Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Scientific Article

Risk factors for postoperative hypothermia in the post-anesthetic care unit: a prospective prognostic pilot study

Fatores de risco para hipotermia pós-operatória em sala de recuperação pós-anestésica: estudo piloto prospectivo de prognóstico

Fabrício Tavares Mendonça; Marcelo Cabral de Lucena; Raul Silva Quirino; Catia Sousa Govêia; Gabriel Magalhaes Nunes Guimarães

Downloads: 24
Views: 1460


Abstract Background: Hypothermia occurs in up to 20% of perioperative patients. Systematic postoperative temperature monitoring is not a standard of care in Brazil and there are few publications about temperature recovery in the postoperative care unit. Design and setting: Multicenter, observational, cross-sectional study, at Hospital de Base do Distrito Federal and Hospital Materno Infantil de Brasília. Methods: At admission and discharge from postoperative care unit, patients undergoing elective or urgent surgical procedures were evaluated according to tympanic temperature, vital signs, perioperative adverse events, and length of stay in postoperative care unit and length of hospital stay. Results: 78 patients, from 18 to 85 years old, were assessed. The incidence of temperatures <36 ºC at postoperative care unit admission was 69.2%. Spinal anesthesia (p < 0.0001), cesarean section (p = 0.03), and patients who received morphine (p = 0.005) and sufentanil (p = 0.003) had significantly lower temperatures through time. During postoperative care unit stay, the elderly presented a greater tendency to hypothermia and lower recovery ability from this condition when compared to young patients (p < 0.001). Combined anesthesia was also associated to higher rates of hypothermia, followed by regional and general anesthesia alone (p < 0.001). Conclusion: In conclusion, this pilot study showed that perioperative hypothermia is still a prevalent problem in our anesthetic practice. More than half of the analyzed patients presented hypothermia through postoperative care unit admission. We have demonstrated the feasibility of a large, multicenter, cross-sectional study of postoperative hypothermia in the post-anesthetic care unit.


Body temperature, Hypothermia, Anesthesia, Postoperative care


Resumo Justificativa: A hipotermia ocorre em até 20% dos pacientes no perioperatório. A monitoração sistemática pós-operatória da temperatura não é um padrão de atendimento no Brasil e há poucas publicações sobre recuperação da temperatura na sala de recuperação pós-anestésica. Desenho e cenário: Estudo multicêntrico, observacional, transversal, conduzido no Hospital de Base do Distrito Federal e no Hospital Materno Infantil de Brasília. Métodos: Na admissão e alta da sala de recuperação pós-anestesia, os pacientes submetidos a procedimentos cirúrgicos eletivos ou de urgência foram avaliados de acordo com a temperatura timpânica, sinais vitais, eventos adversos perioperatórios, tempo de permanência na sala de recuperação pós-anestesia e tempo de internação hospitalar. Resultados: Setenta e oito pacientes com idades entre 18 e 85 anos foram avaliados. A incidência de temperatura <36 ºC na admissão à sala de recuperação pós-anestesia foi de 69,2%. Raquianestesia (p < 0,0001), cesariana (p = 0,03) e os pacientes que receberam morfina (p = 0,005) e sufentanil (p = 0,003) apresentaram temperaturas significativamente menores ao longo do tempo. Durante a permanência na sala de recuperação pós-anestesia, os pacientes idosos apresentaram uma tendência maior a apresentarem hipotermia e menor capacidade de recuperação dessa condição, em comparação com os pacientes jovens (p < 0,001). Anestesia combinada também foi associada a taxas mais altas de hipotermia, seguida pelas anestesias regional e geral isoladas (p < 0,001). Conclusão: Em conclusão, este estudo piloto mostrou que a hipotermia perioperatória ainda é um problema prevalente em nossa prática anestésica. Mais de metade dos pacientes analisados apresentaram hipotermia durante a admissão à sala de recuperação pós-anestésica. Demonstramos a viabilidade de um grande estudo multicêntrico, transversal, de hipotermia pós-operatória em sala de recuperação pós-anestésica.


Temperatura corporal, Hipotermia, Anestesia, Cuidados pós-operatórios


Sessler DI. Mild perioperative hypothermia. N Engl J Med. 1997;336:1730-7.

Lopez M, Sessler DI, Walter K. Rate and gender dependence of the sweating, vasoconstriction, and shivering thresholds in humans. Anesthesiology. 1994;80:780-8.

Yousef MK, Dill DB, Vitez TS. Thermoregulatory responses to desert heat: age, race and sex. J Gerontol. 1984;39:406-14.

Sessler DI. Perioperative thermoregulation and heat balance. Ann N Y Acad Sci. 1997;813:757-77.

Matsukawa T, Sessler DI, Sessler AM. Heat flow and distribution during induction of general anesthesia. Anesthesiology. 1995;82:662-73.

D'Angelo Vanni SM, Castiglia YMM, Ganem EM. Preoperative warming combined with intraoperative skin-surface warming does not avoid hypothermia caused by spinal anesthesia in patients with midazolam premedication. Sao Paulo Med J Rev Paul Med. 2007;125:144-9.

Clark RE, Orkin LR, Rovenstine EA. Body temperature studies in anesthetized man: effect of environmental temperature, humidity, and anesthesia system. J Am Med Assoc. 1954;154:311-9.

Kurz A. Physiology of thermoregulation. Best Pract Res Clin Anaesthesiol. 2008;22:627-44.

Stewart SM, Lujan E, Huff CL. Innovations and excellence: the incidence of adult hypothermia in the postanesthesia care unit. Perioper Nurs Q. 1987;3:57-62.

Frank SM, Fleisher LA, Breslow MJ. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997;277:1127-34.

Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med. 1996;334:1209-16.

Schmied H, Kurz A, Sessler DI. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet Lond Engl. 1996;347:289-92.

Vaughan MS, Vaughan RW, Cork RC. Postoperative hypothermia in adults: relationship of age, anesthesia, and shivering to rewarming. Anesth Analg. 1981;60:746-51.

Poveda VB, Galvao CM, Dantas RAS. Hipotermia no período intra-operatório em pacientes submetidos a cirurgias eletivas. Acta Paul Enferm. 2009;22:361-6.

Gurunathan U, Stonell C, Fulbrook P. Perioperative hypothermia during hip fracture surgery: An observational study. J Eval Clin Pract. 2017;23:762-6.

Sessler DI. Perioperative heat balance. Anesthesiology. 2000;92:578-96.

Singh R, Asthana V, Sharma JP. Effect of irrigation fluid temperature on core temperature and hemodynamic changes in transurethral resection of prostate under spinal anesthesia. Anesth Essays Res. 2014;8:209-15.

Rawls SM, Benamar K. Effects of opioids, cannabinoids, and vanilloids on body temperature. Front Biosci Sch Ed. 2011;3:822-45.

Sabbe MB, Grafe MR, Mjanger E. Spinal delivery of sufentanil, alfentanil, and morphine in dogs. Physiologic and toxicologic investigations. Anesthesiology. 1994;81:899-920.

Kavee EH, Bernstein J, Zakowski MI. The hypothermic action of epidural and subarachnoid morphine in parturients. Reg Anesth. 1991;16:325-8.

Hui C-K, Huang C-H, Lin C-J. A randomised double-blind controlled study evaluating the hypothermic effect of 150 µg morphine during spinal anaesthesia for Caesarean section. Anaesthesia. 2006;61:29-31.

DeGroot DW, Havenith G, Kenney WL. Responses to mild cold stress are predicted by different individual characteristics in young and older subjects. J Appl Physiol Bethesda Md 1985. 2006;101:1607-15.

Wetz AJ, Perl T, Brandes IF. Unexpectedly high incidence of hypothermia before induction of anesthesia in elective surgical patients. J Clin Anesth. 2016;34:282-9.

Kongsayreepong S, Chaibundit C, Chadpaibool J. Predictor of core hypothermia and the surgical intensive care unit. Anesth Analg. 2003;96:826-33.

Agrawal N, Sewell DA, Griswold ME. Hypothermia during head and neck surgery. Laryngoscope. 2003;113:1278-82.

Frank SM, Beattie C, Christopherson R. Epidural versus general anesthesia, ambient operating room temperature, and patient age as predictors of inadvertent hypothermia. Anesthesiology. 1992;77:252-7.

Kenney WL, Munce TA. Invited review: aging and human temperature regulation. J Appl Physiol Bethesda Md 1985. 2003;95:2598-603.

Horn E-P, Bein B, Broch O. Warming before and after epidural block before general anaesthesia for major abdominal surgery prevents perioperative hypothermia: a randomised controlled trial. Eur J Anaesthesiol. 2016;33:334-40.

Joris J, Ozaki M, Sessler DI. Epidural anesthesia impairs both central and peripheral thermoregulatory control during general anesthesia. Anesthesiology. 1994;80:268-77.

Knight P. Conducting research in anaesthesia and intensive care medicine. Anesthesiol J Am Soc Anesthesiol. 2002;97:1327-8.

5dcb02000e8825724f03b87a rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections