Kinderanästhesie – Perioperatives Wärmemanagement bei Kindern

Zusammenfassung

Sinkt die Körpertemperatur des Patienten während einer Operation zu stark ab, kann dies zu Komplikationen führen und das Outcome des Patienten beeinträchtigen. Da gerade Kinder sehr schnell auskühlen, müssen diese besonders gut gegen eine Hypothermie geschützt werden – von der Vorbereitung zur Anästhesie bis zum Aufwachen nach dem Eingriff. Die perioperative Temperaturmessung ist zum Vermeiden einer unbeabsichtigten Hypothermie unabdingbar, und der Aufwand zum Wärmeerhalt muss umso größer sein, je jünger und unreifer Säuglinge sind. Intraoperativ eignen sich dazu Inkubatoren. Bei Kleinkindern sind konvektive Systeme am weitesten verbreitet und auch effektiv in Kombination mit Flüssigkeitswärmung. Postoperatives „shivering“ sollte man behandeln, z.B. mit Pethidin oder Clonidin.

Abstract

Perioperative temperature monitoring is a pre-requisite for successful prevention of inadvertent hypothermia in children. To achive this goal, besides of prewarming, active warming measures have to be intensified the younger and immature infants are. Intraoperatively incubators can be used. Forced-air warming in combination with fluid warming has been proven effective in children. Postoperative shivering should be treated, e.g. with pethidin or clonidine.

Schlüsselwörter:

Hypothermie - shivering - Temperaturmessung - Vorwärmen - Wärmeerhalt

Keywords:

children - perioperative - temperature monitoring - prewarming - active warming - shivering

• Literatur

• 1 Lang F, Lang P Hrsg. Basiswissen Physiologie. Aufl. Heidelberg: Springer; 2007. 2.
• 2 Scott EM, Buckland R. A systematic review of intraoperative warming to prevent postoperative complications. AORN J 2006; 83: 1090-1113
• 3 Torossian A. TEMMP (Thermoregulation in Europe Monitoring and Managing Patient Temperature) Study Group. Survey on intraoperative temperature management in Europe. Eur J Anaesthesiol 2007; 24: 668-675
• 4 Hooper VD, Andrews JO. Accuracy of noninvasive core temperature measurement in acutely ill adults: the state of the science. Biol Res Nurs 2006; 8: 24-34
• 5 Torossian A. Intraoperative temperature management. Anaesthesiol Intensivmed Notfallmed Schmerzther 2008; 43: 397-399
• 6 Barnason S, Williams J, Proehl J et al. Emergency nursing resource: non-invasive temperature measurement in the emergency department. J Emerg Nurs 2012; 38: 523-530
• 7 Batra P, Saha A, Faridi MMA. Thermometry in children. J Emerg Trauma Shock 2012; 5: 246-249
• 8 Maxton FJ, Justin L, Gillies D. Estimating core temperature in infants and children after cardiac surgery: a comparison of six methods. J Adv Nurs 2004; 45: 214-222
• 9 Greenes DS, Fleisher GR. When body temperature changes, does rectal temperature lag?. J Pediatr 2004; 144: 824-826
• 10 Craig JV, Lancaster GA, Taylor S et al. Infrared ear thermometry compared with rectal thermometry in children: a systematic review. Lancet 2002; 360: 603-609
• 11 Reynolds M, Bornham L, Gueck M et al. Are temporal artery temperatures accurate enough to replace rectal temperature in pediatric ED patients?. J Emerg Nurs [Epub ahead of print] DOI: 10.1016/j.jen.2012.07.007.
• 12 McCall EM, Alderdice F, Halliday HL et al. Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants. Cochrane Database Syst Rev 2010;
• 13 de Brito Poveda V, Clark AM, Galvao CM. A systematic review on the effectiveness of prewarming to prevent perioperative hypothermia. J Clin Nurs 2013; 22: 906-918
• 14 Cassey JG, King RAR, Armstrong P. Is there a thermal benefit from preoperative warming in children?. Pediatric Anesthesia 2010; 20: 63-71
• 15 Horn EP, Bein B, Böhm R et al. The effect of short-term periods of pre-operative warming in the prevention of peri-operative hypothermia. Anaesthesia 2012; 67: 612-617
• 16 Torossian A. Thermal management during anaesthesia and thermoregulation standards for the prevention of inadvertent perioperative hypothermia. Best Pract Res Clin Anaesthesiol 2008; 22: 659-668
• 17 Shorrab AA, El-Sawy ME, Othman MM, Hammouda GE. Prevention of hypothermia in children under combined epidural and general anesthesia: a comparison between upper- and lower-body warming. PediatricAnesthesia 2007; 17: 38-41
• 18 Park SM, Mangat HS, Berger K, Rosengart AJ. Efficacy spectrum of antishivering medications: Meta-analysis of randomized controlled trials. Crit Care Med 2012; 40: 3070-3082