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Thesis--Copenhagen University. / Summary in Danish. Includes bibliographical references (p. 96-120).

Thesis--Copenhagen University. / Summary in Danish. Includes bibliographical references (p. 96-120).

Introduktion: Hypotermi är ett tillstånd med en kroppstemperatur ≤ 36°C som uppstår hos ca 70% av alla som opereras och ger en ökad risk för flertalet komplikationer. Enligt rekommendationer skall monitorering ske vid alla operationer längre än 30 minuter, och kroppstemperaturen bör därför alltid monitoreras perioperativt i samverkan med förebyggande interventioner. Syfte: Syftet med studien var att studera perioperativ hypotermi med följande två frågeställningar; förekomsten av hypotermi hos patienter som genomgår ett operativt ingrepp kortare än tre timmar och sjuksköterskor specialiserade inom operation-, och anestesisjukvårds kliniska resonemang kring temperaturmätning och hypotermiförebyggande omvårdnadsåtgärder. Metod: En kvantitativ tvärsnittsstudie, där datainsamlingen utfördes med hjälp av ett studieprotokoll och en webbkonstruerad enkät bestående av egenformulerade frågor. Svarsfrekvensen var 17,2% (n=12) respektive 70% (n=16). Data sammanställdes i programmet Microsoft Excel och analyserades deskriptivt, samt analyserades med hjälp av manifest innehållsanalys. Resultat: Kroppstemperaturen hos samtliga deltagare sjönk någon gång under det perioperativa förloppet och hypotermi förekom hos 66,7%. Nära hälften av specialistsjuksköterskorna uppgav att de saknar kunskap om rekommendationerna och det framkom en skillnad gällande mätning beroende på operationens längd. De ansåg att den främsta orsaken till skillnaden gällande mätning av kroppstemperaturen var en ökad exponeringstid och en ökad medvetenhet om hypotermi vid längre operationer. Bristande förutsättningar ansågs även det vara en orsak till att rekommendationerna inte efterföljs. Slutsats: Hypotermi kan förekomma även vid kortare operativa ingrepp, och specialistsjuksköterskor upplever en skillnad gällande monitorering av kroppstemperaturen beroende på längden av det operativa ingreppet. Denna studie synliggör att det finns bristande kunskap om hypotermi och en bristande följsamhet till rekommendationer gällande monitorering av kroppstemperaturen perioperativt.

Bakgrund: Ett kirurgiskt ingrepp innebär 50–90% risk för att patienten ska drabbas av oavsiktlig hypotermi. Förutom obehaget av postoperativ shivering kan det bidra till flera postoperativa komplikationer. Trots god kunskap om hur hypotermi kan förebyggas tycks det finnas situationer där denna kunskap inte tillämpas fullt ut, därav belyser denna studie det perioperativa samarbetet.  Syfte: Syftet var att belysa operationssjuksköterskors och anestesisjuksköterskors samarbete för att förebygga hypotermi perioperativt vid generell anestesi.  Metod: En kvalitativ intervjustudie genomfördes på tre sjukhus i en storstadsregion i södra Sverige. Nio specialistsjuksköterskor deltog.  Resultat: Studien identifierade tre kategorier av betydelse för samarbetet med att förebygga hypotermi: rollfördelningens inverkan på samarbetet, den psykosociala arbetsmiljöns inverkan på samarbetet samt om samarbetet baseras på rutiner istället för kommunikation. Genomgående identifierades professionernas fokus på patientens välmående.  Slutsats: Det finns en stor kunskap och medvetenhet om risk för hypotermi i samband med operation men studien visar oklarheter gällande ansvar och samarbete i ämnet hos specialistsjuksköterskor inom operation och anestesi. Bidragande faktorer kan vara brister i samarbetet och kommunikationssvårigheter mellan operationssjuksköterskor och anestesisjuksköterskor, Strukturerade kommunikationsmodeller kan öka samarbetet för att förebygga hypotermi hos patienter som genomgår kirurgi. / Introduction A surgical procedure entails 50-90% risk for the patient to be affected of unintentional hypothermia. Except the discomfort of postoperative shiverings it can contribute to postoperative complications. Despite good knowledge of how hypothermia can be prevented, there seem to be situations where this knowledge is not fully applied, hence this study sheds light on perioperative collaboration.   Aim The aim was to illustrate operating theatre nurses and anaesthesia nurses' cooperation in prevention of unintentional hypothermia perioperative in general anaesthesia.  Method A qualitative study with interviews were conducted at three hospitals in a metropolitan area in the south of Sweden. Nine specialist nurses participated.  Results The study identified three areas of importance for cooperation in preventing hypothermia: the role distribution's impact on collaboration, the psychosocial work environment's impact on teamwork and cooperation is based on routines instead of communication. The professionals' focus on the patient's well-being was consistently identified. Conclusion: There is a great deal of knowledge and awareness about the risk of hypothermia in connection with surgery, but the study shows ambiguities regarding responsibility and cooperation in the subject among specialist nurses in surgery and anesthesia. Contributing factors may be shortcomings in the collaboration and communication difficulties between surgical nurses and anesthesia nurses. Structured communication models may increase the collaboration to prevent hypothermia in patients undergoing surgery.

Indiana University-Purdue University Indianapolis (IUPUI) / Differences in voluntary consumption of ethanol have been negatively correlated with differences in initial sensitivity and tolerance to ethanol’s pharmacological effects. From this perspective, both adolescent and adult alcohol-nonpreferring (NP) rats would be expected to be initially more sensitive to the sedative and hypothermic effects of ethanol and fail to acquire tolerance to those effects than preferring (P) rats. The first objective of this experiment was to assess alcohol-induced hypothermia and locomotor sedation in adolescent and adult P and NP rats over five consecutive daily administrations (saline, 1.5 g/kg, or 3.0 g/kg ethanol 17%v/v), testing the hypothesis that the P rats would acquire tolerance to the hypothermic response whereas the NP rats would not show changes across days. In addition, it was hypothesized that there would be age-related differences in initial sensitivity to ethanol, evident by adolescent rats displaying less ethanol-induced hypothermia and locomotor sedation than adult rats on Day 1. The second objective was to determine if conditioning was occurring between the administration environment and the hypothermic response and locomotor sedation elicited by ethanol exposure, via a sixth injection of saline. Female rats were surgically implanted with intraperitoneal Mini Mitter telemetry probes on postnatal day 25 or 85 and experimental manipulations began five days later. Data were collected every minute; temperature data were then converted to change from baseline scores and locomotor data were totaled for each session. On Day 1, maximum temperature reduction elicited by the 3.0 g/kg dose was greater in the NP rats than the P rats, regardless of age. That dose also produced greater levels of locomotor sedation in the adult rats compared to the adolescent rats, regardless of line. The 1.5 g/kg dose of ethanol produced a greater hypothermic response in adult rats compared to adolescent rats, locomotor activity was reduced equally across the groups. With repeated administrations, NP adult rats displayed sensitization to the hypothermic response elicited from the 3.0 g/kg dose; in contrast, tolerance to the hypothermic response was found within the 1.5 g/kg dose for the adolescent P, adult P, and the adult NP rats. Repeated saline administrations also resulted in tolerance to the hypothermic response associated with administration in the adult NP and adolescent P rats. On the Day 6 saline administrations, adult rats which had previously been exposed to the 3.0 g/kg dose, maintained their baseline body temperatures better than both of the other exposure groups. Adolescent rats failed to show any signs of conditioning when administered saline on Day 6. Contrary to prediction the P rats failed to acquire tolerance to the 3.0 g/kg dose for either measure; and the line difference in ethanol-induce hypothermia was due to sensitization of the hypothermic response in adult NP rats. These results also provide further support that adolescent rats are less sensitive to the initial aversive effects of ethanol at the 1.5 g/kg dose for ethanol-induced hypothermia and the 3.0 g/kg dose for locomotor activity. The current experiment provides evidence that initial sensitivity as well as the acquisition of tolerance to ethanol-induced hypothermia may be behavioral phenotypes correlated with selection for high and low alcohol drinking preference.

The controlled lowering of core body temperature to 32°C to 34°C is defined as therapeutic hypothermia (TH). Therapeutic hypothermia has been shown to improve neurological outcome and survival in unconscious patients successfully resuscitated after cardiac arrest. Brain temperature is important for cerebral protection therefore methods for primarily cooling the brain have also been explored. This thesis focuses on the likelihood that intranasal cooling can induce, maintain and control cerebral hypothermia. The method uses bilaterally introduced intranasal balloons circulated with cold saline. Selective brain cooling induced with this method was effectively accomplished in pigs with normal circulation while no major disturbances in systemic circulation or physiological variables were recorded. The temperature gradients between brain and body could be maintained for at least six hours. Intranasal balloon catheters were used for therapeutic hypothermia initiation and maintenance during and after successful resuscitation in pigs. Temperature reduction was also obtained by combined intranasal cooling and intravenous ice-cold fluids with possible additional benefits in terms of physiologic stability after cardiac arrest. Rewarming was possible via the intranasal balloons. In these studies brain temperature was recorded invasively by temperature probes inserted in the brain. The fast changes in pig’s brain temperature could also be tracked by a non-invasive method. High-spatial resolution magnetic resonance spectroscopic imaging (MRSI) without internal reference showed a good association with direct invasive temperature monitoring. In addition the mapping of temperature changes during brain cooling was also possible. In awake and unsedated volunteers subjected to intranasal cooling brain temperature changes were followed by two MR techniques. Brain cooling was shown by the previously calibrated high-spatial resolution MRSI and by the phase-mapping method. Intranasal cooling reduced body temperature slightly. The volunteers remained alert during cooling, the physiological parameters stable, and no shivering was reported.