Unintentional hypothermia is associated with postoperative myocardial ischemia

Steven Mark Frank, C. Beattie, R. Christopherson, E. J. Norris, Bruce Alan Perler, G. M. Williams, S. O. Gottlieb, Curtis L Meinert, P. Rock, S. Parker, H. Yates, M. Breslow, B. Rosenfeld, D. Taylor, B. Brasfield, D. Bourke, P. Bezirdjian, S. Paul, Stephen C Achuff

Research output: Contribution to journalArticle

Abstract

Background: Hypothermia occurs commonly during surgery and can be associated with increased metabolic demands during rewarming in the postoperative period. Although cardiac complications remain the leading cause of morbidity after anesthesia and surgery, the relationship between unintentional hypothermia and myocardial ischemia during the perioperative period has not been studied. Methods: One hundred patients undergoing lower extremity vascular reconstruction received continuous Holter monitoring throughout the first 24 h postoperatively. Myocardial ischemia was determined by a cardiologist masked to clinical variables. The patient's sublingual temperature on arrival at the intensive care unit immediately after the surgical procedure was used to divide the patients into two groups: hypothermic (temperature, <35° C; n = 33) and normothermic (temperature, ≥ 35° C; n = 67). The relationship between unintentional hypothermia and myocardial ischemia occurring during the first postoperative day was evaluated by univariate and multivariate analyses. Results: A greater percentage of patients had electrocardiographic changes consistent with myocardial ischemia in the hypothermic group (36%, 12 of 33) compared with those in the normothermic group (13%, 9 of 67, P = 0.008). Preoperative risk factors for perioperative cardiac morbidity were similar between the two groups, except for patient age. The mean age was 70 ± 2 yr and 62 ± 1 yr in the hypothermic and normothermic groups, respectively (P = 0.001). When subgroup and multivariate analyses were used to adjust for differences in age, temperature remained an independent predictor of ischemia (odds ratio, 1.82 per degree Celsius; 95% confidence interval, 1.09-3.02). The incidence of postoperative angina was greater in the hypothermic group (18%, 6 of 33) than in the normothermic group (1.5%, 1 of 67, P = 0.002). The incidence of Pa(O2) <80 mmHg in the arterial blood was greater in the hypothermic group (52%, 17 of 33) than in the normothermic group (30%, 20 of 67, P = 0.03). Conclusions: Unintentional hypothermia is associated with myocardial ischemia, angina, and Pa(O2) <80 mmHg during the early postoperative period in patients undergoing lower extremity vascular surgery.

Original languageEnglish (US)
Pages (from-to)468-476
Number of pages9
JournalAnesthesiology
Volume78
Issue number3
StatePublished - 1993

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Hypothermia
Myocardial Ischemia
Temperature
Postoperative Period
Blood Vessels
Lower Extremity
Multivariate Analysis
Morbidity
Rewarming
Ambulatory Electrocardiography
Perioperative Period
Incidence
Intensive Care Units
Ischemia
Anesthesia
Odds Ratio
Confidence Intervals

Keywords

  • Complications: ischemia
  • Heart, ischemia: postoperative
  • Temperature, hypothermia: perioperative; complications

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Frank, S. M., Beattie, C., Christopherson, R., Norris, E. J., Perler, B. A., Williams, G. M., ... Achuff, S. C. (1993). Unintentional hypothermia is associated with postoperative myocardial ischemia. Anesthesiology, 78(3), 468-476.

Unintentional hypothermia is associated with postoperative myocardial ischemia. / Frank, Steven Mark; Beattie, C.; Christopherson, R.; Norris, E. J.; Perler, Bruce Alan; Williams, G. M.; Gottlieb, S. O.; Meinert, Curtis L; Rock, P.; Parker, S.; Yates, H.; Breslow, M.; Rosenfeld, B.; Taylor, D.; Brasfield, B.; Bourke, D.; Bezirdjian, P.; Paul, S.; Achuff, Stephen C.

In: Anesthesiology, Vol. 78, No. 3, 1993, p. 468-476.

Research output: Contribution to journalArticle

Frank, SM, Beattie, C, Christopherson, R, Norris, EJ, Perler, BA, Williams, GM, Gottlieb, SO, Meinert, CL, Rock, P, Parker, S, Yates, H, Breslow, M, Rosenfeld, B, Taylor, D, Brasfield, B, Bourke, D, Bezirdjian, P, Paul, S & Achuff, SC 1993, 'Unintentional hypothermia is associated with postoperative myocardial ischemia', Anesthesiology, vol. 78, no. 3, pp. 468-476.
Frank SM, Beattie C, Christopherson R, Norris EJ, Perler BA, Williams GM et al. Unintentional hypothermia is associated with postoperative myocardial ischemia. Anesthesiology. 1993;78(3):468-476.
Frank, Steven Mark ; Beattie, C. ; Christopherson, R. ; Norris, E. J. ; Perler, Bruce Alan ; Williams, G. M. ; Gottlieb, S. O. ; Meinert, Curtis L ; Rock, P. ; Parker, S. ; Yates, H. ; Breslow, M. ; Rosenfeld, B. ; Taylor, D. ; Brasfield, B. ; Bourke, D. ; Bezirdjian, P. ; Paul, S. ; Achuff, Stephen C. / Unintentional hypothermia is associated with postoperative myocardial ischemia. In: Anesthesiology. 1993 ; Vol. 78, No. 3. pp. 468-476.
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abstract = "Background: Hypothermia occurs commonly during surgery and can be associated with increased metabolic demands during rewarming in the postoperative period. Although cardiac complications remain the leading cause of morbidity after anesthesia and surgery, the relationship between unintentional hypothermia and myocardial ischemia during the perioperative period has not been studied. Methods: One hundred patients undergoing lower extremity vascular reconstruction received continuous Holter monitoring throughout the first 24 h postoperatively. Myocardial ischemia was determined by a cardiologist masked to clinical variables. The patient's sublingual temperature on arrival at the intensive care unit immediately after the surgical procedure was used to divide the patients into two groups: hypothermic (temperature, <35° C; n = 33) and normothermic (temperature, ≥ 35° C; n = 67). The relationship between unintentional hypothermia and myocardial ischemia occurring during the first postoperative day was evaluated by univariate and multivariate analyses. Results: A greater percentage of patients had electrocardiographic changes consistent with myocardial ischemia in the hypothermic group (36{\%}, 12 of 33) compared with those in the normothermic group (13{\%}, 9 of 67, P = 0.008). Preoperative risk factors for perioperative cardiac morbidity were similar between the two groups, except for patient age. The mean age was 70 ± 2 yr and 62 ± 1 yr in the hypothermic and normothermic groups, respectively (P = 0.001). When subgroup and multivariate analyses were used to adjust for differences in age, temperature remained an independent predictor of ischemia (odds ratio, 1.82 per degree Celsius; 95{\%} confidence interval, 1.09-3.02). The incidence of postoperative angina was greater in the hypothermic group (18{\%}, 6 of 33) than in the normothermic group (1.5{\%}, 1 of 67, P = 0.002). The incidence of Pa(O2) <80 mmHg in the arterial blood was greater in the hypothermic group (52{\%}, 17 of 33) than in the normothermic group (30{\%}, 20 of 67, P = 0.03). Conclusions: Unintentional hypothermia is associated with myocardial ischemia, angina, and Pa(O2) <80 mmHg during the early postoperative period in patients undergoing lower extremity vascular surgery.",
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author = "Frank, {Steven Mark} and C. Beattie and R. Christopherson and Norris, {E. J.} and Perler, {Bruce Alan} and Williams, {G. M.} and Gottlieb, {S. O.} and Meinert, {Curtis L} and P. Rock and S. Parker and H. Yates and M. Breslow and B. Rosenfeld and D. Taylor and B. Brasfield and D. Bourke and P. Bezirdjian and S. Paul and Achuff, {Stephen C}",
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T1 - Unintentional hypothermia is associated with postoperative myocardial ischemia

AU - Frank, Steven Mark

AU - Beattie, C.

AU - Christopherson, R.

AU - Norris, E. J.

AU - Perler, Bruce Alan

AU - Williams, G. M.

AU - Gottlieb, S. O.

AU - Meinert, Curtis L

AU - Rock, P.

AU - Parker, S.

AU - Yates, H.

AU - Breslow, M.

AU - Rosenfeld, B.

AU - Taylor, D.

AU - Brasfield, B.

AU - Bourke, D.

AU - Bezirdjian, P.

AU - Paul, S.

AU - Achuff, Stephen C

PY - 1993

Y1 - 1993

N2 - Background: Hypothermia occurs commonly during surgery and can be associated with increased metabolic demands during rewarming in the postoperative period. Although cardiac complications remain the leading cause of morbidity after anesthesia and surgery, the relationship between unintentional hypothermia and myocardial ischemia during the perioperative period has not been studied. Methods: One hundred patients undergoing lower extremity vascular reconstruction received continuous Holter monitoring throughout the first 24 h postoperatively. Myocardial ischemia was determined by a cardiologist masked to clinical variables. The patient's sublingual temperature on arrival at the intensive care unit immediately after the surgical procedure was used to divide the patients into two groups: hypothermic (temperature, <35° C; n = 33) and normothermic (temperature, ≥ 35° C; n = 67). The relationship between unintentional hypothermia and myocardial ischemia occurring during the first postoperative day was evaluated by univariate and multivariate analyses. Results: A greater percentage of patients had electrocardiographic changes consistent with myocardial ischemia in the hypothermic group (36%, 12 of 33) compared with those in the normothermic group (13%, 9 of 67, P = 0.008). Preoperative risk factors for perioperative cardiac morbidity were similar between the two groups, except for patient age. The mean age was 70 ± 2 yr and 62 ± 1 yr in the hypothermic and normothermic groups, respectively (P = 0.001). When subgroup and multivariate analyses were used to adjust for differences in age, temperature remained an independent predictor of ischemia (odds ratio, 1.82 per degree Celsius; 95% confidence interval, 1.09-3.02). The incidence of postoperative angina was greater in the hypothermic group (18%, 6 of 33) than in the normothermic group (1.5%, 1 of 67, P = 0.002). The incidence of Pa(O2) <80 mmHg in the arterial blood was greater in the hypothermic group (52%, 17 of 33) than in the normothermic group (30%, 20 of 67, P = 0.03). Conclusions: Unintentional hypothermia is associated with myocardial ischemia, angina, and Pa(O2) <80 mmHg during the early postoperative period in patients undergoing lower extremity vascular surgery.

AB - Background: Hypothermia occurs commonly during surgery and can be associated with increased metabolic demands during rewarming in the postoperative period. Although cardiac complications remain the leading cause of morbidity after anesthesia and surgery, the relationship between unintentional hypothermia and myocardial ischemia during the perioperative period has not been studied. Methods: One hundred patients undergoing lower extremity vascular reconstruction received continuous Holter monitoring throughout the first 24 h postoperatively. Myocardial ischemia was determined by a cardiologist masked to clinical variables. The patient's sublingual temperature on arrival at the intensive care unit immediately after the surgical procedure was used to divide the patients into two groups: hypothermic (temperature, <35° C; n = 33) and normothermic (temperature, ≥ 35° C; n = 67). The relationship between unintentional hypothermia and myocardial ischemia occurring during the first postoperative day was evaluated by univariate and multivariate analyses. Results: A greater percentage of patients had electrocardiographic changes consistent with myocardial ischemia in the hypothermic group (36%, 12 of 33) compared with those in the normothermic group (13%, 9 of 67, P = 0.008). Preoperative risk factors for perioperative cardiac morbidity were similar between the two groups, except for patient age. The mean age was 70 ± 2 yr and 62 ± 1 yr in the hypothermic and normothermic groups, respectively (P = 0.001). When subgroup and multivariate analyses were used to adjust for differences in age, temperature remained an independent predictor of ischemia (odds ratio, 1.82 per degree Celsius; 95% confidence interval, 1.09-3.02). The incidence of postoperative angina was greater in the hypothermic group (18%, 6 of 33) than in the normothermic group (1.5%, 1 of 67, P = 0.002). The incidence of Pa(O2) <80 mmHg in the arterial blood was greater in the hypothermic group (52%, 17 of 33) than in the normothermic group (30%, 20 of 67, P = 0.03). Conclusions: Unintentional hypothermia is associated with myocardial ischemia, angina, and Pa(O2) <80 mmHg during the early postoperative period in patients undergoing lower extremity vascular surgery.

KW - Complications: ischemia

KW - Heart, ischemia: postoperative

KW - Temperature, hypothermia: perioperative; complications

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