Risk factors and outcomes of intraoperative hypothermia in neonatal and infant patients undergoing general anesthesia and surgery

Abstract

ObjectiveThe incidence of intraoperative hypothermia remains high in pediatric patients during anesthesia and surgery even though core body temperature monitoring and warming systems have been greatly improved in recent years. We analyzed the risk factors and outcomes of intraoperative hypothermia in neonates and infants undergoing general anesthesia and surgery.MethodsThe data on the incidence of intraoperative hypothermia, other clinical characteristics, and outcomes from electronic records of 1,091 patients (501 neonates and 590 infants between 28 days and 1 year old), who received general anesthesia and surgery, were harvested and analyzed. Intraoperative hypothermia was defined as a core temperature below 36°C during surgery.ResultsThe incidence of intraoperative hypothermia in neonates was 82.83%, which was extremely higher than in infants (38.31%, p < 0.001)—the same as the lowest body temperature (35.05 ± 0.69°C vs. 35.40 ± 0.68°C, p < 0.001) and the hypothermia duration (86.6 ± 44.5 min vs. 75.0 ± 52.4 min, p < 0.001). Intraoperative hypothermia was associated with prolonged PACU, ICU, hospital stay, postoperative bleeding, and transfusion in either age group. Intraoperative hypothermia in infants was also related to prolonged postoperative extubation time and surgical site infection. After univariate and multivariate analyses, the age (OR = 0.902, p < 0.001), weight (OR = 0.480, p = 0.013), prematurity (OR = 2.793, p = 0.036), surgery time of more than 60 min (OR = 3.743, p < 0.001), prewarming (OR = 0.081, p < 0.001), received >20 mL/kg fluid (OR = 2.938, p = 0.004), and emergency surgery (OR = 2.142, p = 0.019) were associated with hypothermia in neonates. Similar to neonates, age (OR = 0.991, p < 0.001), weight (OR = 0.783, p = 0.019), surgery time >60 min (OR = 2.140, p = 0.017), pre-warming (OR = 0.017, p < 0.001), and receive >20 mL/kg fluid (OR = 3.074, p = 0.001) were relevant factors to intraoperative hypothermia in infants along with the ASA grade (OR = 4.135, p < 0.001).ConclusionThe incidence of intraoperative hypothermia was still high, especially in neonates, with a few detrimental complications. Neonates and infants each have their different risk factors associated with intraoperative hypothermia, but younger age, lower weight, longer surgery time, received more fluid, and no prewarming management were the common risk factors.

Hipotermia associada à anestesia geral e fatores de risco envolvidos: uma revisão integrativa

“…Ainda que os neonatos e lactentes sejam as classes de idades mais afetadas, os valores de incidência de hipotermia intraoperatória nos neonatos foram consideravelmente maiores que os valores dos lactentes (82,83% vs 38,31%). Zhao et al, (2023) em seu estudo retrospectivo realizado no Hospital da Faculdade de Medicina de Zhejiang contou com 501 neonatos e 590 lactentes e demonstrou com base em seus dados que a hipotermia tende a ser muito mais grave em neonatos. A perda de calor observada no recém-nascido nu, em uma temperatura ambiente de 26°C, é igual a perda de calor em um adulto também nu a 0°C, tal fator se explica devido aos altos valores da relação superfície/peso corporal, uma camada de queratina e gordura corporal menos espessas e o sistema termorregulador ser imaturo.…”

Predictors of postoperative mortality among neonates after major-risk surgery: A one-year experience from a Tunisian hospital

“…[15] Challenges in our setting include delays in neonatal surgery due to a lack of specialized anesthesiologists and insufficient devices for difficult intubation [16], ultrasound-guided vascular access [17], and temperature monitoring. [18] We advocate for a multidisciplinary approach involving surgeons, anesthetists, neonatologists, and trained nurses. [19] Continuous education and training for nurses and anesthesia technicians in neonatal healthcare can reduce the risk of postoperative infection, a main complication whose incidence remains high in our setting, necessitating urgent quality improvement programs to save neonates.…”

Intraoperative hypothermia in patients with laparoscopic surgery: Influencing factors and prevention strategies

“…However, currently, the majority of research on intraoperative hypothermia is concentrated within the domain of open surgery, with a particular emphasis on the utilization of thermal insulation equipment and the impact of nursing interventions. In contrast, there is a scarcity of studies that address the risk prediction and management of hypothermia specifically in the context of laparoscopic surgery [ 9 , 10 ]. In recent years, the evolution of laparoscopic surgery and the corresponding increase in operation times have led to a growing concern: hypothermia during laparoscopic procedures is emerging as a significant challenge in clinical practice.…”