Perioperative Hypothermia Essay

The preoperative phase begins when the decision to have surgery is made. It is used to assess the patients suitability for surgery, identify potential risk factors, educate the patient on avoiding complications of surgery and anaesthesia, and plan to meet the patients needs for a safe and sustained recovery upon discharge (Berman, 2014, p. 1015). This process includes addressing all parameters on the preoperative checklist. Fasting is an important part in the preoperative phase. Preoperative fasting is the practice of a patient abstaining from oral food and fluid intake for a certain amount of time before a surgical procedure is performed. This is intended to prevent pulmonary aspiration of stomach contents during general anaesthesia. When

On 01/27/2016, I observed about 22 patients in Postanesthesia Care Unit. Some of the patients were observed after surgeries while others were observed after endoscopy. During my shift, I observed patients awaiting recovery for removal of kidney stones, malignant melanoma (removal of moles), Endometrial Biopsy (EBX), superficial femoral artery (SFA), Hernia repair, Oophorectomy (ovary removal surgery), Cardiorrhaphy (Ventricular repair), Cystolithalopaxy (bladder stone removal), gall stone removal, Ectopic pregnancy surgery, and leg surgery.

ii. Hypothermia, defined as a core body temperature less than 36C, is a relatively common occurrence in the unwarmed surgical patient. A mild degree of perioperative hypothermia can be associated with significant morbidity and mortality. (Hart et al., 2011)

The appropriate assessment of patients prior to surgery to identify coexisting medical problems and to plan peri-operative care is of increasing importance. The goals of peri-operative assessment are to identify important medical issues in order to optimise their treatment, inform the patient of the risks associated with surgery, and ensure care is provided in an appropriate environment secondly to identify important social issues which may have a bearing on the planned procedure and the recovery period and to familiarise the patient with the planned procedure and the hospital processes.(American Society of Anaesthesiologists)

"Therapeutic Hypothermia: The History of General Refrigeration." Resus Review. Charles Bruen, 1 Dec. 2013. Web. 1 June 2015.

Malignant Hyperthermia is primarily thought to be an autosomal dominant genetic disorder that causes a hypermetabolic state after administration of volatile anesthetics. When a patient is under anesthesia, the muscles are usually relaxed, but when a patient is experiencing Malignant Hyperthermia crisis, certain IV anesthesia causes the opposite effect. Most inhaled anesthetics other than nitrous oxide, cause or trigger Malignant Hyperthermia. More specifically, the anesthetic agents: Halothane, Chloroform, and Succinylcholine. The genic condition of Malignant Hyperthermia only becomes apparent when a patient is exposed to certain anesthetics such as halothane, which causes muscle rigidity.

There are two different types of anesthesia; which are local and general. Preoperative services, administration, post-op and monitoring is included in the anesthesia package. Codes for anesthesia codes are simpler that codes for surgery. Qualifying circumstances recognizes four conditions. (99100) which indicates younger than a one year old or older than a 70-year-old, (99116) entire body hyperthermia, (99135) hypotension under control, (99140) situations that are emergency. Anesthesia payment formula is base + time +modifying units x conversion.

After being reminded by the instructor, I was aware of my mistakes and noticed that I failed to maintain patient’s safety. An oxygen below 90% can be very dangerous for the patient, especially for a post-op day #1 patient, because prolonged hypoxemia can cause fatigue, headache, acute respiratory failure, cardiac problems (increased heart rate,

One of the possible complications from surgery for Mrs Smith will be dehydration or electrolyte imbalance which would be why Mrs Smith was commenced on intravenous therapy (Farrell & Dempsey, 2014, p 321). Mrs Smith would be at a high risk of either dehydration or electrolyte imbalance due to the medications she is currently prescribed. Frusemide and Spank K have many side effects one of them for both medications is dehydration although Frusemide should have been ceased 7 days prior to surgery (Tiziani, 2013, p 700). Also contributing to possible dehydration and electrolyte balance would be the amount of time Mrs Smith would have fasted prior to the operation and the amount of time the operation procedure took.

Opioid-free anesthesia, as the name indicates, is the avoidance of opioids in pain treatment pre-operatively, intra-operatively, and post-operatively in an attempt to reduce opioid-induced respiratory complications without sacrificing patient comfort. Some of the reasons to avoid opioids, besides respiratory depression, include: “muscle weakness, excessive somnolence, post-operative nausea and vomiting, ileus and constipation, urinary retention, dizziness, obstructive breathing, negative inotropism, and the possibility of tolerance and addiction” (Mulier, 2012). Post-operatively, the patient’s respiratory system may be too depressed to pass extubation criteria. If able to extubate, early mobilization may be difficult if the patient is too

The management of postoperative pain has received much interest nowadays. The intensity of postoperative pain depends on many factors such as type and duration of the surgery, type of anesthesia and analgesia used, and the patient’s mental and emotional status (11).

Hypothermia is a common problem in surgical patients. Up to 70% of patients experience some degree of hypothermia that is undergoing anesthetic surgery. Complications include but are not limited to wound infections, myocardial ischemia, and greater oxygen demands. The formal definition of hypothermia is when the patient’s core body temperature drops below 36 degrees Celsius or 98.6 degrees Fahrenheit. Thus, the purpose of the paper is to synthesize what studies reveal about the current state of knowledge on the effects of pre-operative warming of patient’s postoperative temperatures. I will discuss consistencies and contradictions in the literature, and offer possible explanations for the inconsistencies.

A study to investigate the relationship between induced normothermia and outcomes after SAH was completed by Badjatia et al. (2010). The purpose of their study was to evaluate if utilization of advanced fever control (AFC) modalities to achieve normothermia reduced fever burden, rate of complications, and functional outcomes after SAH as compared to conventional fever control (CFC) modalities. In this case-control study, the AFC group consisted of 40 patients managed with advanced fever control modalities (surface or intravascular cooling). The CFC group consisted of 80 randomly selected historical patients treated with conventional fever control modalities (acetaminophen and water-circulating cooling blanket) who were matched by age,

Most patients had hypothermia, 229 (82.4%). As for the risk for development of perioperative positioning-related injury, 157 (56.5%) of the patients showed a higher risk and 214 (77%) had pressure-induced skin lesions. None of the patients had focal alopecia. Regarding the association of sociodemographic and clinical factors, hypothermia and the ELPO risk with the occurrence of perioperative positioning-related injuries, only the color on variable (p<0.001) was considered as a predictor for the occurrence of perioperative positioning-related injury. Nevertheless, even though it was not statistically significant, most injuries took place in female patients, adults, with altered BMI, with hypothermia, with normal hemoglobin and with ELPO ≥ 20. Based on the foregoing, we can highlight the importance of risk identification, occurrence of perioperative positioning-related injuries and associated factors with a view to developing strategies that help in the prevention of complications in clinical practice or in the solution of these complications in a suitable

A systematic review undertaken by Smetana (2009) identifies postoperative respiratory failure as an example of cascade iatrogenesis i.e. serial development of multiple medical complications that can be set in motion by a seemingly innocuous first event. In this case, Mrs Hilton’s open cholecystectomy is that first event. Smetana (2009) points out that: when an older patient with postoperative pain is over-sedated, a decline in respiratory function occurs, that if not recognized, can result in respiratory failure that requires mechanical ventilation, that again, if not managed properly can culminate in ventilator-associated pneumonia and even sepsis and death (p.1529). After her upper abdominal surgery Mrs Hilton may have difficulty with deep breathing and coughing due to pain however both are essential interventions for prevention and treatment of respiratory infections and complications. Brown et al. (2008) recommend that when Mrs Hilton is awake, turning, coughing and deep breathing should be encouraged every one to two hours as this aids in the removal of secretions and prevents mucous plugs. They also encourage mobility when possible to increase respiratory excursion. Moreover, as Mrs Hilton