Perioperative Hypothermia Staff Awareness

Running head: DISSERTATION
Perioperative hypothermia staff awareness
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Introduction
Hypothermia refers to a decreased body temperature that generally occurs when more amount
of heat is dissipated, in comparison to the heat absorbed. In humans, the condition is defined
as a body temperature lower than 35.0 °C or 95.0 °F. Some common signs and symptoms of
hypothermia encompass mental confusion and shivering. In addition, people suffering from
moderate hypothermia report increase in confusion, while shivering stops (Wu et al. 2017).
There might also be symptoms of paradoxical undressing in severe hypothermia, concomitant
with the risks of heart failure. The occurrence of hypothermia can be accredited to two major
causes. While it generally occurs due to exposure of the human body to extreme cold
temperature, any condition that brings about a reduction in heat production, or an increase in
loss of heat might also increase likelihood of people to suffer from this condition. Such
conditions typically involve anorexia, reduced blood sugar, alcohol intoxication, and
advanced age. Time and again it has been found that heat is generated in muscle tissue and
the heart, in addition to liver (Kurisu and Yenari 2018). In addition, heat is generally lost
through the lungs and the skin. Muscle contractions are also responsible for increasing heat
production manifold.
According to research evidences, the human body governs the core temperature of the body,
through numerous mechanisms that generally comprise of stimulation of the autonomic
nervous system stimulation, behavioral modification, sweating of the skin surface, and an
increase in production of heat through non-shivering and shivering thermogenesis. In
addition, autonomic regulation mechanism also comprise of peripheral vasodilation or
vasoconstriction, both controlling the core temperature (Klein et al. 2018). It has often been
postulated by researchers that precise regulation of temperature comprises of both the central
and the peripheral nervous systems through autonomic and behavioral triggers. This often
comprises of transmission of afferent signals for hot and cold sensations through the C and

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A-delta nerve fibers, respectively (Cardinali 2018). In addition, the sensory nerve fibers are
also able to identify any kind of change in the environmental temperature, through adequate
skin projections. The “sensors” have recently been characterized in the form of temporary
receptors that are located in the spinal cord and the skin. Signals for temperature from the
spinal cord, skin, deep thoracic tissue, and different regions of the brain mainly combine in
the anterior region of the spinal cord and get transmitted to the hypothalamus, the major
primary area of temperature control. Autonomic and behavioural responses to temperature
changes are then controlled by the hypothalamus (Carnevali et al. 2016). Inadvertent and
accidental perioperative hypothermia is a common occurrence in healthcare settings, and is
generally defined as the reduction of core body temperature lesser than 36 ºC, which can be
accredited to direct thermoregulation anesthetic inhibition, diminished metabolism and
exposure of the patient body to extreme chilling conditions of the operating room.
Furthermore, perioperative hypothermia also occurs under circumstances when the body
cavities gain an exposure, at the time of surgical events, thus mediating further heat loss. This
calls for the need of perioperative temperature control and surveillance that facilitates early
and accurate hypothermia detection, thereby providing assistance during perioperative
thermal governance (Song et al. 2016). Maintaining body temperature at the time of surgery
is significant because the condition leads to the onset of a range of health complications.
Nonetheless, when effectively indicated, vital organs that are suspected to be affected by
ischemia can be protected, like the myocardial and neuronal cells.
Background
The topic has been selected owing to the fact that perioperative hypothermia is quite
prevalent in healthcare settings. According to Yi et al. (2015) inadvertent and intraoperative
hypothermia has been identified as a major risk during surgery and creates severe health
consequences. The researchers elaborated on the fact that the prevalence and incidence of

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unintentional intraoperative hypothermia is significantly high in Beijing, which in turn is
concomitant with a reduce rate of active warming among patients during surgical procedures.
Hence, adequate focus must be placed on prevention of intraoperative hypothermia amid
patients undergoing major surgeries that require prolonged anesthesia, or administration of
un-warmed intravenous fluids. Yi et al. (2017) also conducted a study with the aim of
determining the general incidence of unintentional intraoperative hypothermia and associated
risk factors. They found that hypothermia is generally associated with an increase in
postoperative shivering, and also increases the rate of ICU admission among patients. In
addition, if not managed appropriately, the condition also increases the duration of
postoperative hospital days. The researchers illustrated that perioperative hypothermia is
associated with perioperative haemorrhage, postoperative cardiovascular events,
postoperative infection, and disturbed drug metabolism. Furthermore, the condition also
brings about a reduction in thermal comfort, reduces patient satisfaction, and increases
healthcare costs. Although patients were found to be typically provided passive warmth with
the usage of sheets, cotton blankets and surgical draping, none of the aforementioned
measures were considered effective in maintaining a steady body temperature during surgical
procedures. Collins et al. (2019) opined that it is crucial for the prevention of perioperative
hypothermia that the researchers are able to accurately identify and address major risk
factors, followed by implementation of suitable interventions. Length of surgery was the most
significant risk factor identified by the researchers, such that, longer duration for surgical
procedures increased the chance of a patient being exposed to impaired mechanism of
thermoregulation for a longer period, increased intravenous fluid administration, more fluid
and blood loss, and more loss of heat. In addition, specific group of patients such as,
neonates, female patients, older adults, and those who have experienced fluid shifts or trauma
are more likely to report signs and symptoms of perioperative hypothermia. In the words of