A perioperative temperature management guide for anaesthetists and surgeons, covering physiological basics to warming therapy techniques.

" Perioperative hypothermia is a prevalent phenomenon that decreases the quality of care for adult surgical patients under anesthesia. Negative outcomes secondary to perioperative hypothermia include surgical site infections, adverse cardiovascular events, and impaired coagulation that causes bleeding. A thorough literature review revealed evidence-based temperature management strategies such as forced-air warming that can be used to prevent and alleviate the occurrence of perioperative hypothermia. An evidence-based practice (EBP) project that incorporated education and creation of evidence-based temperature management guidelines to direct anesthesia providers' care was developed. Certified registered nurse anesthetists (CRNAs) and other anesthesia providers were recruited as participants in the project because they are in a prime position to mitigate the effects of perioperative hypothermia. Online education was conducted, and performance observation auditing was done to ensure adherence to best practices regarding temperature management. The EBP project ultimately yielded successful outcomes including 100% compliance with EBP warming methods to prevent perioperative hypothermia and achievement of the temperature management quality benchmark. Achievement of these outcomes demonstrates the ability to effectively minimize perioperative hypothermia in the adult surgical patient population. Key words: perioperative hypothermia, anesthesia, forced-air warmers, warming, temperature management, certified registered nurse anesthetist, CRNA. " -- Abstract

The book provides an excellent review of all the clinical aspects of neuroanesthesia in children, including neurosurgeries during fetal state to neonatal, infancy, toddler, and school-going age groups. To provide optimal anesthetic care in children undergoing neurosurgery, the care provider must have adequate knowledge on the developing brain and spinal cord, and the effect of anesthetics on the neuronal tissue, and the inherent issues pertaining to neurologic lesions. This book covers the diagnostic, imaging, surgical as well as anesthetic managements of all the neurosurgical problems in children. The chapters include a wide range of topics from basic neurophysiology to general concerns for pediatric neuroanesthesia, including fluid management, blood transfusion, temperature regulation, and surgical positioning, as well as specific issues such as anesthesia for brain tumor surgery, hydrocephalus, neural tube defects, cerebrovascular surgeries such as aneurysmal surgery, arteriovenous malformations (AVMs), Moyamoya disease, and vein of Galen malformation, functional neurosurgery, epilepsy surgery, neuroendoscopy, craniovertebral junction anomalies, spinal surgeries, neurotrauma, and brain abscess with congenital heart diseases. Interesting topics like neuroanesthesia in remote locations, regional anesthesia during neurosurgery, and anesthesia for children with neuromuscular disease are also discussed. Moreover, the book elaborates on advanced neuroanesthesia techniques during fetal neurosurgery and craniopagus separation surgery; and the postoperative intensive care management aspects in each chapter. It is supplemented with figures depicting surgical procedures and positioning, neuroimages, tables and illustrations for easy understanding. This book caters to neuroanesthesiologists, pediatric anesthesiologists, residents, and fellows of anesthesia or neuroanesthesia, practicing anesthesiologists, pediatric neurointensivists, nurse anesthetists, neurosurgeons, and pediatric neurosurgeons. It also serves as a reference book for the DM (neuroanesthesiology and neurocritical care), DNB-SS (neuroanesthesiology), and MD (anesthesiology) curriculums apart from anesthesia residency and pediatric anesthesia/ neurosurgery fellowship programs offered at various Institutions worldwide.

Inadvertent Perioperative Hypothermia (IPH) is defined as a patient's core body temperature unintentionally dropping below 36°C at any point in the perioperative environment. IPH occurs most frequently in the first hour after induction of general anesthesia secondary to vasodilation and heat transfer from the patient's core to the periphery. Despite well-known detrimental intraoperative and postoperative outcomes associated with IPH, it continues to occur in approximately half of all surgical patients. Literature reviews reveal that promotion of normothermia throughout the perioperative environment reduces the incidence of complications of IPH, improves patient outcomes, and lowers health care costs. Current preoperative practice is to monitor a patient's temperature only once on admission and subsequently deploy passive warming interventions with no further monitoring. Ensuring that patients are appropriately monitored and actively warmed preoperatively has been identified as a strategy to reduce the incidence of IPH both intraoperatively and postoperatively due to maintenance of peripheral temperature and limiting of heat-transfer following general anesthetic onset. As Orem's Self-Care Deficit Theory maintains the nursing role in purposefully assisting patients to meet their self-care needs, known and unknown, actively ensuring euthermia in the preoperative environment promotes optimal outcomes in surgical patients and aligns nurses with the priorities of patient care and patient advocacy. Active intraoperative warming is effective but frequently insufficient to prevent the occurrence of IPH alone. A standardized, intentional preoperative warming strategy which includes continual patient temperature monitoring and purposeful intervention will reduce the incidence of IPH and associated complications.