory thermogenesis from brown fat. As such it is mandatory to design appropriate diagnostic, preventive and therapeutic strategies which can effectively protect pediatric population from the potential catastrophic complications associated with hypothermia during perioperative period. The current review aims to refresh the basic mechanism of hypothermia and discussion of evidence based management strategies to minimize the incidence of hypothermia in pediatric patients. Key words: Perioperative, Hypothermia, Thermoregulation, Thermogenesis
Anestesia y Medicina del Dolor
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