Anesth Pain Med.  2019 Jan;14(1):112-116. 10.17085/apm.2019.14.1.112.

Postoperative hypothermia in geriatric patients undergoing arthroscopic shoulder surgery

• Chun EH
• Lee GY
• Kim CH

• KMID: 2434209
• DOI: http://doi.org/10.17085/apm.2019.14.1.112

Abstract

BACKGROUND
Hypothermia below 36℃ is a common problem during arthroscopic shoulder surgery. Geriatric patients are more vulnerable to perioperative hypothermia. The present study compared postoperative hypothermia between geriatric and young adult patients receiving arthroscopic shoulder surgery.
METHODS
Data were collected retrospectively from a geriatric group (aged 65 or more, n = 29), and a control group (aged 19-64, n = 33) using the anesthesia records of patients who had undergone arthroscopic shoulder surgery. The primary outcome measure was the incidence of hypothermia upon arrival in the postanesthesia care unit (PACU). The secondary outcome measure was the decrease in body temperature from admission into the operating room to admission into the PACU.
RESULTS
The incidence of hypothermia was 93.1% and 54.5% in the geriatric and control groups, respectively, demonstrating a significant difference between the groups (P < 0.001). Comparison between body temperature revealed a decrease of 1.5 ± 0.6℃ and 1.0 ± 0.4℃ in the geriatric and control groups, respectively, showing a significant difference between the groups (P < 0.001). The degree of hypothermia was significantly different between the groups (P = 0.027). No shivering was observed in either of the two groups, but the incidence of thermal discomfort was higher in the geriatric group than in the control group (P = 0.021).
CONCLUSIONS
In geriatric patients undergoing arthroscopic shoulder surgery, both the incidence of postoperative hypothermia and the associated temperature drop are more prominent than those in young adult patients. Additional warming methods will be needed to prevent postoperative hypothermia in geriatric patients.

Keyword

Aged; Arthroscopy; Hypothermia

MeSH Terms

Anesthesia
Arthroscopy
Body Temperature
Humans
Hypothermia*
Incidence
Operating Rooms
Outcome Assessment (Health Care)
Retrospective Studies
Shivering
Shoulder*
Young Adult

Figure

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  Fig. 1 Changes of mean body temperatures; Data are presented as mean ± SD. Body temperature was significantly lower in the geriatric group on PACU 0 and PACU 30. Asterisks (*) represent significant difference between the groups (P < 0.05). PACU: postanesthesia care unit, PACU 0: time of arrival at PACU, PACU 30: 30 minutes after arrival at PACU.

Reference

1. Board TN, Srinivasan MS. The effect of irrigation fluid temperature on core body temperature in arthroscopic shoulder surgery. Arch Orthop Trauma Surg. 2008; 128:531–3. DOI: 10.1007/s00402-007-0368-x. PMID: 17562057.

2. Jo YY, Kim HS, Chang YJ, Yun SY, Kwak HJ. The effect of warmed inspired gases on body temperature during arthroscopic shoulder surgery under general anesthesia. Korean J Anesthesiol. 2013; 65:14–8. DOI: 10.4097/kjae.2013.65.1.14. PMID: 23904934. PMCID: PMC3726840.

3. Oh JH, Kim JY, Chung SW, Park JS, Kim DH, Kim SH, et al. Warmed irrigation fluid does not decrease perioperative hypothermia during arthroscopic shoulder surgery. Arthroscopy. 2014; 30:159–64. DOI: 10.1016/j.arthro.2013.11.017. PMID: 24485109.

4. Kim YS, Lee JY, Yang SC, Song JH, Koh HS, Park WK. Comparative study of the influence of room-temperature and warmed fluid irrigation on body temperature in arthroscopic shoulder surgery. Arthroscopy. 2009; 25:24–9. DOI: 10.1016/j.arthro.2008.08.005. PMID: 19111215.

5. Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997; 277:1127–34. DOI: 10.1001/jama.1997.03540380041029. DOI: 10.1001/jama.277.14.1127. PMID: 9087467.

6. Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet. 1996; 347:289–92. DOI: 10.1016/S0140-6736(96)90466-3. PMID: 8569362.

7. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of wound infection and temperature group. N Engl J Med. 1996; 334:1209–15. DOI: 10.1056/NEJM199605093341901. PMID: 8606715.

8. Lenhardt R, Marker E, Goll V, Tschernich H, Kurz A, Sessler DI, et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology. 1997; 87:1318–23. DOI: 10.1097/00000542-199712000-00009. PMID: 9416715.

9. Ozaki M, Sessler DI, Matsukawa T, Ozaki K, Atarashi K, Negishi C, et al. The threshold for thermoregulatory vasoconstriction during nitrous oxide/sevoflurane anesthesia is reduced in the elderly. Anesth Analg. 1997; 84:1029–33. DOI: 10.1213/00000539-199705000-00014. PMID: 9141926.

10. Vaughan MS, Vaughan RW, Cork RC. Postoperative hypothermia in adults: relationship of age, anesthesia, and shivering to rewarming. Anesth Analg. 1981; 60:746–51. DOI: 10.1097/00132586-198206000-00062. PMID: 7197479.

11. NICE. Inadvertent perioperative hypothermia. National Institute for Health and Care Excellence. 2008. Apr [updated 2016 Dec; cited 2018 Jan 12]. Available from https://pathways.nice.org.uk/pathways/inadvertent-perioperative-hypothermia .

12. Yoo HS, Park SW, Yi JW, Kwon MI, Rhee YG. The effect of forced-air warming during arthroscopic shoulder surgery with general anesthesia. Arthroscopy. 2009; 25:510–4. DOI: 10.1016/j.arthro.2008.10.022. PMID: 19409309.

13. Sessler DI. Complications and treatment of mild hypothermia. Anesthesiology. 2001; 95:531–43. DOI: 10.1097/00000542-200108000-00040. PMID: 11506130.

14. Shin KS, Lee GY, Chun EH, Kim YJ, Kim WJ. Effect of short-term prewarming on body temperature in arthroscopic shoulder surgery. Anesth Pain Med. 2017; 12:388–93.

15. Frank SM, Beattie C, Christopherson R, Norris EJ, Rock P, Parker S, et al. Epidural versus general anesthesia, ambient operating room temperature, and patient age as predictors of inadvertent hypothermia. Anesthesiology. 1992; 77:252–7. DOI: 10.1097/00000542-199208000-00005. PMID: 1642343.

16. Vassilieff N, Rosencher N, Sessler DI, Conseiller C. Shivering threshold during spinal anesthesia is reduced in elderly patients. Anesthesiology. 1995; 83:1162–6. DOI: 10.1097/00000542-199512000-00005. PMID: 8533907.

17. Carli F, Gabrielczyk M, Clark MM, Aber VR. An investigation of factors affecting postoperative rewarming of adult patients. Anaesthesia. 1986; 41:363–9. DOI: 10.1111/j.1365-2044.1986.tb13219.x. PMID: 3706684.

18. Lim SH, Lee W, Park J, Kim MH, Cho K, Lee JH, et al. Preoperative interscalene brachial plexus block aids in perioperative temperature management during arthroscopic shoulder surgery. Korean J Anesthesiol. 2016; 69:362–7. DOI: 10.4097/kjae.2016.69.4.362. PMID: 27482313. PMCID: PMC4967631.

19. Poveda VB, Nascimento AS. Intraoperative body temperature control: esophageal thermometer versus infrared tympanic thermometer. Rev Esc Enferm USP. 2016; 50:946–52. DOI: 10.1590/s0080-623420160000700010. PMID: 28198959.