Prevalance of intra-operative hypothermia and associated factors among pediatric patients undergoing surgery at Muhimbili National Hospital.

Abstract

ABSTRACT Background: Hypothermia remains among the leading cause of morbidity and mortality worldwide. Paediatric patients are particularly vulnerable to hypothermia due to the lack of subcutaneous fat, an immature thermoregulatory centre and a higher surface area to volume ratio. Aim of the study: To determine the prevalence of intra-operative hypothermia and associated factors among paediatric patients undergoing surgery at Muhimbili national Hospital. Methodology: This was a hospital-based analytical cross-sectional study conducted among 327 paediatric patients at Muhimbili National Hospital. All patients who met the inclusion criteria were enrolled after obtained consent from their parents on the day of surgery. Patients were recruited using a consecutive sampling technique. Data was collected through a specifically designed questionnaire, intraoperative anaesthetic charts, and the patient medical records file, The chi-square test, univariate and multi variate logistic regressions were utilised to determine the relationship between the independent variables and the dependent variable. A p-value of <0.05 and a 95%CI were considered statistically significant. Results: A total of 327 paediatric patients who underwent surgery at MNH were enrolled into the study. Among the enrolled participants, majority were aged between 2-5 years127 (38.84%). The majority of participants 177(54.13%) were male and more than three quarter 291(88.99%) had ASA physical status 1. The prevalence of intraoperative hypothermia was found to be 82.8%. This was affected by duration of surgery [AOR: 13.38, 95% CI: 5.47–32.71], and anaesthesia [AOR: 8.90, 95% CI: 3.05–25.92], ASAII [AOR: 7.88, 95% CI: 1.686–37.95], amount of fluid administered [AOR: 0.55, 95% CI: 0.34–0.90], fluid warmed [AOR: 3.74, 95% CI: 6.35-29.73], ], Forced air warming [AOR = 0.4, 95% CI: 0.26 - 1.04], Operating room temperature[AOR = 5.76, 95% CI: 3.38 - 8.97], and elective surgery [AOR: 2.65, 95% CI: 1.34-5.21] which were statistically significant. Conclusion and recommendation: The paediatric population undergoing surgery at MNH developed intraoperative hypothermia by 82.8%. Factors which contributed to hypothermia were duration of surgery and anaesthesia, ASA status, amount of fluid administered, operating room temperature, forced air warming devices, and elective surgery. The study recommends the use of standard intravenous fluid protocol, short duration of surgery and anaesthesia, avoiding use of un-warmed IV fluid and continuous medical education (CME)