Pencegahan Hipotermia Intraoperatif selama Laparoskopi Apendiks pada Pasien Anak di IBS RSA UGM: Studi Kasus

https://doi.org/10.22146/jkkk.98512

Qory Nurulita Andayani(1*), Arifin Triyanto(2), Anita Ruswanti(3)

(1) Program Studi Ilmu Keperawatan, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada
(2) Departemen Keperawatan Medikal Bedah, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada
(3) Instalasi Bedah Sentral, Rumah Sakit Akademik Universitas Gadjah Mada
(*) Corresponding Author

Abstract


Background: Children have a higher risk in experiencing intraoperative hypothermia (a body temperature below 36 ºC) compared to adults. This is due to an ineffective thermoregulation system, higher surface area compared to volume, and limited subcutaneous fat reserves.
Objective: To determine effective management to prevent intraoperative hypothermia in pediatric patients.
Case report: Pediatric patient A, 7 year old female with a diagnosis of acute appendicitis underwent appendix laparoscopy procedure. The patient's preoperative temperature was 36,9 ºC, the procedure took around 55 minutes, and the operating room temperature was between 18 - 20 ºC. Nurse gave active and passive mechanisms to prevent intraoperative hypothermia. The active mechanism was done by using a warming blanket with a temperature of 39 ºC. Passive management involved the use of 4 sterile draping, the draping process was carried out quickly to minimize the time patient's body was exposed to the cold air of the operating room, and in addition, blanket was applied over patient’s body while mobilized from the reception room to the pick-up room.
Outcome: After intervention using active and passive mechanisms, it was found that the child did not shiver, the temperature was 36 ºC post-operatively, and no acral cyanosis was found.
Conclusion: The application of active mechanisms in the form of using warming blankets and passive mechanisms using blankets and draping is effective in preventing intraoperative hypothermia in children.

INTISARI

Latar belakang: Anak memiliki risiko lebih tinggi mengalami hipotermia intraoperatif (keadaan temperatur tubuh di bawah 36ºC) dibandingkan dewasa. Hal tersebut karena anak memiliki sistem termoregulasi yang belum efektif, luas permukaan tubuh yang lebih tinggi dibandingkan dengan volume, dan cadangan lemak subkutan yang terbatas.
Tujuan: Mengetahui manajemen yang efektif untuk mencegah hipotermia intraoperatif pada pasien anak.
Laporan kasus: Pasien An. A, anak perempuan berusia 7 tahun dengan diagnosis apendisitis akut dilakukan laparoskopi apendiks. Suhu pre-operatif pasien yaitu 36,9ºC, tindakan berlangsung sekitar 55 menit, dengan suhu kamar operasi antara 18 - 20 ºC. Perawat melakukan mekanisme aktif dan pasif untuk mencegah hipotermia intraoperatif. Mekanisme aktif dilakukan melalui penggunaan warming blanket dengan suhu 39 ºC. Manajemen pasif melalui penggunaan draping dengan 4 duk steril, proses draping dilakukan dengan cepat untuk meminimalkan waktu tubuh pasien terpapar udara dingin kamar operasi dan ditambah dengan penggunaan selimut pada tubuh pasien, saat dipindahkan mulai dari ruang penerimaan sampai dengan ruang penjemputan.

Hasil: Setelah dilakukan intervensi aplikasi mekanisme aktif dan pasif pencegahan hipotermia intraoperatif, didapatkan hasil pasien anak tidak menggigil, suhu post-operatif 36 ºC, dan tidak ditemukan sianosis pada akral.
Simpulan: Penerapan mekanisme aktif berupa penggunaan warming blanket dan mekanisme pasif dengan penggunaan selimut serta draping, terbukti efektif untuk mencegah terjadinya hipotermia intraoperatif pada anak.


Keywords


anak; hipotermia intraoperatif; warming blanket

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References

  1. Ramadhan D, Faizal KM, Fitri N. Pengaruh Konseling dengan Pendekatan, Thinking, Feeling dan Acting (TFA) terhadap Tekanan Darah pada Pasien Pre-operasi. J Penelit Perawat Prof. 2023; 5(2): 637–644. https://doi.org/10.37287/jppp.v5i2.1522.

  2. Rose Khavari NDRCYP. Epidemiology of Pediatric Surgery in The United States. Cravero J, Editor. Pediatr Anesth. 2020; 30(10): 1083–90. https://doi.org/10.1111/pan.13993.

  3. British Association of Paediatric. Paediatric Surgery [homepage on the internet]. c.2023. [update 2023; cited 2024]. Available from https://www.baps.org.uk/

  4. Peiffer S, Ssentongo AE, Keeney L, Amponsah-Manu F, Yeboako R, Ofosu-Akromah R, et al. Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Ghana. BMC Surg. 2020; 20(1): 1–10. https://doi.org/10.1186/s12893-020-00867-9.

  5. Kosif R, Kecialan R. Anatomical Differences between Children and Adults. Int J Sci Res Manag. 2020; 08(05): 355–9. https://ijsrm.net/index.php/ijsrm/article/view/2696.

  6. Maheshwari M, Sanwatsarkar S, Katakwar M. Pharmacology Related to Paediatric Anaesthesia. Indian J Anaesth. 2019; 63(9): 698. https://doi.org/10.4103/ija.IJA_487_19.

  7. Islam MA, Firoz A. Intra-Operative and Post-Operative Complications in Pediatric Anesthesia: A Prospective Observation Study. EAS J Anaesthesiol Crit Care. 2021; 3(4): 47–50. https://doi.org /10.36349/easjacc.2021.v03i04.003.

  8. Simegn GD, Bayable SD, Fetene MB. Prevention and Management of Perioperative Hypothermia in Adult Elective Surgical Patients: A Systematic Review. Ann Med Surg. 2021; 72; 1-7. https://doi.org/10.1016/j.amsu.2021.103059.

  9. Zhao J, Le Z, Chu L, Gao Y, Zhang M, Fan J, et al. Risk Factors and Outcomes of Intraoperative Hypothermia in Neonatal and Infant Patients Undergoing General Anesthesia and Surgery. Front Pediatr. 2023; 11(15): 1–8. https://doi.org/10.3389/fped.2023.1113627.

  10. Mekete G, Gebeyehu G, Jemal S, Fentie Y. Magnitude and Associated Factors of Intra-Operative Hypothermia among Pediatric Patients Undergoing Elective Surgery: A Multi-center Cross-sectional Study. Ann Med Surg. 2022; 75(1). https://doi.org/10.1016/j.amsu.2022.103338.

  11. Kelleci Y, Abdullayev R, Cakmak G, Ozdemir H, Umuroglu T, Saracoglu A. Perioperative Hypothermia and Associated Factors: A Prospective Cohort Study. Anestezi Derg. 2023; 31(4): 339–48. https://doi.org/10.54875/jarss.2023.29964.

  12. Riley C, Andrzejowski J. Inadvertent Perioperative Hypothermia. BJA Educ. 2018; 18(8): 227–33. https://doi.org/10.1016/j.bjae.2018.05.003.

  13. Kulsirichawaroj P, Lumbiganon D. Incidence and Associated Factors of Congenital Syphilis at A Tertiary Care Center in Thailand. Asian Biomed. 2023; 17(1): 13–21. https://doi.org/10.2478/abm-2023-0039.

  14. Lee SY, Wan SYK, Tay CL, Tan ZH, Wong I, Chua M, et al. Perioperative Temperature Management in Children: What Matters? Pediatr Qual Saf. 2020; 5(5): 1-9. https://doi.org/10.1097/pq9.0000000000000350.

  15. Chen HY, Su LJ, Wu HZ, Zou H, Yang R, Zhu YX. Risk Factors for Inadvertent Intraoperative Hypothermia in Patients Undergoing Laparoscopic Surgery: A Prospective Cohort Study. PLoS One. 2021; 16(9): 1–12. http://dx.doi.org/10.1371/journal.pone.0257816.

  16. Cumin D, Fogarin J, Mitchell SJ, Windsor JA. Perioperative Hypothermia in Open and Laparoscopic Colorectal Surgery. ANZ J Surg. 2022; 92(5): 1125–1131. https://doi.org/10.1111/ans.17493.

  17. Görges M, Afshar K, West N, Pi S, Bedford J, Whyte SD. Integrating intraoperative physiology data into outcome analysis for the ACS Pediatric National Surgical Quality Improvement Program. Paediatr. Anaesth. 2019; 29: 27–37. https://doi.org/10.1111/pan.13531.

  18. Pearce B, Christensen R, Voepel-Lewis T. Perioperative Hypothermia in the Pediatric Population: Prevalence, Risk Factors and Outcomes. J. Anesth. Clin. Res. 2010; 1: 102. https://doi.org/10.4172/2155-6148.1000102.

  19. Nemeth M, Miller C, Bräuer A. Perioperative Hypothermia in Children. Int J Environ Res Public Health. 2021; 18(14): 1-18. https://doi.org/10.3390/ijerph18147541.

  20. Brindle ME, McDiarmid C, Short K, Miller K, MacRobie A, Lam JYK, et al. Consensus Guidelines for Perioperative Care in Neonatal Intestinal Surgery: Enhanced Recovery after Surgery (ERAS®) Society Recommendations. World J Surg. 2020; 44(8): 2482–2492. https://doi.org/10.1007/s00268-020-05530-1.

  21. Upadhya R K, Shenoy L, Venkateswaran R. Effect of Intravenous Dexmedetomidine Administered as Bolus or As Bolus-Plus-Infusion on Subarachnoid Anesthesia with Hyperbaric Bupivacaine. J Anaesthesiol Clin Pharmacol. 2018; 34(3): 46–50. https://doi.org/10.4103/joacp.JOACP_132_16.

  22. Hu Y, Tian Y, Zhang M, Zhao J, Shu Q. Study of Risk Factors for Intraoperative Hypothermia during Pediatric Burn Surgery. World J Pediatr Surg. 2021; 4(1): 1–6. https://doi.org/10.1136/wjps-2020-000141.

  23. Pratiwi NKDT, Raya NAJ, Puspita LM. Manajemen Hipotermia dalam Keperawatan Perioperatif pada Pasien yang Menjalani Pembedahan Abdomen: A Literature Review. Coping Community Publ Nurs. 2021; 9(5): 497-506. https://ojs.unud.ac.id/index.php/coping/article/download/74560/43159.

  24. Billeter AT, Hohmann SF, Druen D, Cannon R, Polk HCJ. Unintentional Perioperative Hypothermia is Associated with severe Complications and High Mortality in Elective Operations. Surgery. 2014; 156(5): 1245–1252. https://doi.org/10.1016/j.surg.2014.04.024.

  25. Herdman TH, Kamitsuru S. NANDA-I Diagnosis Keperawatan Definisi dan Klasifikasi 2018-2020. 11th Ed. Jakarta: EGC Medical Publisher; 2018.

  26. Fekede MS, Sahile WA. Magnitude and Associated Factors of Perioperative Hypothermia in Patients Who Underwent Elective Surgery at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Int J Med Sci Clin Invent. 2019; 6(2): 4332–4336. https://doi.org/10.18535/ijmsci/v6i2.10.

  27. Pereira NHC, De Mattia AL. Postoperative Complications Related to Intraoperative Hypothermia. Enferm Glob. 2019; 18(3): 270–284. http://dx.doi.org/10.6018/eglobal.18.3.328791.

  28. Rini CA, Novitasari D, Cahyaningrum ED. Hubungan Usia dan Lama Operasi dengan Kejadian Hipotermia Pasca-General Anestesi di Instalasi Bedah Sentral RS Mitra Plumbon Indramayu. Semin Nas Penelit dan Pengabdi Kpd Masy. 2022; 2809(2767): 409–416. https://prosiding.uhb.ac.id/index.php/SNPPKM/article/download/1063/359/product/N/affe.

  29. Imam Prasetyo E, Nur Rahmat N, Aini Isnawati I. Hubungan Status Fisik American Society of Anesthesiologist dengan Derajat Shivering pada Pasien Pasca-Spinal Anestesi di RSUD Grati Kabupaten Pasuruan. Nurs Updat J Ilm Ilmu Keperawatan. 2023; 14(2): 313–22. https://stikes-nhm.e-journal.id/NU/article/view/1243/1188.

  30. Menteri Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 7 Tahun 2019 Tentang Kesehatan Lingkungan Rumah Sakit. 2019. c.2019. [update 2019; cited 2024]. Available from https://peraturan.bpk.go.id/Details/111721/permenkes-no-7-tahun-2019.

  31. Jacob B. Hammond, Grace M. Madura, Yu-Hui H. Chang, Elisabeth S. Lim, Elizabeth Habermann, Robert Cima, Dorin Colibaseanu, Eric T. Siebeneck DAE. The Influence of Operating Room Temperature and Humidity on Surgical Site Infection: A Multisite ACS-NSQIP Analysis. Am J Surg. 2023; 226(6): 840–844. https://doi.org/10.1016/j.amjsurg.2023.06.039.

  32. Butcher H, Bulechek G, Dochterman J, Wagner C. Nursing Intervention Classification (NIC). 7th Indone. Elsevier Singapore Pte Ltd; 2018.

  33. Ackermann W, Fan Q, Parekh AJ, Stoicea N, Ryan J, Bergese SD. Forced-Air Warming and Resistive Heating Devices. Updated Perspectives on Safety and Surgical Site Infections. Front Surg. 2018; 5(64): 1–7. https://doi.org/10.3389/fsurg.2018.00064.

  34. Firmansyah D, Nursanti I, Irawati D, Jumaiayah W. Efek Pemberian Blanket Warmer terhadap Termoregulasi Pasien Perioperatif Transurethral Resection of The Prostate (TURP). J Perawat Indones. 2022; 6(2): 1109–1118. https://doi.org/10.32584/jpi.v6i2.1763.

  35. Shaw CA, Steelman VM, DeBerg J, Schweizer ML. Effectiveness of Active and Passive Warming for The Prevention of Inadvertent Hypothermia in Patients Receiving Neuraxial Anesthesia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Anesth. 2017; 38(3): 93–104. https://linkinghub.elsevier.com/retrieve/pii/S0952818016304056.

  36. Bräuer A, Perl T, Uyanik Z, English MJM, Weyland W, Braun U. Perioperative Thermal Insulation: Minimal Clinically Important Differences? Br J Anaesth. 2004; 92(6): 836–40. https://doi.org/10.1093/bja/aeh156.

  37. A. RJ and L. Pediatric Vital Signs Normal Ranges [homepage on the internet]. c.2024. [update 2024; cited 2024]. Available from https://medicine.uiowa.edu/iowaprotocols/pediatric-vital-signs-normal-ranges.

  38. Bashaw MA. Guideline Implementation: Preventing Hypothermia. AORN J. 2016; 103(3): 304–313. https://aornjournal.onlinelibrary.wiley.com/doi/10.1016/j.aorn.2016.01.009.

  39. Sari NMS, Raya NAJ. Case Report of Perioperative Nursing: Body Temperature Management in Surgery Patient of Mitral Valve Repair with Cardiopulmonary Bypass. J Ilmu Keperawatan Med Bedah. 2023; 6(1): 43–55. http://dx.doi.org/10.32584/jikmb.v6i1.1813.



DOI: https://doi.org/10.22146/jkkk.98512

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