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Review
. 2021 Jul 15;18(14):7541.
doi: 10.3390/ijerph18147541.

Perioperative Hypothermia in Children

Marcus Nemeth  1 , Clemens Miller  1 , Anselm Bräuer  1
Affiliations
Review

Perioperative Hypothermia in Children

Marcus Nemeth et al. Int J Environ Res Public Health. .

Abstract

Background: First described by paediatric anaesthesiologists, perioperative hypothermia is one of the earliest reported side effects of general anaesthesia. Deviations from normothermia are associated with numerous complications and adverse outcomes, with infants and small children at the highest risk. Nowadays, maintenance of normothermia is an important quality metric in paediatric anaesthesia.

Methods: This review is based on our collection of publications regarding perioperative hypothermia and was supplemented with pertinent publications from a MEDLINE literature search.

Results: We provide an overview on perioperative hypothermia in the paediatric patient, including definition, history, incidence, development, monitoring, risk factors, and adverse events, and provide management recommendations for its prevention. We also summarize the side effects and complications of perioperative temperature management.

Conclusions: Perioperative hypothermia is still common in paediatric patients and may be attributed to their vulnerable physiology, but also may result from insufficient perioperative warming. An effective perioperative warming strategy incorporates the maintenance of normothermia during transportation, active warming before induction of anaesthesia, active warming during anaesthesia and surgery, and accurate measurement of core temperature. Perioperative temperature management must also prevent hyperthermia in children.

Keywords: anaesthesiology; children; hypothermia; infant; newborn; paediatric; perioperative; risk; warming strategy.

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Conflict of interest statement

A. Bräuer is a member of the advisory board of 3M Europe and has received payments from 3M Germany, 3M Europe, 3M Asia Pacific Pte Ltd Singapore. and Moeck and Moeck GmbH, Germany for consultancy work.

Figures

Figure 1
Figure 1
Pathophysiological pathways resulting from adverse events induced by cold stress in neonates.
Figure 2
Figure 2
Intraoperative X-ray of a 6-year-old boy undergoing Broviac catheter implantation with appropriate depth of oesophageal temperature probe inserted, according to the estimation method by Whitby et al. [64].
Figure 3
Figure 3
Use of an underbody, forced-air, warming blanket and insulation cover to efficiently prewarm a 4-month-old child.
Figure 4
Figure 4
Continued warming therapy after mask-induction during IV-cannulation of an infant.
Figure 5
Figure 5
Insulation of the body parts (e.g., napkin for the head) that cannot be actively warmed to reduce heat losses during washing and draping of an infant.
Figure 6
Figure 6
Second-degree burn of a 3-year-old boy after complex cardiac surgery with critically reduced peripheral perfusion. Reproduced from Truell KD, Bakerman PR, Teodori MF, Maze A. Third-degree burns to intraoperative use of a Bair Hugger warming device. Ann Thorac Surg 200; 69: 1933–1934 with permission of Elsevier [100].
Figure 7
Figure 7
Third-degree burn of a 3-year-old girl after a neurosurgical procedure. As a result of a malfunctioning device, a large full-skin burn occurred. Reprinted from Acikel C, Kale B, Celikoz B. Major thermal burn due to intraoperative heating blanket malfunction. Burns 2002; 28: 283–284 with permission of Elsevier [106].
Figure 8
Figure 8
Gas bubbles in a heated fluid.
See this image and copyright information in PMC

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