Intraoperative body temperature and emergence delirium in elderly patients after non-cardiac surgery: A secondary analysis of a prospective observational study.
Journal
Chinese medical journal
ISSN: 2542-5641
Titre abrégé: Chin Med J (Engl)
Pays: China
ID NLM: 7513795
Informations de publication
Date de publication:
05 Oct 2023
05 Oct 2023
Historique:
medline:
23
10
2023
pubmed:
21
3
2023
entrez:
20
3
2023
Statut:
epublish
Résumé
Emergence delirium (ED) is a kind of delirium that occured in the immediate post-anesthesia period. Lower body temperature on post-anesthesia care unit (PACU) admission was an independent risk factor of ED. The present study was designed to investigate the association between intraoperative body temperature and ED in elderly patients undergoing non-cardiac surgery. This study was a secondary analysis of a prospective observational study. Taking baseline body temperature as a reference, intraoperative absolute and relative temperature changes were calculated. The relative change was defined as the amplitude between intraoperative lowest/highest temperature and baseline reference. ED was assessed with the confusion assessment method for intensive care unit at 10 and 30 min after PACU admission and before PACU discharge. A total of 874 patients were analyzed with a mean age of 71.8 ± 5.3 years. The incidence of ED was 38.4% (336/874). When taking 36.0°C, 35.5°C, and 35.0°C as thresholds, the incidences of absolute hypothermia were 76.7% (670/874), 38.4% (336/874), and 17.5% (153/874), respectively. In multivariable logistic regression analysis, absolute hypothermia (lowest value <35.5°C) and its cumulative duration were respectively associated with an increased risk of ED after adjusting for confounders including age, education, preoperative mild cognitive impairment, American Society of Anesthesiologists grade, duration of surgery, site of surgery, and pain intensity. Relative hypothermia (decrement >1.0°C from baseline) and its cumulative duration were also associated with an increased risk of ED, respectively. When taking the relative increment >0.5°C as a threshold, the incidence of relative hyperthermia was 21.7% (190/874) and it was associated with a decreased risk of ED after adjusting above confounders. In the present study, we found that intraoperative hypothermia, defined as either absolute or relative hypothermia, was associated with an increased risk of ED in elderly patients after non-cardiac surgery. Relative hyperthermia, but not absolute hyperthermia, was associated with a decreased risk of ED. Chinese Clinical Trial Registry (No. ChiCTR-OOC-17012734).
Sections du résumé
BACKGROUND
BACKGROUND
Emergence delirium (ED) is a kind of delirium that occured in the immediate post-anesthesia period. Lower body temperature on post-anesthesia care unit (PACU) admission was an independent risk factor of ED. The present study was designed to investigate the association between intraoperative body temperature and ED in elderly patients undergoing non-cardiac surgery.
METHODS
METHODS
This study was a secondary analysis of a prospective observational study. Taking baseline body temperature as a reference, intraoperative absolute and relative temperature changes were calculated. The relative change was defined as the amplitude between intraoperative lowest/highest temperature and baseline reference. ED was assessed with the confusion assessment method for intensive care unit at 10 and 30 min after PACU admission and before PACU discharge.
RESULTS
RESULTS
A total of 874 patients were analyzed with a mean age of 71.8 ± 5.3 years. The incidence of ED was 38.4% (336/874). When taking 36.0°C, 35.5°C, and 35.0°C as thresholds, the incidences of absolute hypothermia were 76.7% (670/874), 38.4% (336/874), and 17.5% (153/874), respectively. In multivariable logistic regression analysis, absolute hypothermia (lowest value <35.5°C) and its cumulative duration were respectively associated with an increased risk of ED after adjusting for confounders including age, education, preoperative mild cognitive impairment, American Society of Anesthesiologists grade, duration of surgery, site of surgery, and pain intensity. Relative hypothermia (decrement >1.0°C from baseline) and its cumulative duration were also associated with an increased risk of ED, respectively. When taking the relative increment >0.5°C as a threshold, the incidence of relative hyperthermia was 21.7% (190/874) and it was associated with a decreased risk of ED after adjusting above confounders.
CONCLUSIONS
CONCLUSIONS
In the present study, we found that intraoperative hypothermia, defined as either absolute or relative hypothermia, was associated with an increased risk of ED in elderly patients after non-cardiac surgery. Relative hyperthermia, but not absolute hyperthermia, was associated with a decreased risk of ED.
REGISTRATION
BACKGROUND
Chinese Clinical Trial Registry (No. ChiCTR-OOC-17012734).
Identifiants
pubmed: 36939236
doi: 10.1097/CM9.0000000000002375
pii: 00029330-990000000-00462
pmc: PMC10538877
doi:
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2330-2339Informations de copyright
Copyright © 2023 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.
Références
Mittal V, Walker E. Diagnostic and statistical manual of mental disorders. Psychiatry Res 2011; 189:158–159. doi: 10.1016/j.psychres.2011.06.006.
doi: 10.1016/j.psychres.2011.06.006
Aldecoa C, Bettelli G, Bilotta F, Sanders RD, Audisio R, Borozdina A, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol 2017; 34:192–214. doi: 10.1097/eja.0000000000000594.
doi: 10.1097/eja.0000000000000594
Hesse S, Kreuzer M, Hight D, Gaskell A, Devari P, Singh D, et al. Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the post-anaesthesia care unit: an early sign of postoperative complications. Br J Anaesth 2019; 122:622–634. doi: 10.1016/j.bja.2018.09.016.
doi: 10.1016/j.bja.2018.09.016
Munk L, Andersen G, Møller AM. Post-anaesthetic emergence delirium in adults: incidence, predictors and consequences. Acta Anaesthesiol Scand 2016; 60:1059–1066. doi: 10.1111/aas.12717.
doi: 10.1111/aas.12717
Zhang Y, He ST, Nie B, Li XY, Wang DX. Emergence delirium is associated with increased postoperative delirium in elderly: a prospective observational study. J Anesth 2020; 34:675–687. doi: 10.1007/s00540-020-02805-8.
doi: 10.1007/s00540-020-02805-8
Fields A, Huang J, Schroeder D, Sprung J, Weingarten T. Agitation in adults in the post-anaesthesia care unit after general anaesthesia. Br J Anaesth 2018; 121:1052–1058. doi: 10.1016/j.bja.2018.07.017.
doi: 10.1016/j.bja.2018.07.017
Ramroop R, Hariharan S, Chen D. Emergence delirium following sevoflurane anesthesia in adults - a prospective observational study. Braz J Anesthesiol 2019; 69:233–241. doi: 10.1016/j.bjan.2018.12.003.
doi: 10.1016/j.bjan.2018.12.003
Cotoia A, Mirabella L, Beck R, Matrella P, Assenzo V, Chazot T, et al. Effects of closed-loop intravenous anesthesia guided by Bispectral Index in adult patients on emergence delirium: a randomized controlled study. Minerva Anestesiol 2018; 84:437–446. doi: 10.23736/S0375-9393.17.11915-2.
doi: 10.23736/S0375-9393.17.11915-2
Sessler DI. Perioperative thermoregulation and heat balance. Lancet 2016; 387:2655–2664. doi: 10.1016/S0140-6736(15)00981-2.
doi: 10.1016/S0140-6736(15)00981-2
Yi J, Lei Y, Xu S, Si Y, Li S, Xia Z, et al. Intraoperative hypothermia and its clinical outcomes in patients undergoing general anesthesia: National study in China. PLoS One 2017; 12:e0177221doi: 10.1371/journal.pone.0177221.
doi: 10.1371/journal.pone.0177221
Rudiger A, Begdeda H, Babic D, Krüger B, Seifert B, Schubert M, et al. Intra-operative events during cardiac surgery are risk factors for the development of delirium in the ICU. Crit Care 2016; 20:264doi: 10.1186/s13054-016-1445-8.
doi: 10.1186/s13054-016-1445-8
Xara D, Silva A, Mendonca J, Abelha F. Inadequate emergence after anesthesia: Emergence delirium and hypoactive emergence in the Post-anesthesia Care Unit. J Clin Anesth 2013; 25:439–446. doi: 10.1016/j.jclinane.2013.02.011.
doi: 10.1016/j.jclinane.2013.02.011
Card E, Pandharipande P, Tomes C, Lee C, Wood J, Nelson D, et al. Emergence from general anaesthesia and evolution of delirium signs in the post-anaesthesia care unit. Br J Anaesth 2015; 115:411–417. doi: 10.1093/bja/aeu442.
doi: 10.1093/bja/aeu442
Peterson JF, Pun BT, Dittus RS, Thomason JW, Jackson JC, Shintani AK, et al. Delirium and its motoric subtypes: a study of 614 critically ill patients. J Am Geriatr Soc 2006; 54:479–484. doi: 10.1111/j.1532-5415.2005.00621.x.
doi: 10.1111/j.1532-5415.2005.00621.x
Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, et al. Evaluation of delirium in critically ill patients: validation of the confusion assessment method for the intensive care unit (CAM-ICU). Crit Care Med 2001; 29:1370–1379. doi: 10.1097/00003246-200107000-00012.
doi: 10.1097/00003246-200107000-00012
Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113:941–948. doi: 10.7326/0003-4819-113-12-941.
doi: 10.7326/0003-4819-113-12-941
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic co-morbidity in longitudinal-studies: development and validation. J Chronic Dis 1987; 40:373–383. doi: 10.1016/0021-9681(87)90171-8.
doi: 10.1016/0021-9681(87)90171-8
Desquilbet L, Mariotti F. Dose-response analyses using restricted cubic spline functions in public health research. Stat Med 2010; 29:1037–1057. doi: 10.1002/sim.3841.
doi: 10.1002/sim.3841
Ye C, Zhang Y, Luo S, Cao Y, Gao F, Wang E. Correlation of serum BACE1 with emergence delirium in postoperative patients: a preliminary study. Front Aging Neurosci 2020; 12:555594doi: 10.3389/fnagi.2020.555594.
doi: 10.3389/fnagi.2020.555594
Sun Y, Lin D, Wang J, Geng M, Xue M, Lang Y, et al. Effect of tropisetron on prevention of emergence delirium in patients after non-cardiac surgery: a trial protocol. JAMA Netw Open 2020; 3:e2013443doi: 10.1001/jamanetworkopen.2020.13443.
doi: 10.1001/jamanetworkopen.2020.13443
Neufeld KJ, Leoutsakos JS, Sieber FE, Joshi D, Wanamaker BL, Rios-Robles J, et al. Evaluation of two delirium screening tools for detecting postoperative delirium in the elderly. Br J Anaesth 2013; 111:612–618. doi: 10.1093/bja/aet167.
doi: 10.1093/bja/aet167
Assefa MT, Chekol WB, Melesse DY, Nigatu YA. Incidence and risk factors of emergence delirium after anesthesia in elderly patients at a post-anesthesia care unit in Ethiopia: prospective observational study. Patient Relat Outcome Meas 2021; 12:23–32. doi: 10.2147/PROM.S297871.
doi: 10.2147/PROM.S297871
Cascella M, Bimonte S, Di Napoli R. Delayed emergence from anesthesia: what we know and how we act. Local Reg Anesth 2020; 13:195–206. doi: 10.2147/LRA.S230728.
doi: 10.2147/LRA.S230728
Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Br J Anaesth 2018; 121:1005–1012. doi: 10.1016/j.bja.2017.11.087.
doi: 10.1016/j.bja.2017.11.087
Aldrete JA. Modifications to the post-anesthesia score for use in ambulatory surgery. J Perianesth Nurs 1998; 13:148–155. doi: 10.1016/S1089-9472(98)80044-0.
doi: 10.1016/S1089-9472(98)80044-0
Wagner D, Hooper V, Bankieris K, Johnson A. The relationship of postoperative delirium and unplanned perioperative hypothermia in surgical patients. J Perianesth Nurs 2021; 36:41–46. doi: 10.1016/j.jopan.2020.06.015.
doi: 10.1016/j.jopan.2020.06.015
John M, Crook D, Dasari K, Eljelani F, El-Haboby A, Harper CM. Comparison of resistive heating and forced-air warming to prevent inadvertent perioperative hypothermia. Br J Anaesth 2016; 116:249–254. doi: 10.1093/bja/aev412.
doi: 10.1093/bja/aev412
Yamasaki H, Tanaka K, Funai Y, Suehiro K, Ikenaga K, Mori T, et al. The impact of intraoperative hypothermia on early postoperative adverse events after radical esophagectomy for cancer: a retrospective cohort study. J Cardiothorac Vasc Anesth 2014; 28:943–947. doi: 10.1053/j.jvca.2014.02.013.
doi: 10.1053/j.jvca.2014.02.013
Sun Z, Honar H, Sessler DI, Dalton JE, Yang D, Panjasawatwong K, et al. Intraoperative core temperature patterns, transfusion requirement, and hospital duration in patients warmed with forced air. Anesthesiology 2015; 122:276–285. doi: 10.1097/ALN.0000000000000551.
doi: 10.1097/ALN.0000000000000551
Chen H, Jiang H, Chen B, Fan L, Shi W, Jin Y, et al. The incidence and predictors of postoperative delirium after brain tumor resection in adults: a cross-sectional survey. World Neurosurg 2020; 140:E129–E139. doi: 10.1016/j.wneu.2020.04.195.
doi: 10.1016/j.wneu.2020.04.195
Fu R, Zou L, Song X-C, Shen X, Huang F-H, Xiao L-Q, et al. Therapeutic effect of perioperative mild hypothermia on postoperative neurological outcomes in patients with acute Stanford type A aortic dissection. Heart Surg Forum 2020; 23:E815–E820. doi: 10.1532/hsf.3141.
doi: 10.1532/hsf.3141
Foudraine NA, Algargoush A, van Osch FH, Bos AT. A multimodal sevoflurane-based sedation regimen in combination with targeted temperature management in post-cardiac arrest patients reduces the incidence of delirium: an observational propensity score-matched study. Resuscitation 2021; 159:158–164. doi: 10.1016/j.resuscitation.2020.10.042.
doi: 10.1016/j.resuscitation.2020.10.042
Tayefeh F, Plattner O, Sessler DI, Ikeda T, Marder D. Circadian changes in the sweating-to-vasoconstriction interthreshold range. Pflugers Arch 1998; 435:402–406. doi: 10.1007/s004240050530.
doi: 10.1007/s004240050530
Pei L, Huang Y, Mao G, Sessler DI. Axillary temperature, as recorded by the iThermonitor WT701, well represents core temperature in adults having non-cardiac surgery. Anesth Analg 2018; 126:833–838. doi: 10.1213/ANE.0000000000002706.
doi: 10.1213/ANE.0000000000002706