Effect of temperature maintenance by forced-air warming blankets of different temperatures on changes in inflammatory factors in children undergoing congenital hip dislocation surgery

Abstract

Background Hypothermia is associated with many adverse clinical outcomes in pediatric patients, and thus, it is important to find an effective and safe method for preventing peri-operative hypothermia and its associated adverse outcomes in pediatric patients. This study aimed to investigate the effect of forced-air warming blankets with different temperatures on changes in the transforming growth factor-β (TGF-β), tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-10 levels in children undergoing surgical treatment for developmental displacement of the hip (DDH). Methods The study included 123 children undergoing surgery for DDH under general anesthesia. The patients were randomly assigned to three groups, using a random number table: the 32, 38, and 43°C groups according to the temperature setting of the forced-air warming blankets. For each patient, body temperature was recorded immediately after anesthesia induction and intubation (T 0 ), at initial incision (T 1 ), at 1 h after incision (T 2 ), at 2 h after incision (T 3 ), at the end of surgery (T 4 ), immediately upon return to the ward after surgery (T 5 ), and then at 12 h (T 6 ), 24 h (T 7 ), 36 h (T 8 ), and 48 h (T 9 ) after the surgery. The serum levels of TGF-β, TNF-α, IL-1β, and IL-10 were measured at T 0 and T 4 for all groups. Results The number of patients with fever in the 38°C group was significantly less than those in the 32 and 43°C groups ( χ 2 = 6.630, P = 0.036). At T 0 , the body temperatures in the 38 and 43°C groups were significantly higher than that in the 32°C group ( F = 17.992, P < 0.001). At T 2 , the body temperature was significantly higher in the 43°C group than those in the 32 and 38°C groups ( F = 12.776, P < 0.001). Moreover, at T 4 , the serum levels of TGF-β ( F = 3286.548, P < 0.001) and IL-10 ( F = 4628.983, P < 0.001) were significantly increased in the 38°C group, and the serum levels of TNF-α ( F = 911.415, P < 0.001) and IL-1β ( F = 322.191, P < 0.001) were significantly decreased in the 38°C group, compared with the levels in the 32 and 43°C groups. Conclus...

Can the hyperthermia‐mediated heat shock factor/heat shock protein 70 pathway dampen the cytokine storm during SARS‐CoV‐2 infection?

“…However, in cancer treatment, several protocols were tested locally, such as hyperthermic intraperitoneal chemotherapy (Gelli et al, 2018; Lavoue et al, 2019), or using deep regional apparatus (Franckena et al, 2009; Overgaard et al, 1996; Pennacchioli, Fiore, & Gronchi, 2009). Recently, a clinical study showed that warming blankets (38°C) can be used to decrease inflammatory cytokines in patients after surgical treatment of hip displacement (He, Liu, Wen, & Wu, 2020; Petta et al, 2016). In inflammatory or infectious pathologies, hyperthermia was shown to have promising effects in sepsis‐induced acute lung injury in rats (Villar et al, 1994).…”

Perioperative active warming strategies in children: a protocol for a multicentre, prospective, randomized controlled trial

“…This relationship is especially true for infants, who generate heat through brown adipose tissue metabolism instead of shivering in low-temperature environments. This metabolism is innervated by sympathetic nerves and inhibited during general anaesthesia, further increasing the risk of IPH ( 17 – 19 ). Therefore, it is imperative to undertake appropriate warming measures for children during the perioperative period.…”

“…In contrast, active warming strategies are more effective, and the effects have been verified in adult patients ( 21 ). Active warming strategies generally include forced-air warming blankets ( 19 , 22 ), infusion heating apparatuses ( 23 ), forced air warmers ( 24 ), body cavity lavage liquid heating ( 25 ), increasing operating room temperature ( 26 ), etc. In addition, some studies have pointed out that prewarming 30–60 min before the operation can effectively decrease the incidence of IPH by reducing the redistribution of core body temperature ( 27 , 28 ).…”

Incidence and Risk factors for Intraoperative Hypothermia during Cancer Surgery of Gastrointestinal Tracts: a single-center retrospective study

“…However, due to the effect of general anaesthesia, the body is no longer able to counteract the reduction in temperature by shivering or vasoconstriction [2] ,and Intraoperative hypothermia occurs when thermal autoregulation is abolished under general anesthesia [3] . Hypothermia, generally de ned as a core body temperature <36℃, can occur at any stage in the perioperative period [4] .In general, hypothermia causes peripheral vasoconstriction, an increase in blood viscosity and a reduced blood ow, which can ultimately lead to increased thrombogenic potential [5] , increases intraoperative blood loss and risk of transfusion, delayes wound healing [6] , increases length of hospital stay and health-related costs, metabolic dysfunction, and even death [7] . Thus, intraoperative maintenance of normothermia is strongly recommended by several versions of the enhanced recovery after surgery (ERAS) guidelines as one of the major elements of perioperative care in colorectal surgery [8] .…”