Perioperative temperature management: a survey of 6 Asia-Pacific countries

Wenjun Koh, Murali Chakravarthy, Edgard Simon, Raveenthiran Rasiah, Somrat Charuluxananan, Tae-Yop Kim, Sophia T H Chew, Anselm Bräuer, Lian Kah Ti, Wenjun Koh, Murali Chakravarthy, Edgard Simon, Raveenthiran Rasiah, Somrat Charuluxananan, Tae-Yop Kim, Sophia T H Chew, Anselm Bräuer, Lian Kah Ti

Abstract

Background: Anesthesia leads to impairments in central and peripheral thermoregulatory responses. Inadvertent perioperative hypothermia is hence a common perioperative complication, and is associated with coagulopathy, increased surgical site infection, delayed drug metabolism, prolonged recovery, and shivering. However, surveys across the world have shown poor compliance to perioperative temperature management guidelines. Therefore, we evaluated the prevalent practices and attitudes to perioperative temperature management in the Asia-Pacific region, and determined the individual and institutional factors that lead to noncompliance.

Methods: A 40-question anonymous online questionnaire was distributed to anesthesiologists and anesthesia trainees in six countries in the Asia-Pacific (Singapore, Malaysia, Philippines, Thailand, India and South Korea). Participants were polled about their current practices in patient warming and temperature measurement across the preoperative, intraoperative and postoperative periods. Questions were also asked regarding various individual and environmental barriers to compliance.

Results: In total, 1154 valid survey responses were obtained and analyzed. 279 (24.2%) of respondents prewarm, 508 (44.0%) perform intraoperative active warming, and 486 (42.1%) perform postoperative active warming in the majority of patients. Additionally, 531 (46.0%) measure temperature preoperatively, 767 (67.5%) measure temperature intraoperatively during general anesthesia, and 953 (82.6%) measure temperature postoperatively in the majority of patients. The availability of active warming devices in the operating room (p < 0.001, OR 10.040), absence of financial restriction (p < 0.001, OR 2.817), presence of hospital training courses (p = 0.011, OR 1.428), and presence of a hospital SOP (p < 0.001, OR 1.926) were significantly associated with compliance to intraoperative active warming.

Conclusions: Compliance to international perioperative temperature management guidelines in Asia-Pacific remains poor, especially in small hospitals. Barriers to compliance were limited temperature management equipment, lack of locally-relevant standard operating procedures and training. This may inform international guideline committees on the needs of developing countries, or spur local anesthesiology societies to publish their own national guidelines.

Keywords: Asia; Health knowledge, attitudes, practice; Hypothermia; Monitoring, intraoperative; Perioperative care; Practice guidelines as topic; Temperature.

Conflict of interest statement

The authors of this manuscript have the following competing interests: AB is a member of the advisory board of 3 M Europe, and has received payments from 3 M Germany, 3 M Europe, 3 M Asia Pacific Pte Ltd. (https://www.3m.com/) for consultancy work. MC, ES, RR, SC, TYK, and LKT are Members of the Asia Normothermia Advisory Board. WK and STHC declare no competing interests. A total of 848 participants participated in the 3 M lucky draw, and the lucky draw prizes for survey respondents were provided by 3 M (Saint Paul, MN, USA. https://www.3m.com/). The lucky prizes were distributed independently of the study. The license fee for the online questionnaire (SurveyMonkey®, San Mateo, CA, USA) was provided by the Department of Anaesthesia, National University Hospital, Singapore, awarded to LKT.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Respondents’ compliance to key principles of perioperative temperature management guidelines

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