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3.
Zhonghua Yi Xue Za Zhi ; 99(35): 2777-2780, 2019 Sep 17.
Artigo em Chinês | MEDLINE | ID: mdl-31550802

RESUMO

Objective: To investigate the effect of intraoperative warming on the postoperative relaxation recovery of cisatracurium in patients undergoing gastrointestinal surgery. Methods: Sixty ASA Ⅰ-Ⅱ patients, aged 20 to 60, undergoing elective gastrointestinal surgery in Cancer Hospital Chinese Academy of Medical Sciences from October, 2016 to March, 2019 were selected and they were randomly divided into two groups (n=30), N group and H group by random number table. N group was non-heat preserving group, and H group was heat preserving group. Tracheal intubation was induced by general anesthesia with cisatracurium 0.15 mg/kg, and the nasopharyngeal temperature were continuously monitored and recorded. Cisatracurium were infused 1-3 µg·kg(-1)·min(-1) by venous pump during operation with T1 at 1%-10% and stopped infusion 30 minutes before the end of surgery. The time when T1 recovered from 25% to 75%(muscle relaxation recovery index), and the time of T1 recovered to 25% to TOF ratios (TOFR, the ratio of the fourth muscle twitch height to T1 in TOF) recovery to 90% (full recovery time), cumulative drug use and surgery time were recorded. Results: There was no significant difference between the two groups in the cumulative drug dosage and operation time (P>0.05).The body temperature N group (35.7±0.2) ℃ was significantly lower than the H group (36.2±0.1) ℃ (t=13.940, P<0.01). The recovery index of N group (16.5±1.8) min was significantlyhigher than H group (10.5±2.1) min (t=12.094, P<0.01) and complete recovery time in N group (26.9±4.1) min was obviously longer than those in H group (15.0±2.9) (t=13.082, P<0.01). Conclusions: Patients with open gastrointestinal surgery are prone to hypothermia during surgery and heat protection is helpful to muscle relaxation recovery of cisatracurium.


Assuntos
Atracúrio/análogos & derivados , Temperatura Corporal , Procedimentos Cirúrgicos do Sistema Digestório , Hipotermia/prevenção & controle , Relaxamento Muscular , Adulto , Anestesia Geral , Atracúrio/administração & dosagem , Humanos , Cuidados Intraoperatórios , Pessoa de Meia-Idade , Adulto Jovem
4.
Medicine (Baltimore) ; 98(27): e16151, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277116

RESUMO

PURPOSE: Some studies have reported that warmed humidified carbon dioxide (CO2) insufflation in adult laparoscopic surgery could reduce pain and improve the core body temperature (CBT). However, similar studies are lacking in infants. Thus, this study aimed to investigate the clinical effects of warmed, humidified CO2 insufflation in pediatric patients undergoing major laparoscopic surgeries. METHODS: From January 2015 to December 2017, infants who underwent major laparoscopic surgeries in Ningbo Women and Children's Hospital were randomized to Group A (standard CO2 insufflation) or Group B (warmed humidified CO2 insufflation, 35°C, 95% relative humidity). Change in CBT at the end of surgery was the primary outcome. Secondary outcomes included surgery time, intraoperative blood loss, oxygen saturation (SO2), and Face, Legs, Activity, Cry and Consolability (FLACC) scale. These variables were compared between the 2 groups. RESULTS: Sixty-three infants (38 females, 25 males) were included; 30 patients were in Group A and 33 in Group B. The diseases treated with the laparoscopic approach included congenital megacolon, congenital diaphragmatic hernia, and intestinal malrotation. No deaths were noted. CBT was significantly higher in Group B at the end of surgery (P = .021). The occurrence of postoperative shivering (P = .02), hypothermia (P = .032), bowel movement (P = .044), and hospital stay (P = .038) was significantly different between the 2 groups; Group B had less shivering and hypothermia occurrence after surgery. Moreover, Group B demonstrated a more rapid postoperative recovery of bowel movement and shortened hospital stay than Group A. There was no statistical difference in operative time (P = .162), intraoperative blood loss (P = .541), SO2 (P = .59), and FLACC scale (P = .65) between the 2 groups. CONCLUSION: The use of warmed humidified CO2 insufflation in infants undergoing major laparoscopic surgery was helpful for maintaining normothermia and was associated with several positive postoperative outcomes, including less shivering and hypothermia, faster recovery of bowel movement, and shortened hospital stay.


Assuntos
Temperatura Corporal , Dióxido de Carbono/administração & dosagem , Insuflação/métodos , Laparoscopia/efeitos adversos , Feminino , Humanos , Hipotermia/prevenção & controle , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Dor Pós-Operatória/prevenção & controle , Tremor por Sensação de Frio
5.
Gynecol Oncol ; 154(3): 590-594, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31285083

RESUMO

OBJECTIVE: To increase the rate of normothermia (core temperature ≥ 36 °C) in patients undergoing gynecologic surgery. METHODS: The rate of surgical normothermia was evaluated in a single institution. A two-phase quality improvement project was undertaken; Phase 1 included the use of intra-operative room temperature regulation and intra-operative patient warming and Phase 2 included pre-operative patient warming. Clinical characteristics, median temperatures, and rate of normothermia were abstracted for patients in each phase. Cohorts were compared using chi-square and t-tests. RESULTS: The project was performed in two phases, each with a historic and intervention cohort. There were 503 patients in the historical cohort and 636 patients in the intervention cohort in phase 1; there were 291 patients in the historical cohort and 259 patients in the intervention cohort for Phase 2. Patient characteristics and anesthetic type and duration did not differ between cohorts. After intra-operative temperature regulation and patient warming in Phase 1, significantly more patients achieved normothermia (79% versus 68%, P < 0.0001). However operating room staff were more likely to rate the temperature as very hot in 40% of cases post-intervention, compared to only 2% historically. In Phase 2, after the intervention of pre-warming patients, there was no difference in achieving normothermia, 78% versus 83%, P = 0.09. Staff had no statistical difference in personal comfort with the temperature, however did feel efforts were very effective more frequently, 7.7% historic versus 32.7% post-intervention, P < 0.0001. CONCLUSIONS: Quality improvement methodology can be applied to pre- and intra-operative decision making to improve rates of surgical patient normothermia.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Hipertermia Induzida/métodos , Estudos de Coortes , Feminino , Procedimentos Cirúrgicos em Ginecologia/normas , Humanos , Hipotermia/etiologia , Hipotermia/prevenção & controle , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos
6.
Nursing ; 49(7): 49-53, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31166246

RESUMO

Thermal comfort helps patients maintain normothermia, decreases preoperative anxiety, and increases their sense of well-being. This article details an initiative to improve surgical patient satisfaction with thermal comfort using reflective blankets at a 115-bed major medical center and Level III trauma center in the Southwest US.


Assuntos
Roupas de Cama, Mesa e Banho , Hipotermia/prevenção & controle , Satisfação do Paciente/estatística & dados numéricos , Enfermagem Perioperatória , Difusão de Inovações , Humanos , Sudoeste dos Estados Unidos , Centros de Traumatologia
7.
Chin J Traumatol ; 22(4): 207-211, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31208792

RESUMO

PURPOSE: Trauma is a major health problem in developing countries and worldwide which requires many resources and much time in an emergency department (ED). Although Advanced Trauma Life Support (ATLS) is the gold standard, operator dependence can affect the quality of care. The objective was to identify differences in numbers and time to lifesaving interventions, investigation, ED length of stay, and mortality between an in-house protocol and conventional practice. METHODS: This was a single-center prospective non-randomized study for adult trauma patients in the ED. The trauma protocol was developed from the recent ATLS guideline. RESULTS: Thirty-two and 41 cases were in the in-house protocol group and conventional practice group, respectively. Endotracheal intubation was done more frequently in the in-house protocol group (84% vs. 59%, p = 0.03). Intercostal drainage tube insertion was done faster (6-26 min, median 11 min vs. 15-84 min, median 35 min, p = 0.02) and pre-arrival notification by emergency medical service increased in the in-house protocol group (66% vs. 30%, p = 0.01). Hypothermia in the operating room was found only in the conventional practice group (62% vs. 0, p = 0.007) and a warm blanket was used significantly more often in the in-house protocol group (25% vs. 0, p < 0.001). A directed acyclic graph with multivariate analysis was used to identify confounders. Time to Focused Assessment Sonography in Trauma was significantly shorter in the in-house protocol group (6.5-15.6 min, median 11 min, p = 0.019). CONCLUSION: In addition to the ATLS guideline, the trauma protocol could improve trauma care by reduced time to investigation, early notification of the trauma team in pre-hospital situations, reduced incidence of hypothermia in the operating room, and increased use of a warm blanket.


Assuntos
Cuidados de Suporte Avançado de Vida no Trauma , Serviço Hospitalar de Emergência , Ferimentos e Lesões/terapia , Adulto , Drenagem/métodos , Drenagem/estatística & dados numéricos , Serviços Médicos de Emergência , Feminino , Humanos , Hipotermia/prevenção & controle , Intubação Intratraqueal/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Fatores de Tempo
8.
Surg Technol Int ; 34: 40-45, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31037721

RESUMO

BACKGROUND: Although forced-air warming is the most commonly used method for perioperative patient warming, it is fundamentally problematic because it disturbs the carefully designed airflow in the operating room. Because unintended hypothermia has significant consequences, there is a need for more effective warming strategies. The effectiveness of warming technologies that apply heat through the skin is based on surface-area contact with the heat source and the duration of pre-warming. Therefore, we sought to test the therapeutic effectiveness of combined above- and below-warming therapies. Our hospital prohibits forced-air warming before the patient is draped, so a secondary goal was to determine the effect of preoperative warming using a system that does not interfere with airflow in the operating room. METHODS: We prospectively randomized 35 patients undergoing total knee arthroplasty into two groups: 1) forced-air warming/water mattress, using both WarmTouch® upper-body forced-air warming (Medtronic/Covidien Inc., Dublin, Ireland) and a Norm-O-Temp® underbody water mattress (CSZ/Gentherm Inc., Cincinnati, OH, USA), and 2) conductive fabric warming, using a HotDog® electric upper-body blanket (Augustine Temperature Management LLC, Eden Prairie, MN, USA) and a HotDog® underbody mattress. RESULTS: Throughout the surgical procedure, group 2 patients had significantly higher temperatures; this group experienced superior pre-warming during preoperative preparations and thus the redistribution temperature drop following the induction of anesthesia was reduced. Both groups achieved 100% normothermia by the end of surgery. CONCLUSION: Based solely on the temperatures at the end of surgery, these data indicate that forced-air warming in conjunction with a water mattress warming system is as effective as a conductive fabric electric warming system alone.


Assuntos
Calefação/instrumentação , Hipotermia/prevenção & controle , Artroplastia do Joelho/métodos , Leitos , Temperatura Corporal , Humanos , Assistência Perioperatória , Estudos Prospectivos , Equipamentos de Proteção
9.
Wilderness Environ Med ; 30(2): 163-176, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056372

RESUMO

INTRODUCTION: We compared the effectiveness of 5 heated hypothermia wrap systems. METHODS: Physiologic and subjective responses were determined in 5 normothermic subjects (1 female) for 5 heated hypothermia wraps (with vapor barrier and chemical heat sources) during 60 min of exposure to a temperature of -22°C. The 5 systems were 1) user-assembled; 2) Doctor Down Rescue Wrap; 3) hypothermia prevention and management kit (HPMK); 4) MARSARS Hypothermia Stabilizer Bag; and 5) Wiggy's Victims Casualty Hypothermia Bag. Core and skin temperature, metabolic heat production, skin heat loss, and body net heat gain were determined. Subjective responses were also evaluated for whole body cold discomfort, overall shivering rating, overall temperature rating, and preferential ranking. RESULTS: The Doctor Down and user-assembled systems were generally more effective, with higher skin temperatures and lower metabolic heat production; they allowed less heat loss, resulting in higher net heat gain (P<0.05). HPMK had the lowest skin temperature and highest shivering heat production and scored worse than the other 4 systems for the "whole body cold discomfort" and "overall temperature" ratings (P<0.05). CONCLUSIONS: The user-assembled and Doctor Down systems were most effective, and subjects were coldest with the HPMK system. However, it is likely that any of the tested systems would be viable options for wilderness responders, and the choice would depend on considerations of cost; volume, as it relates to available space; and weight, as it relates to ability to carry or transport the system to the patient.


Assuntos
Temperatura Baixa , Hipotermia/prevenção & controle , Reaquecimento/instrumentação , Adolescente , Adulto , Temperatura Corporal , Regulação da Temperatura Corporal/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tremor por Sensação de Frio , Temperatura Cutânea , Medicina Selvagem/instrumentação
10.
Anaesthesia ; 74(8): 1026-1032, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31062351

RESUMO

Pre-hospital transfusion of blood products is a vital component of many advanced pre-hospital systems. Portable fluid warmers may be utilised to help prevent hypothermia, but the limits defined by manufacturers often do not reflect their clinical use. The primary aim of this randomised in-vitro study was to assess the warming performance of four portable blood warming devices (Thermal Angel, Hypotherm X LG, °M Warmer, Buddy Lite) against control at different clinically-relevant flow rates. The secondary aim was to assess haemolysis rates between devices at different flow rates. We assessed each of the four devices and the control, at flow rates of 50 ml.min-1 , 100 ml.min-1 and 200 ml.min-1 , using a controlled perfusion circuit with multisite temperature monitoring. Free haemoglobin concentration, a marker of haemolysis, was measured at multiple points during each initial study run with spectrophotometry. At all flow rates, the four devices provided superior warming performance compared with the control (p < 0.001). Only the °M Warmer provided a substantial change in temperature at all flow rates (mean (95%CI) temperature change of 21.1 (19.8-22.4) °C, 20.4 (19.1-21.8) °C and 19.4 (17.7-21.1) °C at 50 ml.min-1 , 100 ml.min-1 and 200 ml.min-1 , respectively). There was no association between warming and haemolysis with any device (p = 0.949) or flow rate (p = 0.169). Practical issues, which may be relevant to clinical use, also emerged during testing. Our results suggest that there were significant differences in the performance of portable blood warming devices used at flow rates encountered in clinical practice.


Assuntos
Transfusão de Sangue , Serviços Médicos de Emergência , Calefação/instrumentação , Hipotermia/prevenção & controle , Hemoglobinas/análise , Hemólise , Humanos
11.
Anaesth Intensive Care ; 47(2): 169-174, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31106574

RESUMO

The importance of preventing hypothermia in the perioperative period cannot be overemphasised. The use of active warming devices is advocated and practised widely. The forced-air warming (FAW) blanket is currently a popular modality. The BARRIER® EasyWarm® (Mölnlycke Healthcare, Belrose, Australia) self-heating blanket, which does not require a power unit, has been proposed as an easy-to-use alternative to the FAW blanket. We conducted a single-centre, randomized controlled trial to compare the efficacy of the EasyWarm® self-heating blanket to the Cocoon blanket (Care Essentials, North Geelong, Australia), a conventional FAW blanket, in preventing intraoperative hypothermia. Forty patients undergoing elective surgery under general anaesthesia lasting >1 h were randomized in a 1:1 ratio. Prewarming was not allowed; 39 patients were analysed (19 EasyWarm® group and 20 Cocoon blanket group). There was no statistically significant difference between the two groups with regard to the mean (±standard deviation) final nasopharyngeal temperature (35.89 ± 0.82 °C versus 35.74 ± 0.77 °C; P = 0.72 in the Cocoon and EasyWarm® blanket groups, respectively). Similarly, the difference between average temperatures at 1, 2 and 3 h was not statistically significant. We found the EasyWarm® blanket to be as effective as the Cocoon FAW blanket in preventing intraoperative hypothermia. Due to its ease of use, the EasyWarm® blanket may have an additional benefit in preoperative warming of patients.


Assuntos
Roupas de Cama, Mesa e Banho , Hipotermia , Complicações Intraoperatórias , Austrália , Temperatura Corporal , Calefação , Humanos , Hipotermia/prevenção & controle , Complicações Intraoperatórias/prevenção & controle
12.
Medicine (Baltimore) ; 98(22): e15895, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145350

RESUMO

BACKGROUND: Postoperative hypothermia in elderly patients is a well-known serious complication as it impairs wound healing, induces coagulopathy, increases the risk of blood loss, enhances oxygen consumption, and precipitates cardiac arrhythmias. We conducted this randomized controlled trial to evaluate the effect of a forced-air warming system on rewarming elderly patients undergoing total knee or hip arthroplasty. METHODS: We recruited 243 elderly patients undergoing total knee or hip arthroplasty between May and December 2016. They were divided into three groups according to a computer-generated randomization table: group C (n = 78, rewarmed with only a regular blanket), group F1 (n = 82, rewarmed with a forced-air warming system set at 38°C), and group F2 (n = 83, rewarmed with a forced-air warming system set at 42°C). The nasopharyngeal temperature was recorded every 5 min for the first half hour, then every 10 min up to the end of the PACU (postanesthesia care unit) stay. The primary outcome was the rewarming time. The rewarming rate, increase in nasopharyngeal temperature (compared to the start of rewarming), hemodynamics, recovery time, and incidences of adverse effects were recorded. RESULTS: No significant differences were found among the three groups in terms of the baseline clinical characteristics, use of narcotic drugs, intraoperative temperature, and hemodynamics (P > .05). Compared with the elderly patients in groups C and F1, both the heart rate and mean arterial pressure of those in group F2 were significantly increased 20 min after arrival at the PACU (P < .05). Patients in group F2 had the shortest rewarming time (35.89 ±â€Š6.45 min, P < .001), highest rewarming efficiency (0.028 ±â€Š0.001°C/min, P < .001), and fastest increased nasopharyngeal temperature among the three groups. Moreover, the elderly patients in group F2 had lower incidences of arrhythmia and shivering (P < .05). CONCLUSIONS: The use of a forced-air warming system set at 42°C was shown to be the most effective way of rewarming elderly patients with postoperative hypothermia.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Hipotermia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Reaquecimento/métodos , Idoso , Temperatura Corporal/fisiologia , Feminino , Humanos , Hipotermia/etiologia , Masculino , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Prospectivos , Tremor por Sensação de Frio/fisiologia
13.
Eur J Anaesthesiol ; 36(6): 442-448, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30985539

RESUMO

BACKGROUND: Peri-operative hypothermia and shivering are frequent events in patients during caesarean delivery under spinal anaesthesia. OBJECTIVE: We assessed the efficacy of combined pre-anaesthetic forced-air warming in combination with warmed intravenous fluid infusion for preventing hypothermia and shivering during caesarean delivery under spinal anaesthesia. DESIGN: A randomised controlled study. SETTING: A tertiary care teaching hospital from July 2017 to April 2018. PATIENTS: A total of 50 pregnant women, American Society of Anaesthesiologists physical status 2, aged 20 to 45 years, scheduled for caesarean delivery under spinal anaesthesia. INTERVENTION: Patients were enrolled and randomised into two groups: an active warming group (n = 25), which received combined pre-anaesthetic whole body forced-air warming for 15 min and prewarmed intravenous fluids, and a control group, which received no active warming or warmed fluids (C group; n = 25). Spinal anaesthesia was induced with 10 mg bupivacaine containing fentanyl (10 µg). MAIN OUTCOME MEASURES: Tympanic membrane temperature and shivering severity were measured at baseline and every 10 min during surgery, and then every 10 min for 1 h postoperatively. Neonatal outcomes (tympanic membrane temperature at birth, umbilical venous blood pH, Apgar score) were also recorded. RESULTS: The incidences of peri-operative hypothermia (0 vs. 48%, P < 0.001) and shivering (22 vs. 52%, P = 0.031) were significantly lower in the active warming than in the C group. The maximum temperature change was also significantly lower in the active warming than in the C group. Maternal thermal comfort scores were higher in the active warming than in the C group. Neonatal parameters were not significantly different between the groups. CONCLUSION: The combination of pre-anaesthetic forced-air warming and warmed intravenous fluid infusions appears to be effective for preventing hypothermia and shivering during caesarean delivery under spinal anaesthesia. TRIAL REGISTRATION: This trial was registered with Clinical Trials.gov (identifier: NCT03256786).


Assuntos
Anestesia Obstétrica/efeitos adversos , Raquianestesia/efeitos adversos , Cesárea/efeitos adversos , Hipotermia/prevenção & controle , Adulto , Ar , Anestesia Obstétrica/métodos , Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Temperatura Corporal/efeitos dos fármacos , Temperatura Corporal/fisiologia , Estudos de Casos e Controles , Terapia Combinada/métodos , Feminino , Temperatura Alta/uso terapêutico , Humanos , Hipotermia/etiologia , Hipotermia/fisiopatologia , Infusões Intravenosas/métodos , Período Perioperatório , Gravidez , Estudos Prospectivos , Tremor por Sensação de Frio/efeitos dos fármacos , Tremor por Sensação de Frio/fisiologia , Resultado do Tratamento
14.
Rev Gaucha Enferm ; 40(spe): e20180218, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30970103

RESUMO

OBJECTIVE: To describe the thermoregulation protocol implementation for newborns (NB). METHODS: An experimental report, conducted at a neonatal unit in Salvador, Bahia, from January 2016 to January 2017. The Plan, Do, Check, Action cycle guided the construction, implementation and applicability of the protocol. RESULTS: Implementation of the protocol that allowed the reduction of adverse events due to thermal instability during surgical procedures and introduction of new technologies. CONCLUSION: The protocol could improve and strengthen the care practices related to safe surgery in newborns.


Assuntos
Protocolos Clínicos , Febre/prevenção & controle , Hipotermia/prevenção & controle , Complicações Intraoperatórias/prevenção & controle , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios , Humanos , Recém-Nascido , Guias de Prática Clínica como Assunto
16.
Rev Lat Am Enfermagem ; 27: e3103, 2019 Jan 17.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-30698215

RESUMO

OBJECTIVE: to compare the efficacy of three active heating methods in the prevention of intraoperative hypothermia in open gastroenterological surgeries. METHOD: randomized clinical trial with a sample of 75 patients, whose initial body temperature measured by a tympanic thermometer. Esophageal temperature <36ºC was considered hypothermic. Patients were divided into three groups using: thermal mattress, underbody forced-air warming blanket and heated infusion system. The tympanic and esophageal temperatures were measured at different times of the intraoperative period, but the temperature considered gold standard was the esophageal. To evaluate the homogeneity of the groups, we used chi-square test (categorical variables). In the comparison of temperature measurements over time, the analysis of variance (ANOVA) and the contrast profile test were used for the difference in temperature between the times. The non-parametric Kruskal-Wallis test was used to compare the three groups. The level of significance was 5%. RESULTS: regarding the studied variables, the groups were not homogeneous as to the categorical variable sex. All patients presented hypothermia during the intraoperative period (p> 0.05). CONCLUSION: there was no significant difference between the heating methods in the prevention of intraoperative hypothermia. REBEC - Brazilian Registry of Clinical Trials (RBR- no. 52shjp).


Assuntos
Anestesia Geral/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório , Calefação/instrumentação , Hipotermia/prevenção & controle , Complicações Intraoperatórias/prevenção & controle , Adulto , Temperatura Corporal , Feminino , Gastroenterologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
17.
Surg Infect (Larchmt) ; 20(3): 215-218, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30653405

RESUMO

BACKGROUND: Despite the indisputable need to prevent peri-operative hypothermia, some evidence in the literature questions the possible role of forced air warming systems as a risk factor for the occurrence of surgical site infection. The objective of the study is to evaluate the micro-biologic safety of a forced air warming systems (FAW) in relation to the risk of emission of micro-organisms in the surgical environment. METHODS: A quantitative, descriptive-exploratory laboratory study performed in a large hospital. An evaluation of possible internal contamination was performed by collecting air from the hose onto plates containing Trypticase Soy Agar. The experiment was performed in triplicate two months after replacing the filter and again after six months using a random sample of 50% of the FAW in use, which corresponded to 13 FAW and a total of 75 samples. RESULTS: Among the 39 samples analyzed in the first stage, only nine (23.1%) plates presented microbial growth of one or two colonies, while only six (16.7%) plates of the 36 evaluated samples in the second phase had growth of one or two colonies. CONCLUSIONS: This study showed small microbial growth of culture after 48 hours after filter replacement. New investigations that correlate the findings of micro-biology analysis and the occurrence of surgical site infection should be conducted.


Assuntos
Microbiologia do Ar , Calefação/efeitos adversos , Calefação/métodos , Hipotermia/complicações , Hipotermia/prevenção & controle , Período Intraoperatório , Infecção da Ferida Cirúrgica/epidemiologia , Ar , Estudos de Avaliação como Assunto , Humanos , Infecção da Ferida Cirúrgica/prevenção & controle
18.
Asian J Surg ; 42(1): 11-18, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29627391

RESUMO

Enhanced recovery after surgery (ERAS) is a series of perioperative optimized treatment measures based on evidence-based medicine which can control perioperative pathological and physiological responses, reduce surgical trauma and postoperative stress, and then achieve rapid recovery. This is a new concept in the 21st century, which is a revolution to the medical treatment and rehabilitation mode. Based on the clinical application study and expert experience in present ERAS in hepatectomy field at home and abroad, Chinese Expert Consensus on Enhanced Recovery After Hepatectomy (Version 2017) is established. The Chinese Expert consensus is the first guideline in the area of ERAS in hepatic surgery in China, which is drafted by the committee organized by Chinese Medical Association and China International Exchange and Promotive Association for Medical and Health Care.


Assuntos
Consenso , Hepatectomia , Complicações Intraoperatórias/prevenção & controle , Assistência Perioperatória , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Recuperação de Função Fisiológica , Sociedades Médicas/organização & administração , Anestesia , Ansiolíticos/administração & dosagem , Antibioticoprofilaxia , China , Aconselhamento , Medicina Baseada em Evidências , Jejum , Hepatectomia/métodos , Hipotermia/prevenção & controle , Apoio Nutricional , Educação de Pacientes como Assunto , Náusea e Vômito Pós-Operatórios/prevenção & controle , Privação de Água
19.
J Eval Clin Pract ; 25(2): 340-345, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30450648

RESUMO

RATIONALE, AIMS, AND OBJECTIVES: During general anaesthesia, body core temperature is influenced by several factors that are either anaesthesia-related (type and duration of anaesthesia and fluid management), surgery-related (type of surgery and extent of the surgical procedure), or patient-related (age, gender, body weight, and preoperative body core temperature). Interestingly, data concerning body mass index (BMI) and its influence on patients' temperature are sparse. The aim of this study was to evaluate the impact of BMI on body core temperature under general anaesthesia. METHODS: A single centre, prospective, observational study was conducted at a university hospital. Two cohorts (lower limb surgery and abdominal surgery) were evaluated. Patients were treated according to actual German guidelines for the prevention of hypothermia. Temperature was measured sublingually prior to anaesthesia and during the first 60 minutes of anaesthesia. Each cohort was divided in three subgroups (BMI < 24 kg m-2 , BMI 25-34.9 kg m-2 , and BMI > 35 kg m-2 ) according to body weight. RESULTS: A total of 206 patients were evaluated. One hundred four underwent lower limb surgery; 102 underwent abdominal surgery. After induction of anaesthesia, temperature dropped in all subgroups, but this decline was more pronounced in patients with lower BMI. Significant differences concerning temperature changes were observed in abdominal surgery between low and high BMI groups. After 60 minutes of anaesthesia, group-dependent temperature differences had levelled out, and relevant differences compared with preoperative temperatures could no longer be observed in any of the groups. CONCLUSION: Current guidelines provide effective protection against perioperative hypothermia. In the current study, this was true for obese as well as normal weight patients.


Assuntos
Anestesia , Índice de Massa Corporal , Hipotermia/prevenção & controle , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
20.
Injury ; 50(2): 308-317, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30409730

RESUMO

BACKGROUND: Vehicle extrication of crash victims is a highly-demanding challenge, due to the frequently life-threatening injuries of entrapped occupants. In this phase, crash victims are often exposed to the outdoor-temperature, with the risk of sustained hypothermia. Hypothermia can significantly raise the morbidity and mortality rates of crash victims. Therefore, we have correlated the incidence of severe car accidents with entrapped patients, the outdoor conditions, and expenditure of time for extrication. Furthermore, different warming strategies have been evaluated regarding their integrability within the rescue procedure. METHODS: To estimate the incidence of severe car accidents with entrapped patients, we performed retrospective data mining for the cold season of a three-year period in a rural district in Germany. We evaluated the integrability of a chemical heated blanket, its combined application with a forced-air warmer, or with an infrared radiator for patient warming. Therefore, we analysed the time tracking of extrication reference points during extrication exercises undertaken by the rescue services, simulating a severe vehicle accident and evaluated questionnaires administered to rescue personnel and subjects. Furthermore, we monitored subjects' physiologic parameters to estimate the warming effect. RESULTS: Incidence analysis resulted in extrication times of up to 80 min, representing two severely-entrapped patients per month in the cold seasons, corresponding to about four entrapments per 100.000 inhabitants every year. Of the different warming strategies analysed, the chemical blanket and the combination infrared radiator/chemical blanket were favoured regarding the items 'operator convenience', 'weight/size/handling', 'stability in positioning', 'time needed for installation', 'manpower requirement', 'hindrance during extrication operation', 'versality during extrication process', and 'robustness' by the rescue personnel; the forced-air warmer and the infrared radiator were preferred with regard to 'warming effect', the forced-air warmer and the chemical blanket was advantageous with regard to 'physical protection'. CONCLUSIONS: Vehicle extrication procedures are time consuming, a relevant finding that provides a rationale for discussing and optimising the rescue procedure to prevent sustained hypothermia. We determined that combined application of an infrared radiator and a chemical blanket is advantageous in terms of integration into the rescue process. However, a more detailed investigation, focussing on warming efficacy, must be performed.


Assuntos
Acidentes de Trânsito , Regulação da Temperatura Corporal/fisiologia , Temperatura Baixa/efeitos adversos , Exposição Ambiental/efeitos adversos , Calefação/métodos , Hipotermia/prevenção & controle , Trabalho de Resgate , Superfície Corporal , Serviços Médicos de Emergência , Alemanha , Calefação/instrumentação , Humanos , Hipotermia/etiologia , Incidência , Trabalho de Resgate/métodos , Trabalho de Resgate/organização & administração , Estudos Retrospectivos , Fatores de Tempo
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