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Pediyatrik Laparoskopik Cerrahide İstenmeyen Perioperatif Hipotermi İnsidansı: Tek Merkezli Gözlemsel Araştırma

Year 2022, , 297 - 303, 25.12.2022
https://doi.org/10.46332/aemj.1083413

Abstract

Amaç: Pediyatrik yaş grubu yetersiz yağ dokusu ve gelişmemiş termoregulatuar cevapları nedeniyle istenmeyen perioperatif hipotermi (İPH) için risk grubudur. Laparoskopik cerrahi altındaki pediyatrik yaş grubundaki İPH sıklığını saptamayı amaçladık.

Araçlar ve Yöntem: Bu araştırma gözlemsel prospektiftir. Genel anestezi altında laparoskopik cerrahi uygulanan pediyatrik hastalar (1-18 yaş) değerlendirildi. Hastaların timpanik membran sıcaklıkları (°C) anestezi indüksiyonu öncesi (T0) ve sonrasında cerrahi sırasında her 15 dakikada ölçüldü.

Bulgular: Toplam 100 hasta değerlendirildi. İstenmeyen perioperatif hipotermi sıklığı 13(%13) saptandı. Elektif cerrahilerdeki İPH sıklığı acil cerrahilerdekinden daha fazladır (<0.001). Toplam 28 elektif hastanın 11’inde (39.3%) İPH gelişti. Hipotermik hastaların yaş, vücut kitle indeksi, intravenöz sıvı volümü ve insufle edilen CO2 volümünün normotermik hastalarınkinden istatiksel olarak daha düşük olduğu saptandı. Normotermik ve hipotermik hastaların T0 (°C) (37.8±0.53 vs 36.8±0.60, sırasıyla, 95% CI, 37.6 to 37.8, p<0.001) arasında anlamlı istatiksel farklılık saptandı. Toplamda, ilk 30 dakikada vücut sıcaklığında yaklaşık 0.7 °C azalma gelişti.

Sonuç: Pediyatrik yaş grubundaki laparoskopik cerrahi sırasında İPH sıklıkla gelişmektedir. Kullandığımız güncel sıcaklık yönetimi ve pasif ısıtma sistemleri hipotermiden korumayı sağlamak için yeterli görünmemektedir. 


References

  • 1. Sessler DI. Complications and treatment of mild hypothermia. Anesthesiology. 2001;95(2):531-543.
  • 2. Collins S, Budds M, Raines C, Hooper V. Risk Factors for Perioperative Hypothermia: A Literature Review. J Perianesth Nurs. 2019;34(2):338-346.
  • 3. Kim P, Taghon T, Fetzer M, Tobias JD. Perioperative hypothermia in the pediatric population: a quality improvement project. Am J Med Qual. 2013;28(5): 400-406.
  • 4. Beedle SE, Phillips A, Wiggins S, Struwe L. Preventing Unplanned Perioperative Hypothermia in Children. AORN J. 2017;105(2):170-183.
  • 5. WHO. WHO guidelines for safe surgery 2009 – safe surgery saves life. WHO Press. Updated 01.04.2021. http://whqlibdoc.who.int/publications/2009/9789241598552_eng.pdf. Accessed 1 February, 2020.
  • 6. Gulack BC, Wong K, Sparks E, Ramjist J, Zhu H, Pierro A. Is the Laparotomy Here to Stay? A Review of the Disadvantages of Laparoscopy. Eur J Pediatr Surg. 2020;30(2):181-186.
  • 7. Fujimoto T, Segawa O, Lane GJ, Esaki S, Miyano T. Laparoscopic surgery in newborn infants. Surg Endosc. 1999;13(8):773-777.
  • 8. Ott DE. Laparoscopic hypothermia. J Laparoendosc Surg. 1991;1(3):127-131.
  • 9. Meng-Meng T, Xue-Jun X, Xiao-Hong B. Clinical effects of warmed humidified carbon dioxide insufflation in infants undergoing major laparoscopic surgery. Medicine (Baltimore). 2019;98(27):e16151.
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  • 13. Tander B, Baris S, Karakaya D, Ariturk E, Rizalar R, Bernay F. Risk factors influencing inadvertent hypothermia in infants and neonates during anesthesia. Paediatr Anaesth. 2005;15(7):574-579.
  • 14. Holland AJ, Ford WD. The influence of laparoscopic surgery on perioperative heat loss in infants. Pediatr Surg Int. 1998;13(5-6):350-351.
  • 15. Saad S, Minor I, Mohri T, Nagelschmidt M. The clinical impact of warmed insufflation carbon dioxide gas for laparoscopic cholecystectomy. Surg Endosc. 2000;14(9):787-790.
  • 16. Dean M, Ramsay R, Heriot A, Mackay J, Hiscock R, Lynch AC. Warmed, humidified CO2 insufflation benefits intraoperative core temperature during laparoscopic surgery: A meta-analysis. Asian J Endosc Surg. 2017;10(2):128-136.
  • 17. Cheong JY, Keshava A, Witting P, Young CJ. Effects of Intraoperative Insufflation With Warmed, Humidified CO2 during Abdominal Surgery: A Review. Ann Coloproctol. 2018;34(3):125-137.
  • 18. Birch DW, Dang JT, Switzer NJ, et al. Heated insufflation with or without humidification for laparoscopic abdominal surgery. Cochrane Database Syst Rev. 2016;10(10):CD007821.
  • 19. Journeaux M. Peri-operative hypothermia: implications for practice. Nurs Stand. 2013;27(45):33-38.
  • 20. Burns SM, Wojnakowski M, Piotrowski K, Caraffa G. Unintentional hypothermia: implications for perianesthesia nurses. J Perianesth Nurs. 2009;24(3): 167-173.
  • 21. Sessler DI. Temperature monitoring: the consequences and prevention of mild perioperative hypothermia. South. African J. Anaesth. Analg. 2014;20(1):25-31.

Incidence of Inadvertent Perioperative Hypothermia in Pediatric Laparoscopic Surgery: a Prospective Observational Single-Center Study

Year 2022, , 297 - 303, 25.12.2022
https://doi.org/10.46332/aemj.1083413

Abstract

Purpose: The pediatric age group is a risk group for Inadvertent perioperative hypothermia (IPH) due to insufficient subcutane-ous adipose tissue and underdeveloped thermoregulatory responses.
We aimed to determine the frequency of IPH in the pediatric age group undergoing laparoscopic surgery.

Materials and Methods: The study is prospective observational. Pediatric patients (1-18 years old) who underwent laparoscopic surgery under general anesthesia were evaluated. The tympanic membrane temperature measurements of the patients (°C) were recorded before anesthesia induction (T0) and then every 15 minutes during the surgery.

Results: A total of 100 patients were evaluated. The frequency of inadvertent perioperative hypothermia was detected as 13(13%). The frequency of IPH in elective surgery patients was higher than in emergency surgery (<0.001). IPH occurred in 11 of a total of 28(39.3%) patients during elective surgery.
Age, body mass index, intravenous fluid volume, and insufflated CO2 volume of hypothermic patients were detected to be statistically significantly lower than the normothermic group. A significant statistical difference was detected between T0 (°C) of nor-mothermic and hypothermic patients (37.8±0.53 vs. 36.8±0.60, respectively, 95% CI, 37.6 to 37.8, P<0.001). In total, a decrease of approximately 0.7 °C in body temperature was observed in the first 30 minutes.

Conclusion: IPH frequently develops during laparoscopic surgeries in the pediatric age group. The current temperature manage-ment practices and passive heating systems that we use do not seem adequate to provide protection from hypothermia.

References

  • 1. Sessler DI. Complications and treatment of mild hypothermia. Anesthesiology. 2001;95(2):531-543.
  • 2. Collins S, Budds M, Raines C, Hooper V. Risk Factors for Perioperative Hypothermia: A Literature Review. J Perianesth Nurs. 2019;34(2):338-346.
  • 3. Kim P, Taghon T, Fetzer M, Tobias JD. Perioperative hypothermia in the pediatric population: a quality improvement project. Am J Med Qual. 2013;28(5): 400-406.
  • 4. Beedle SE, Phillips A, Wiggins S, Struwe L. Preventing Unplanned Perioperative Hypothermia in Children. AORN J. 2017;105(2):170-183.
  • 5. WHO. WHO guidelines for safe surgery 2009 – safe surgery saves life. WHO Press. Updated 01.04.2021. http://whqlibdoc.who.int/publications/2009/9789241598552_eng.pdf. Accessed 1 February, 2020.
  • 6. Gulack BC, Wong K, Sparks E, Ramjist J, Zhu H, Pierro A. Is the Laparotomy Here to Stay? A Review of the Disadvantages of Laparoscopy. Eur J Pediatr Surg. 2020;30(2):181-186.
  • 7. Fujimoto T, Segawa O, Lane GJ, Esaki S, Miyano T. Laparoscopic surgery in newborn infants. Surg Endosc. 1999;13(8):773-777.
  • 8. Ott DE. Laparoscopic hypothermia. J Laparoendosc Surg. 1991;1(3):127-131.
  • 9. Meng-Meng T, Xue-Jun X, Xiao-Hong B. Clinical effects of warmed humidified carbon dioxide insufflation in infants undergoing major laparoscopic surgery. Medicine (Baltimore). 2019;98(27):e16151.
  • 10. Sessler DI. Temperature monitoring and perioperative thermoregulation. Review. Anesthesiology. 2008;109 (2):318-338.
  • 11. American Society of Anesthesiologists AC. Standards for Basic Anesthetic Monitoring. https://www.asahq.org/standards-and-guidelines/standards-for-basic-anesthetic-monitoring. Accessed 1 February, 2020.
  • 12. 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.
  • 13. Tander B, Baris S, Karakaya D, Ariturk E, Rizalar R, Bernay F. Risk factors influencing inadvertent hypothermia in infants and neonates during anesthesia. Paediatr Anaesth. 2005;15(7):574-579.
  • 14. Holland AJ, Ford WD. The influence of laparoscopic surgery on perioperative heat loss in infants. Pediatr Surg Int. 1998;13(5-6):350-351.
  • 15. Saad S, Minor I, Mohri T, Nagelschmidt M. The clinical impact of warmed insufflation carbon dioxide gas for laparoscopic cholecystectomy. Surg Endosc. 2000;14(9):787-790.
  • 16. Dean M, Ramsay R, Heriot A, Mackay J, Hiscock R, Lynch AC. Warmed, humidified CO2 insufflation benefits intraoperative core temperature during laparoscopic surgery: A meta-analysis. Asian J Endosc Surg. 2017;10(2):128-136.
  • 17. Cheong JY, Keshava A, Witting P, Young CJ. Effects of Intraoperative Insufflation With Warmed, Humidified CO2 during Abdominal Surgery: A Review. Ann Coloproctol. 2018;34(3):125-137.
  • 18. Birch DW, Dang JT, Switzer NJ, et al. Heated insufflation with or without humidification for laparoscopic abdominal surgery. Cochrane Database Syst Rev. 2016;10(10):CD007821.
  • 19. Journeaux M. Peri-operative hypothermia: implications for practice. Nurs Stand. 2013;27(45):33-38.
  • 20. Burns SM, Wojnakowski M, Piotrowski K, Caraffa G. Unintentional hypothermia: implications for perianesthesia nurses. J Perianesth Nurs. 2009;24(3): 167-173.
  • 21. Sessler DI. Temperature monitoring: the consequences and prevention of mild perioperative hypothermia. South. African J. Anaesth. Analg. 2014;20(1):25-31.
There are 21 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Articles
Authors

Recai Dağlı 0000-0002-6364-0545

Ülgen Çeltik 0000-0001-5707-2986

Fatma Çelik 0000-0003-0192-0151

Zeynel Abidin Erbesler 0000-0002-1571-1695

Zeynep Köylü 0000-0002-7774-9971

Publication Date December 25, 2022
Published in Issue Year 2022

Cite

APA Dağlı, R., Çeltik, Ü., Çelik, F., Erbesler, Z. A., et al. (2022). Incidence of Inadvertent Perioperative Hypothermia in Pediatric Laparoscopic Surgery: a Prospective Observational Single-Center Study. Ahi Evran Medical Journal, 6(3), 297-303. https://doi.org/10.46332/aemj.1083413
AMA Dağlı R, Çeltik Ü, Çelik F, Erbesler ZA, Köylü Z. Incidence of Inadvertent Perioperative Hypothermia in Pediatric Laparoscopic Surgery: a Prospective Observational Single-Center Study. Ahi Evran Med J. December 2022;6(3):297-303. doi:10.46332/aemj.1083413
Chicago Dağlı, Recai, Ülgen Çeltik, Fatma Çelik, Zeynel Abidin Erbesler, and Zeynep Köylü. “Incidence of Inadvertent Perioperative Hypothermia in Pediatric Laparoscopic Surgery: A Prospective Observational Single-Center Study”. Ahi Evran Medical Journal 6, no. 3 (December 2022): 297-303. https://doi.org/10.46332/aemj.1083413.
EndNote Dağlı R, Çeltik Ü, Çelik F, Erbesler ZA, Köylü Z (December 1, 2022) Incidence of Inadvertent Perioperative Hypothermia in Pediatric Laparoscopic Surgery: a Prospective Observational Single-Center Study. Ahi Evran Medical Journal 6 3 297–303.
IEEE R. Dağlı, Ü. Çeltik, F. Çelik, Z. A. Erbesler, and Z. Köylü, “Incidence of Inadvertent Perioperative Hypothermia in Pediatric Laparoscopic Surgery: a Prospective Observational Single-Center Study”, Ahi Evran Med J, vol. 6, no. 3, pp. 297–303, 2022, doi: 10.46332/aemj.1083413.
ISNAD Dağlı, Recai et al. “Incidence of Inadvertent Perioperative Hypothermia in Pediatric Laparoscopic Surgery: A Prospective Observational Single-Center Study”. Ahi Evran Medical Journal 6/3 (December 2022), 297-303. https://doi.org/10.46332/aemj.1083413.
JAMA Dağlı R, Çeltik Ü, Çelik F, Erbesler ZA, Köylü Z. Incidence of Inadvertent Perioperative Hypothermia in Pediatric Laparoscopic Surgery: a Prospective Observational Single-Center Study. Ahi Evran Med J. 2022;6:297–303.
MLA Dağlı, Recai et al. “Incidence of Inadvertent Perioperative Hypothermia in Pediatric Laparoscopic Surgery: A Prospective Observational Single-Center Study”. Ahi Evran Medical Journal, vol. 6, no. 3, 2022, pp. 297-03, doi:10.46332/aemj.1083413.
Vancouver Dağlı R, Çeltik Ü, Çelik F, Erbesler ZA, Köylü Z. Incidence of Inadvertent Perioperative Hypothermia in Pediatric Laparoscopic Surgery: a Prospective Observational Single-Center Study. Ahi Evran Med J. 2022;6(3):297-303.

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