Incidence, risk factors and outcome of perioperative hypothermia in paediatric patients at Kigali University Teaching Hospital

Abstract

Background: To maintain normal temperature in pediatric patients is problematic. Hypothermia can cause physiological derangements including coagulopathy, decreased drug metabolism and vasoconstriction. Patients who develop perioperative hypothermia, are prone to severe complications including impaired wound healing, postoperative infections, increased bleeding with blood transfusions, cardiac disorders and prolonged hospital stay. Since inadvertent perioperative hypothermia is a modifiable condition, understanding its risk factors may help prevent hypothermia and its associated complications. Objective: The aim of this study was to determine the incidence of perioperative hypothermia, factors associated with intraoperative hypothermia and outcome of perioperative hypothermia in pediatric patients operated at KUTH. Methods: A prospective observational study was conducted. Selected pediatric patients undergoing surgery in theatre between June 2018 and August 2018 were eligible for the study. Temperature was taken on arrival in theatre, immediately after induction of anesthesia, then after every hour until the procedure finished. The postoperative temperature was taken every 30 minutes up to 2 hours considering that patients stay in the postoperative care unit for 1-2 hours. Data were entered and texted using Microsoft word, cleaned with SPSS version 22.0. Tables and graphs were made using Microsoft excel. The quantitative variables were analyzed with “t” test and chi square was used for qualitative variables. Logistic regression was used to test each factor with the dependent variable and variables were carried to multi variant analysis. P value of <0.05 was a cutoff point to test for significance of associations. Results: 103 pediatric patients were enrolled to the study of whom 28 females and 75 males. Incidences of preoperative, intraoperative and postoperative hypothermia were 67%, 71.7% and 67.7% respectively. Female patients, use of general anesthesia, elective surgery, not using a warmer perioperatively and low operating room temperature (22-24˚C) were associated with intraoperative hypothermia. Hypothermic patients had increased transfusion requirements compared to the ones with normothermia. Hypothermic patients had longer PACU stay compared to normothermic patients. Conclusion: Perioperative hypothermia is common in our hospital. Warming patients, continuous temperature monitoring and management of operating room temperature should be done during anesthesia and in PACU.