Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Dec 2008
ReviewThermal management during anaesthesia and thermoregulation standards for the prevention of inadvertent perioperative hypothermia.
Incidence of inadvertent perioperative hypothermia is still high, and thus thermoregulatory standards are warranted. This review summarizes current evidence of thermal management during anaesthesia, referring to recognized clinical queries (temperature measurement, definition of hypothermia, risk factors, warming methods, implementation strategies). Body temperature is a vital sign, and 37 degrees C is the mean core temperature of a healthy human. ⋯ The patient's body temperature should be above 36 degrees C before induction of anaesthesia, and should be measured continuously throughout surgery. Active warming should be applied intraoperatively. Postoperative patient temperature and outcomes should be evaluated.
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Best Pract Res Clin Anaesthesiol · Dec 2008
ReviewHyperthermia during anaesthesia and intensive care unit stay.
Nosocomial hyperthermia (fever) occurs in about 30% of all medical patients at some time during their hospital stay. In patients admitted to the intensive care unit with severe sepsis the incidence of hyperthermia is greater than 90%, while in a specialized neurological critical care unit the incidence is reported as 47%. In contrast, hyperthermia during anaesthesia is rare owing to the impairment of thermoregulation by anaesthetic agents. This article is designed to give an overview on the various causes of hyperthermia with special emphasis on fever during general and regional anaesthesia in general and neurological critical care patients.
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Best Pract Res Clin Anaesthesiol · Dec 2008
ReviewThermoregulatory management for mild therapeutic hypothermia.
In recent years the use of mild therapeutic hypothermia as a means of neuroprotection has become an important concept for treatment after cerebral ischemic hypoxic injury. Mild therapeutic hypothermia has been shown to improve outcome after out-of-hospital cardiac arrest, and many studies suggest a beneficial effect of mild therapeutic hypothermia on patient outcome after traumatic brain injury, cerebrovascular damage and neonatal asphyxia. This review article explores the numerous possibilities and methods for the induction of mild therapeutic hypothermia, reviews thermoregulatory management during maintenance and discusses associated risks and complications.
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Best Pract Res Clin Anaesthesiol · Dec 2008
ReviewTherapeutic hypothermia after cardiac arrest and myocardial infarction.
About 17 million people worldwide die from cardiovascular diseases each year. Impaired neurologic function after sudden cardiac arrest is a major cause of death in these patients. Up to now, no specific post-arrest therapy was available to improve outcome. ⋯ A broad implementation of this new therapy could save thousands of lives worldwide, as only 6 patients have to be treated to get one additional patient with favourable neurological recovery. At present, myocardial reperfusion by thrombolytic therapy or primary PCI as early as possible is the most effective therapy in patients with acute myocardial infarction. Mild therapeutic hypothermia might be a promising new therapy to prevent reperfusion injury after myocardial infarction, but its use in daily clinical routine cannot be recommended with the available evidence.
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Core body temperature is one of the most tightly regulated parameters of human physiology. At any given time, body temperature differs from the expected value by no more than a few tenths of a degree. ⋯ Consequently, perioperative hypothermia leads to a number of complications including postoperative shivering (which unacceptably increases patients' metabolic rates), impaired coagulation, prolonged drug action, and negative postoperative nitrogen balance. In this review I will describe how anesthesia and surgery impair thermoregulation, the resulting changes in heat balance, and the physiological responses provoked by perioperative alterations in body temperature.