masterThesis
Proporción de pacientes que presentan hipotermia peri operatoria durante un reemplazo articular de cadera, rodilla u hombro
Fecha
2016Autor
Medina, Juana
Cárdenas, Laura
Alarcón, Diego
Navas, Mónica
Niño, Claudia
Hermida, Eduardo
Rodríguez, Fernanda
Institución
Resumen
Introduction: Hypothermia in the surgical patient has been documented as a risk factor that increases myocardial morbimortality, triples the risk of surgical site infection and increases blood loss, which in consequence, will increase the hospital length of stay and healthcare costs. The impact of anesthesia during major procedures becomes relevant as it triggers the loss of temperature control. The main objective of this study is to report the proportion of cases of hypothermia, defined as a body core temperature lower than 36.0°C in a population of patients that underwent a total hip, knee and shoulder replacement at the Hospital Universitario
Fundación Santa Fe de Bogotá from November 2014 to March 2015.
Materials and Methods: A longitudinal analytic study was performed. Body core temperature was measured via the nasopharynx, esophageal or the tympanum. The temperature was registered prior to anesthetic induction and follow-up measurements were taken 30, 60 and 90 minutes after anesthetic induction. An additional temperature was measured after surgery at the recovery room. Normal distribution of the variables was assessed during the different periods in order to decide which statistical analysis should be used to test differences.
Results: Eighty-eight patients were analyzed. Mean age at the time of surgery was 70 years (SD 11.6), 63% were women. Among these patients, 55.7% underwent hip surgery, 39.7% knee surgery and 4.5% shoulder surgery. All patients were operated under general anesthesia and mean duration was 164 minutes. None of the patients received warming interventions prior to the anesthetic induction and 65% of them were warmed during surgical procedure. The proportion of patients in whom hypothermia was present during anesthetic induction was 12.5%, after 30 minutes 48.9%, after 60 minutes 48.8%, after 90 minutes 39.7% and, at recovery room 15.9%. A chi-square test was performed in order to compare the proportions between induction and the following periods in which temperature was measured. The proportion of patients with hypothermia during intraoperative measurements was statistically significant compared with the proportion of hypothermic patients during induction (p value 30min = 0.003, p value 60min = 0.019 and p value 90min = 0.002). There was no statistical difference between the proportion of patients with hypothermia during induction and the one taken at the recovery room (p value = 0.8).
Conclusion: Hypothermia was a prevalent condition during our primary joint replacements, a condition that can be attributable to the use of systemic anesthetics. It is apparent from the study that patient warming during the procedure is insufficient to prevent hypothermia in most patients. This is in concordance with the literature that recommends pre-warming as an indispensable step to prevent significant decrease in the intraoperative temperature.