Evaluierung eines Algorithmus zur Adjustierung der aktiven Wärmezufuhr zur Prävention von iatrogener Hyperthermie in der Kinderanästhesie

Background: Perioperative hypothermia is associated with several adverse outcomes in children. To avoid this, forced-air warming devices are frequently used. However, their excessive use can lead to iatrogenic hyperthermia. Aims: To circumvent both hypo- and hyperthermia, we hypothesized that a simple algorithm could help minimize the incidence of intraoperative hyperthermia (core temperature >38°C) in children. Methods: This prospective study included children ≤12 years undergoing general anesthesia for noncardiac surgery. Children were placed on a forced-air warmed underbody blanket already in operation upon arrival, set to an initial temperature of 40°C or 43°C, as recommended by the manufacturer. Core temperature was measured by an esophageal temperature probe. The temperature of the forced-air warming device was reduced to 32°C when esophageal temperature reached 37.3°C. Conversely, if the esophageal temperature dropped below 36.5°C, the temperature of the forced-air warming device was to set to a maximal temperature of 43°C. Corresponding temperature alarm limits were set. Primary outcome were the prevalences of hyper- and hypothermia. Secondary outcomes included the characteristics of adjustments to the temperature settings and influencing factors, analyzed by linear, logistic, Cox regression, and zero-inflated Poisson models. Results: In 105 children (median age: 5.3 years), the incidences of hyperthermia and hypothermia were 0% and 6.7%, respectively. The temperature settings of the forced-air warming device were adjusted on 61 occasions (53 reductions) in 56 children. Following the initial reduction, a median increase of 0.1°C [1 st –3 rd 0.0-0.2] was observed in the esophageal temperature, which was reached after 5 minutes [1 st -3 rd 0.0-11.3]. An earlier necessity for reduction of temperature settings was associated with an increased initial esophageal temperature (OR 1.30, 95%-CI 1.13-1.53, p