Complicações pós-operatórias relacionadasà hipotermia intraoperatória

Abstract

Hypothermia is a common event in the intraoperative period, which leads to consequences in the patient recovery, and it is one of the most frequent postoperative nursing diagnoses. Complications resulting from hypothermia affect several body systems, such as cardiac, respiratory, integumentary, digestive, immune and also the coagulation system. The reduction of patient´s thermal discomfort and the control of complications associated with intraoperative hypothermia, must be performed throughout the perioperative period with the use of preventive measures and treatment of hypothermia. Objective: The purpose of this study was to analyze the complications presented by the patient in the postoperative period associated to intraoperative hypothermia. Method: It is a longitudinal, retrospective, analytical, comparative study, characterized as a retrospective cohort study. It was realized in a public hospital, in Belo Horizonte city. The sample consisted of 54 patient charts that were participated in an earlier experimental study in which the patients were submitted, or not, to warmed venous infusion in the intraoperative and anesthetic recovery period. The data were collected from April to June 2015. The variables were treated as dichotomous categoricals, considering as a variable response the most frequent category and analyzed in 4 different times, on arrival at the hospital unit, after 17 hours, 32 hours and 108 hours of postoperative. In this way, the model used was the marginal logistics. Results: Most patients were female, 40 patients (74.07%), with a mean pre-operative systolic blood pressure of 124.82 mmHg, 32 patients (59.26%), presented classification by American Society of Anesthesiologists equal to II, 42 patients (77.78%) left the post anesthetic recovery room normothermic, with a mean temperature of 36.21ºC, and mean age of 47.06 years. The most frequent comorbidities Hypertension, 18 (56.25%), the diagnosis of Cholelithiasis, 7 (12.96%), and the surgical specialty was Digestive System Surgery, 28 (51.85%). In relation to the variables studied, most of the patients presented normal vital signs over time, like, Normal Blood Pressure with 405 measurements (85.26%), Normal Heart Rate with 433 measurements (91.54 %), Normal Respiratory Rate, 452 measurements (96.79%) and normal body temperature, 402 measurements (85.53%). They also presented pain, 95 measurements (19.87%), nausea, 19 measurements (3.97%) and vomiting, 19 measurements (3.97%), diuresis present with 266 measurements (55, 65%), present evacuation with 63 measurements (13.18%), flatulence, 42 measurements (8.79%), insomnia, 8 measurements (1.68%), inappetence with 32 measurements (6.69%) and surgical wound clean and dry in 84.78% of patients (234 measurements over time). Only one patient had moderate vaginal bleeding. The comparison between variables and groups of normothermic and hypothermic patients, over time, the variables that presented statistical significance were hospitalization time (p-value: 0.024), pain (p-value: 0.026), nausea (P value: 0.002 / p-value: 0.001 / p-value: 0.006), evacuation (p value: 0.024 / p-value: 0.035), clean and dry surgical wound (p-value: 0.017) and with drainage (p-value: 0.018). Conclusion: Hypothermia leads to countless complications from the moment it is installed in the patient, either in the intraoperative period, or in the postoperative period. Based on the complications found in this study, we assure the need to develop preventive and control actions for intraoperative hypothermia aiming at a better recovery of the patient in the postoperative period.