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

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. 

Keywords

• Genel anestezi
• İstenmeyen hipotermi
• Laparoskopi
• Pediyatrik
• Vücut sıcaklı değişimi

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

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.

Keywords

• Accidental hypothermia
• Body temperature changes
• General anaesthesia
• Laparoscopy
• Pediatric

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