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Perioperative Hypothermie

Beeinflussung der Wundheilung

Perioperative hypothermia

Impact on wound healing

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Zuammenfassung

Eine milde perioperative Hypothermie tritt bei chirurgischen Eingriffen unter Allgemeinanästhesie häufig auf, beeinflusst neben anderen Prozessen die Wundheilung und führt vermehrt zu Wundinfektionen. Die perioperative Hypothermie stört die Gerinnung, das Immunsystem und somit die frühen Phasen der Wundheilung. Außerdem trägt eine perioperative Hypothermie durch Hemmung der Kollagenvernetzung und Verlängerung der postoperativen Katabolie zu Wundkomplikationen bei. Wundkomplikationen verlängern den Krankenhausaufenthalt und erhöhen die Behandlungskosten erheblich. Deshalb ist die Aufrechterhaltung der perioperativen Normothermie anzustreben, um die Rate an Wundkomplikationen zu senken.

Abstract

Mild perioperative hypothermia is a common complication of anesthesia and surgery associated with several adverse effects including impaired wound healing and more frequently leads to wound infections. Perioperative hypothermia affects the hemostasis and various immune functions and therefore interferes with the initial phases of the wound healing process. Furthermore, perioperative hypothermia contributes to wound complications by inhibition of deposition of collagen and prolongation of postoperative catabolism. Wound complications prolong hospitalization and substantially increase medical costs. Thus, maintaining normothermia perioperatively is essential to reduce the number of wound complications.

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Literatur

  1. Aukhil I (2000) Biology of wound healing. Periodontology 22: 44–50

    Article  CAS  Google Scholar 

  2. Bardosi L, Tekeres M (1985) Impaired metabolic activity of phagocytic cells after anaesthesia and surgery. Br J Anaesth 57: 520–523

    Article  PubMed  CAS  Google Scholar 

  3. Barone JE, Tucker JB, Cecere J et al. (1999) Hypothermia does not result in more complications after colon surgery. Am Surg 65: 356–359

    PubMed  CAS  Google Scholar 

  4. Beilin B, Shavit Y, Razumovsky J et al. (1998) Effects of mild perioperative hypothermia on cellular immune responses. Anesthesiology 89: 1133–1140

    Article  PubMed  CAS  Google Scholar 

  5. Carli F, Emery PW, Freemantle CAJ (1989) Effect of perioperative normothermia on postoperative protein metabolism in elderly patients undergoing hip arthroplasty. Br J Anaesth 63: 276–282

    Article  PubMed  CAS  Google Scholar 

  6. Classen DC, Evans RS, Pestotnik SL et al. (1992) The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 326: 281–286

    Article  PubMed  CAS  Google Scholar 

  7. Faraday N, Rosenfeld BA (1998) In vitro hypothermia enhances platelet GPIIb-IIIa activation and P-selectin expression. Anesthesiology 88: 1579–1585

    Article  PubMed  CAS  Google Scholar 

  8. Forstot RM (1995) The etiology and management of inadvertent perioperative hypothermia. J Clin Anesth 7: 657–674

    Article  PubMed  CAS  Google Scholar 

  9. Frank SM, Higgins MS, Breslow MJ et al. (1995) The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia. A randomized clinical trial. Anesthesiology 82: 83–93

    Article  PubMed  CAS  Google Scholar 

  10. Fröhlich D, Wittmann S, Rothe G et al. (2004) Mild hypothermia down-regulates receptor-dependent neutrophil function. Anesth Analg 99: 284–292

    Article  PubMed  Google Scholar 

  11. Gillitzer R, Goebeler M (2001) Chemokines in cutaneous wound healing. J Leukoc Biol 69: 513–521

    PubMed  CAS  Google Scholar 

  12. Greif R, Akca O, Horn EP et al. (2000) Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. Outcomes Research Group. N Engl J Med 342: 161–167

    Article  PubMed  CAS  Google Scholar 

  13. Guest JD, Vanni S, Silbert L (2004) Mild hypothermia, blood loss and complications in elective spinal surgery. Spine J 4: 130–137

    Article  PubMed  Google Scholar 

  14. Hopf HW, Hunt TK, West JM et al. (1997) Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg 132: 997–1004

    PubMed  CAS  Google Scholar 

  15. Jonsson K, Jensen JA, Goodson WH 3rd et al. (1991) Tissue oxygenation, anemia, and perfusion in relation to wound healing in surgical patients. Ann Surg 214: 605–613

    Article  PubMed  CAS  Google Scholar 

  16. Jensen LS, Andersen AJ, Christiansen PM et al. (1992) Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery. Br J Surg 79: 513–516

    Article  PubMed  CAS  Google Scholar 

  17. Kattlove HE, Alexander B (1971) The effect of cold on platelets. I. Cold-induced platelet aggregation. Blood 38: 39–48

    PubMed  CAS  Google Scholar 

  18. Kettner SC, Kozek SA, Groetzner JP et al. (1998) Effects of hypothermia on thrombelastography in patients undergoing cardiopulmonary bypass. Br J Anaesth 80: 313–317

    PubMed  CAS  Google Scholar 

  19. Koveker GB (2000) Growth factors in clinical practice. Int J Clin Pract 54: 590–593

    PubMed  CAS  Google Scholar 

  20. Kurz A, Sessler DI, Lenhardt R (1996) Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 334: 1209–1215

    Article  PubMed  CAS  Google Scholar 

  21. Lenhardt R, Marker E, Goll V et al. (1997) Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology 87: 1318–1323

    Article  PubMed  CAS  Google Scholar 

  22. Lindenblatt N, Menger MD, Klar E, Vollmar B (2005) Sustained hypothermia accelerates microvascular thrombus formation in mice. Am J Physiol Heart Circ Physiol 289: H2680–H2687

    Article  PubMed  CAS  Google Scholar 

  23. Michelson AD, MacGregor H, Barnard MR et al. (1994) Reversible inhibition of human platelet activation by hypothermia in vivo and in vitro. Thromb Haemost 71: 633–640

    PubMed  CAS  Google Scholar 

  24. Miles AA, Miles EM, Burke J (1957) The value and duration of defense reactions of the skin to the primary lodgement of bacteria. Br J Exp Pathol 38: 79–96

    PubMed  CAS  Google Scholar 

  25. Schmied H, Kurz A, Sessler DI et al. (1996) Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet 347: 289–292

    Article  PubMed  CAS  Google Scholar 

  26. Sessler DI, Akca O (2002) Nonpharmacological prevention of surgical wound infections. Clin Infect Dis 35: 1397–1404

    Article  PubMed  Google Scholar 

  27. Sessler DI, Kurz A, Lenhardt R (1999) Re: Hypothermia reduces resistance to surgical wound infections (letter). Am Surg 65: 1193–1196

    PubMed  CAS  Google Scholar 

  28. Sheffield CW, Sessler DI, Hunt TK (1994) Mild hypothermia during isoflurane anesthesia decreases resistance to E. coli dermal infection in guinea pigs. Acta Anaesthesiol Scand 38: 201–205

    Article  PubMed  CAS  Google Scholar 

  29. Singer AJ, Clark RA (1999) Cutaneous wound healing. N Engl J Med 341: 738–746

    Article  PubMed  CAS  Google Scholar 

  30. Valeri CR, Feingold H, Cassidy G et al. (1987) Hypothermia-induced reversible platelet dysfunction. Ann Surg 205: 175–181

    Article  PubMed  CAS  Google Scholar 

  31. Weber EW, Slappendel R, Prins MH et al. (2005) Perioperative blood transfusions and delayed wound healing after hip replacement surgery: effects on duration of hospitalization. Anesth Analg 100: 1416–1421

    Article  PubMed  Google Scholar 

  32. Wenisch C, Narzt E, Sessler DI et al. (1996) Mild intraoperative hypothermia reduces production of reactive oxygen intermediates by polymorphonuclear leukocytes. Anesth Analg 82: 810–816

    Article  PubMed  CAS  Google Scholar 

  33. Winkler M, Akca O, Birkenberg B et al. (2000) Aggressive warming reduces blood loss during hip arthroplasty. Anesth Analg 91: 978–984

    Article  PubMed  CAS  Google Scholar 

  34. Wolberg AS, Meng ZH, Monroe DM 3rd, Hoffman M (2004) A systematic evaluation of the effect of temperature on coagulation enzyme activity and platelet function. J Trauma 56: 1221–1228

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Abteilung für Allgemeine, Thorax-, Gefäß- und Transplantationschirurgie, Chirurgische Universitätsklinik, Universität Rostock, Schillingallee 35, 18057, Rostock, Deutschland

    A.P. Pietsch, N. Lindenblatt & E. Klar

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  1. A.P. Pietsch
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  2. N. Lindenblatt
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  3. E. Klar
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Correspondence to A.P. Pietsch.

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Pietsch, A., Lindenblatt, N. & Klar, E. Perioperative Hypothermie. Anaesthesist 56, 936–939 (2007). https://doi.org/10.1007/s00101-007-1217-6

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