Best practice & research. Clinical anaesthesiology
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This chapter describes the incidence, mechanisms and possible consequences of hypothermia during cardiac surgery, including protection against ischaemia, alteration of the coagulation cascade and the inflammatory response. Various temperature-specific topics related to cardiac surgery are discussed, including the use of hypothermia or normothermia during cardiopulmonary bypass, and the temperature reached during rewarming at the end of cardiopulmonary bypass and its deleterious consequences for the brain (postoperative neurocognitive dysfunction). ⋯ Modern cardiac techniques, such as off-pump surgery and minimal extracorporeal circulation, and their implications for temperature preservation are discussed. Finally, a protocol is proposed that combines mild intra-operative hypothermia with peripheral active warming in order to avoid the need for fast, intense rewarming, thus avoiding the potential incidence of brain damage.
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Perioperative hypothermia is a common and serious complication of anesthesia and surgery and is associated with many adverse perioperative outcomes. It prolongs the duration of action of inhaled and intravenous anesthetics as well as the duration of action of neuromuscular drugs. Mild core hypothermia increases thermal discomfort, and is associated with delayed post anaesthetic recovery. ⋯ Hypothermia adversely affects antibody- and cell-mediated immune defences, as well as the oxygen availability in the peripheral wound tissues. Furthermore mild hypothermia triples the incidence of postoperative adverse myocardial events. Thus, even mild hypothermia contributes significantly to patient care costs and needs to be avoided.