The Incidence of Hyperthermia during Craniotomy

Abstract

There is evidence that even mild hyperthermia may exacerbate brain injury. There seem reasonable grounds for considering patients undergoing craniotomy as 'at risk' for brain injury. A retrospective observational study was undertaken to measure the incidence of mild hyperthermia in craniotomy cases in which the patient was initially normothermic. Auckland City Hospital's database of electronic anaesthetic records was searched for adult patients who were normothermic (≤37°C) prior to undergoing craniotomy procedures. For each case, demographic data, intraoperative naso-or oropharyngeal temperature measurements, and paracetamol use were extracted. We identified the proportion of patients whose temperature rose to exceed normal (>37°C) and further subdivided that group into the proportion in whom the temperature rose to ≥38°C. Two thousand, nine hundred and thirty-five craniotomy cases began their operations while normothermic and had adequate temperature data collected. There were 984 (33.5%) cases that had at least one temperature reading >37°C, for a mean (standard deviation [SD]) time of 66.0 (64.6) minutes, and 49 (1.7%) cases that had at least one reading ≥38°C for a mean (SD) time of 40.4 (38.1) minutes. The majority (77.8%) who became mildly hyperthermic remained so at the end of the procedure. New mild hyperthermia occurs commonly during craniotomy. In view of the compelling evidence of potential harm arising from mild hyperthermia in brain injury, these findings suggest an opportunity for practice improvement in the anaesthetic management of craniotomy patients. Reasonable steps should be taken by anaesthetists to avoid intraoperative hyperthermia of any degree.

Comment on the article of К.А. Tokmakov et al. “English for anesthesiologist: fashion or necessity?”

“…Если этот методический подход является реально рабочим, а так, по-видимому, и есть, то перспективы для этой методики церебральной термометрии открываются колоссальные. Но, конечно, основное поле для деятельности не анестезиология (хотя в недавней публикации Malpas et al [6] частота спонтанной гипертермии во время краниотомии составила 33,5 %), а интенсивная терапия пациентов с тяжелыми церебральными катастрофами [4,[7][8][9][10].…”

Perioperative hypothermia in open and laparoscopic colorectal surgery

“…22 Another small (n = 107) prospective non-randomized study in colorectal surgery patients and also found no significant difference in the incidence of perioperative hypothermia. 23,24 There was no significant difference in perioperative temperature profiles between open and laparoscopic (minimally invasive) surgery in a review of 45 casecontrolled anaesthetics, 26 and the incidence of hypothermia in colorectal surgery was 74% (n = 255) with no significant difference between open and laparoscopic surgery. 25 A weakness of the aforementioned studies is relatively small size.…”

“…A weakness of the aforementioned studies is relatively small size. Anaesthesia information management systems (AIMS) allow for continuous recording and audit of patient temperature profiles 26 . The aim of this study was to compare the perioperative temperature profile of patients undergoing open and laparoscopic colorectal surgery to define the incidence and severity of IPH, and to compare these two surgical approaches.…”

“…Anaesthesia information management systems (AIMS) allow for continuous recording and audit of patient temperature profiles. 26 The aim of this study was to compare the perioperative temperature profile of patients undergoing open and laparoscopic colorectal surgery to define the incidence and severity of IPH, and to compare these two surgical approaches. Understanding this may help to develop more effective warming interventions to improve patient outcomes in these two settings.…”