RESUMO
BACKGROUND: Hypothermia is common in many plastic surgery procedures, but few measures to prevent its occurrence are taken. OBJECTIVES: This study evaluated the effect of hypothermia in patients undergoing plastic surgery procedures and the effect of utilizing simple and inexpensive measures to prevent patient hypothermia during surgery. METHODS: A randomized controlled clinical trial was performed among 3 groups of patients who underwent body contouring surgery for longer than 3.5 hours. In group 1, no protective measures were taken to prevent hypothermia; in group 2, maneuvers were applied intraoperatively for the duration of the entire surgical procedure; and in group 3, measures were taken preoperatively and intraoperatively. The results were quantified and analyzed through a bivariate analysis, including degree of hypothermia, anesthesia recovery time, time spent in the recovery area, intensity of pain, cold perception, response to opioids, and nausea. RESULTS: There were 122 patients included in the study: 43 in group 1, 39 in group 2, and 40 in group 3. All patients in group 1 had a higher degree of hypothermia, longer recovery time from anesthesia, longer overall recovery time, increased pain, increased feeling of cold, and more nausea. These patients also required a greater amount of opioids compared with the patients in groups 2 and 3. Many of the results were statistically significant. CONCLUSIONS: The adoption of simple and inexpensive measures before and during plastic surgery can prevent patient hypothermia during the procedures, leading to a shorter anesthesia recovery time and avoiding the undesirable effects associated with hypothermia. In addition, these measures may have significant economic savings.
Assuntos
Contorno Corporal/efeitos adversos , Hipotermia/prevenção & controle , Complicações Intraoperatórias/prevenção & controle , Assistência Perioperatória/métodos , Adulto , Regulação da Temperatura Corporal , Estudos de Coortes , Feminino , Humanos , Hipotermia/epidemiologia , Hipotermia/etiologia , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Pessoa de Meia-Idade , Duração da Cirurgia , Fatores de Tempo , Resultado do TratamentoRESUMO
Abstract Introduction: Hypothermia is perhaps the most frequent undesirable event in elective surgery. It is estimated that 1 h after surgery has initiated 70-90% of patients will experience hypothermia. In elective surgery, there are several factors leading to temperatures under 34 °C. Hypothermia may increases infections, bleeding and need for transfusion as well as the occurrence of an undesirable effect of discomfort and feared such as cold and postoperative shivering that can lead to cardiac complications due to increased of sympathetic influence. Objectives: Review the causes of these low temperatures within intraoperative elective surgery and check if the current alternatives to prevent hypothermia are effective. Methods: Review of non-systematic literature in PubMed and Medline was performed. Results: Hypothermia is the most common and least diagnosed undesirable event of patients undergoing surgery although it is easy to detect and preventive measures do not present major difficulties in their implementation. Conclusions: There are effective measures easy to set up, economical and effective to prevent hypothermia; the most important is the patient warm with hot air under pressure for 1 h and maintenance of air conditioning in the room above 22 °C. We just need to understand these measures and start to implement them.
Resumen Introducción: La hipotermia es tal vez el evento indeseable mas frecuente en los pacientes que van a cirugía programada. Se considera que 1 hora después de iniciada la cirugía el 70 al 90% de los pacientes se encuentran hipotérmicos. En cirugía Electiva en pacientes sanos hay varios factores que llevan a que nuestros pacientes mantengan cifras de temperaturas de 34 °C e inclusive menores. El problema está en que la hipotermia aumenta las infecciones, el sangrado y la necesidad de trasfusión, la aparición de un efecto indeseable y temido por el paciente como es el frío y temblor postoperatorio que puede llevar a complicaciones cardiacas debido al aumento del influjo simpático. Objetivos: Revisarlas causas que llevan a estas bajas temperaturas intraoperatorias en cirugía programada y revisar si las opciones que tenemos hoy en día para prevenir la hipotermia pueden ser efectivas. Métodos: Se realizó una revisión de la literatura no sistemática en las bases de datos PubMed y Medline. Resultados: La hipotermia es el evento indeseable más frecuente y menos diagnosticado en el paciente que va a cirugía a pesar que es fácil de detectar y las medidas preventivas son relativamente fáciles de instaurar. Conclusiones: Hay medidas efectivas, fáciles de instaurar, económicas y efectivas para evitar la hipotermia y entre ellas la más importante es el precalentamiento del paciente con aire caliente a presión por 1 hora, el mantenimiento del aire acondicionado de la sala por encima de 22 grados centígrados. Solo necesitamos entender cuales son estas medidas e iniciar a ponerlas en practica.