Inzidenz, Einflussgrößen und Folgen der unbeabsichtigten perioperativen Hypothermie während lungenchirurgischer Operationen: Eine retrospektive Analyse

Incidence, influential variables and sequelae of inadvertent perioperative hypothermia in the course of lung surgery: A retrospective analysis

by Gereon Maria Johannes Gries
Doctoral thesis
Date of Examination:2015-09-22
Date of issue:2015-09-03
Advisor:Prof. Dr. Anselm Bräuer
Referee:Prof. Dr. Anselm Bräuer
Referee:PD Dr. Bernhard C. Danner
Referee:Prof. Dr. Christina Unterberg-Buchwald
Persistent Address: http://dx.doi.org/10.53846/goediss-5248

 

 

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Abstract

English

Inadvertent perioperative hypothermia is a common event in the course of surgical interventions and aggravates perioperative morbidity among others by impairment of hemostasis and wound healing. Furthermore, it is associated with an increased risk of ischemic cardiac events. Nonetheless, little is known about the relevance and influential variables particularly with regard to the chosen anesthetic and surgical techniques. Influential variables of incidence and extent of perioperative hypothermia in the course of lung surgery are supposed to be identified in this publication. In addition, incidence of perioperative hypothermia is quantified and implication of perioperative morbidity and mortality shall be investigated. The analysis of 339 patients reveals an incidence of 64,3%. Based on multivariate analysis, time for anesthetic induction (p=0,004) becomes apparent as a facilitating variable, whereas larger body surface area (p=0,006) and the presence of pulmonary disease (p=0,007) decrease the incidence. Extent of perioperative hypothermia, determined by lowest perioperative temperature, is - in addition to anesthetic induction time (p=0,010) - negatively influenced by intraoperative infused volume (p=0,005), epidural anesthesia (p=0,002) and execution of the procedure by means of video-assisted thoracoscopic surgery (p=0,011). As opposed to this, larger body mass index (p=<0,001) and impairment of pulmonary function (p=0,008) have positive influence. However, there is no difference apparent between perioperative normothermic and hypothermic patients regarding transfusion, necessity and duration of mechanical ventilation and length of stay on the intensive care unit. Nevertheless, patients that suffered perioperative hypothermia were discharged from hospital earlier (p=0,012). There was no difference found regarding mortality during hospitalization. Despite the methodical deficiency of a retrospective analysis, especially the influence of anesthetic induction time and impairment of pulmonary function shown here mean promising origin for further research. More particularly, the negative influence of video-assisted thoracoscopic surgery demands more clarification.
Keywords: Accidential Hypothermia; Perioperative Care; Pulmonary Surgical Procedures; Epidural Anesthesia; VATS
Schlagwörter: Unbeabsichtigte Hypothermie; Perioperative Versorgung; Lungenchirurgie; Epiduralanästhesie; VATS
 
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