“Since hypothermia during surgery directly affects the patient’s prognosis, active management through a multidisciplinary approach is essential. This is why we need active incentives to lead to this along with raising awareness.”
As hypothermia during surgery has been reported to have a direct impact on the patient’s prognosis, the need to manage it has emerged.
While active guidelines for hypothermia prevention are already being issued around the world, especially in developed countries, the Korean Society of Anesthesiology and Pain Medicine has also adopted this year’s recommendation and is actively responding to it.
Then, why is it important to maintain body temperature during surgery? Also, how should hypothermia be prevented?
“Low awareness compared to the risk of hypothermia during surgery”
Kim Seong-hyeop (Konkuk University College of Medicine), general affairs director of the Korean Society of Anesthesia and Pain Medicine, cited raising awareness as the first task. It is explained that the first piece of the puzzle is to be aware of this for both medical staff and patients.
Kim Seong-hyeop, executive director of the Society for Anesthesiology and Pain Medicine, emphasized the urgent need to raise awareness about hypothermia during surgery.
“In fact, hypothermia during surgery is one of the areas that anesthesiologists are aware of. However, it has not been properly approached due to various environmental factors so far. This is also why awareness raising is urgent. “
If so, does hypothermia during surgery actually occur frequently enough to cause alarm? His answer to this is ‘yes’.
He points out that the environment of the operating room itself is maintained at a low temperature, and if cold fluid or blood is injected while the patient is undressed for surgery, there is a greater risk of being exposed to hypothermia more easily than expected.
Director Kim said, “Patients often tremble due to psychological factors such as anxiety before surgery, and when anesthesia progresses, the temperature control center in the cerebrum is suppressed and peripheral blood vessels are dilated, so body temperature loss increases.” , It means that risk factors are scattered until after surgery,” he explained.
He continued, “However, because these changes in body temperature occur very slowly, even medical staff focusing on surgery often do not recognize them,” adding, “This is why a preemptive response is necessary.”
However, the side effects caused by hypothermia are more serious than expected. Looking at overseas clinical papers, there are reports that surgical site infection more than doubles, and there are results that increase the number of hospital stays.
In the end, experts believe that if the body temperature is properly maintained during surgery, various benefits such as preventing infection and reducing the length of hospital stay can be obtained.
Director Kim Seong-hyeop said, “Once hypothermia occurs, blood pressure rises from a hemodynamic perspective, and oxygen consumption increases as heart rate increases. This is the reason why it is a major cause of complications such as myocardial ischemia in patients with coronary artery disease or the elderly. ” he pointed out.
“Especially, if the blood flow in the wound is not smooth, it can cause infection and slow recovery,” he said. .
Agree on the need for management plans in the medical world… Emphasis on ERAS protocol, etc.
As awareness of the risk of hypothermia during surgery increases, the medical community is also busy moving around the Korean Society of Anesthesiology and Pain Medicine.
Director Kim emphasized the importance of temperature management during surgery as part of the ERAS program.
It is for the same reason that the Korean Society of Anesthesiology and Pain Medicine published ‘Expert Recommendations for Temperature Management in Patients During Surgery’ this year. This is a measure to improve awareness and promote proper warming.
This recommendation includes a recommendation to maintain core body temperature at or above 35.5°C during surgery.
In addition, it is recommended to actively utilize a warming device and to consider ‘forced air warmer’ first.
Director Kim Seong-hyeop said, “Maintaining core body temperature is most important to prevent hypothermia during surgery.” The method of heating and using blood when injecting it is considered.”
He continued, “The most common and effective method is a convection-type warming device that injects warm air.” It is a matter that is recommended as a priority in the recommendations made.”
However, since awareness of hypothermia during surgery is so low, support for it is clear. This means that there are many restrictions even if medical staff actively try to maintain body temperature.
In fact, if you look at the current domestic disposable blanket reimbursement standard, only one-time reimbursement is applied, limited to major surgeries such as general anesthesia, organ transplantation, and heart surgery for patients under the age of 6 and over the age of 70.
Director Kim said, “Intraoperative warming measures should be performed before, during, and after surgery for all patients, regardless of the type of surgery or the age of the patient.” It’s not easy, and if continuous warming is not done, it can fall into hypothermia again.”
He continued, “However, the current salary standard applies to a specific surgery at a specific age, and only one blanket per surgery case, so there is a great limitation in using it in the pre-surgery cycle.” It means that there are realistic limits,” he confessed.
Accordingly, the Korean Society of Anesthesiologists and others are focusing on improving awareness by emphasizing the importance of ERAS (Enhanced Recovery after Surgery), a postoperative recovery improvement program.
There are already reports that the ERAS protocol reduces overall medical costs and improves patient prognosis, and the world is in a hurry to introduce it.
Director Kim Seong-hyeop said, “The ERAS protocol has already accumulated numerous evidence that it substantially improves patients’ prognosis and reduces overall medical costs.”
A multidisciplinary approach is also being actively pursued. As the ERAS protocol itself requires a multidisciplinary approach, joint efforts are being made among academic societies.
A typical example is the proposal of the ERAS pilot project to the Ministry of Health and Welfare jointly by the Korean Society of Surgery and the Korean Society of Anesthesiologists.
Director Kim said, “Once such a pilot project is carried out, we expect that it will be of great help in raising awareness of temperature management during surgery, and that the voices of patients who have not recognized the importance of this will be actively heard.” We need to improve, but I think that changing patients’ perceptions is also one of the very important axes.”
In addition, he said, “I think it is very encouraging that body temperature measurements during surgery have been included in the adequacy evaluation items related to anesthesia.” We hope that it will serve as an opportunity to create an environment for Gaon.”
2023-07-12 20:30:00
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