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Thermal Burn Injury from a Forced-Air Warming Device in an Anesthetized Dog with Peripheral Hypoperfusion

  • Lee, Sungin (Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University) ;
  • Lee, Aeri (Department of Veterinary Surgery, Seeu Animal Medical Center) ;
  • Lee, Maro (Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University) ;
  • Kim, Wan Hee (Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University)
  • Received : 2020.11.11
  • Accepted : 2020.12.04
  • Published : 2020.12.31

Abstract

A 13-year-old female Poodle presented with gallbladder rupture caused by a mucocele and hypoperfusion. The animal had a thermal burn injury caused by a forced-air warming device used for hypothermia during surgery. This could be attributed to two causes. First, the forced-air warming device was used with direct hosing, without attachment to an air blanket, and the heat was concentrated in a single area. Second, perioperative peripheral hypoperfusion hampered heat dissipation and increased the susceptibility to a burn injury. These findings suggest that an air blanket should be used with a forced-air warming device according to the manufacturer's instructions. Furthermore, patients with peripheral hypoperfusion are at a higher risk of burn injuries and require close monitoring.

Keywords

References

  1. Ait-Oufella H, Bourcier S, Alves M, Galbois A, Baudel JL, Margetis D, Bige N, Offenstadt G, Maury E, Guidet B. Alteration of skin perfusion in mottling area during septic shock. Ann Intens Care 2013; 3: 31. https://doi.org/10.1186/2110-5820-3-31
  2. Boag AK, Hughes D. Assessment and treatment of perfusion abnormalities in the emergency patient. Vet Clin Small Anim 2005; 35: 319-342. https://doi.org/10.1016/j.cvsm.2004.10.010
  3. Brandt S, Oguz R, Hüttner H, Waglechner G, Chiari A, Greif R, Kurz A, Kimberger O. Resistive-polymer versus forced-air warming: comparable efficacy in orthopedic patients. Anesth Analg 2010; 110: 834-838. https://doi.org/10.1213/ane.0b013e3181cb3f5f
  4. Chung K, Lee S, Oh SC, Choi J, Cho HS. Thermal burn injury associated with a forced-air warming device. Korean J. Anesthesiol 2012; 62: 391-392. https://doi.org/10.4097/kjae.2012.62.4.391
  5. Committee ARP. Recommended practices for the prevention of unplanned perioperative hypothermia. AORN J 2007; 85: 972-974, 976-984, 986-988. https://doi.org/10.1016/j.aorn.2007.04.015
  6. Dabrowski GP, Steinberg SM, Ferrara JJ, Flint LM. A critical assessment of endpoints of shock resuscitation. Surg Clin N Am 2000; 80: 825-844. https://doi.org/10.1016/S0039-6109(05)70098-0
  7. Duke-Novakovski T, Vries MD, Seymour C. BSAVA manual of canine and feline anaesthesia and analgesia. Quedgeley, UK: British Small Animal Veterinary Association. 2016.
  8. Hartmann M, Montgomery A, Jonsson K, Haglund U. Tissue oxygenation in hemorrhagic shock measured as transcutaneous oxygen tension, subcutaneous oxygen tension, and gastrointestinal intramucosal pH in pigs. Crit Care Med 1991; 19: 205-210. https://doi.org/10.1097/00003246-199102000-00016
  9. Hettiaratchy S, Dziewulski P. Pathophysiology and types of burns. BMJ 2004; 328: 1427-1429. https://doi.org/10.1136/bmj.328.7453.1427
  10. Hofmeister EH, Brainard BM, Braun C, Figueiredo JP. Effect of a heat and moisture exchanger on heat loss in isofluraneanesthetized dogs undergoing single-limb orthopedic procedures. J Am Vet Med Assoc 2011; 239: 1561-1565. https://doi.org/10.2460/javma.239.12.1561
  11. Hooper VD, Chard R, Clifford T, Fetzer S, Fossum S, Godden B, Martinez EA, Noble KA, O'Brien D, Odom-Forren J, Peterson C, Ross J, Wilson L; ASPAN. ASPAN's evidence-based clinical practice guideline for the promotion of perioperative normothermia: second edition. J Perianesth Nurs 2010; 25: 346-365. https://doi.org/10.1016/j.jopan.2010.10.006
  12. Kanda T, Ikeda M, Ouchi M, Nagasaki A, Yamamoto R, Morishita T, Maeta N, Sasaki T, Furumoto K, Kake S, Murao N, Furukawa T. Administration of warmed intravenous fluids for medetomidine-induced hypothermia in normal dogs. Japanese J Vet Anesth Surg 2011; 42: 7-12. https://doi.org/10.2327/jvas.42.7
  13. Khenissi L, Covey-Crump G, Knowles TG, Murrell J. Do heat and moisture exchangers in the anaesthesia breathing circuit preserve body temperature in dogs undergoing anaesthesia for magnetic resonance imaging? Vet Anaesth Analg 2017; 44: 452-460. https://doi.org/10.1016/j.vaa.2016.05.016
  14. Kurz A, Kurz M, Poeschl G, Faryniak B, Redl G, Hackl W. Forced-air warming maintains intraoperative normothermia better than circulating-water mattresses. Anesth Analg 1993; 77: 89-95.
  15. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 1996; 334: 1209-1216. https://doi.org/10.1056/NEJM199605093341901
  16. Machon RG, Raffe MR, Robinson EP. Warming with a forced air warming blanket minimizes anesthetic‐induced hypothermia in cats. Vet Surg 1999; 28: 301-310. https://doi.org/10.1053/jvet.1999.0301
  17. Redondo JI, Suesta P, Serra I, Soler C, Soler G, Gil L, GomezVillamandos RJ. Retrospective study of the prevalence of postanaesthetic hypothermia in dogs. Vet. Rec 2012; 171: 374-374. https://doi.org/10.1136/vr.100476
  18. Schlichtig R, Kramer DJ, Pinsky MR. Flow redistribution during progressive hemorrhage is a determinant of critical O2 delivery. J Appl Physiol 1991; 70: 169-178. https://doi.org/10.1152/jappl.1991.70.1.169
  19. Soto N, Towle Millard HA, Lee RA, Weng HY. In vitro comparison of output fluid temperatures for room temperature and prewarmed fluids. J Small Anim Pract 2014; 55: 415-419. https://doi.org/10.1111/jsap.12236
  20. Steinbacher R, Mosing M, Eberspacher E, Moens Y. Perioperative use of fluidwarmers reduces hypothermia in cats [Article in German]. Tierarztl Prax Ausg K Kleintiere Heimtiere 2010; 38: 15-22. https://doi.org/10.1055/s-0038-1622823
  21. Truell KD, Bakerman PR, Teodori MF, Maze A. Third-degree burns due to intraoperative use of a Bair Hugger warming device. Ann Thorac Surg 2000; 69: 1933-1934. https://doi.org/10.1016/S0003-4975(00)01322-9
  22. Uzun G, Mutluoglu M, Evinc R, Ozdemir Y, Sen H. Severe burn injury associated with misuse of forced-air warming device. J Anesth 2010; 24: 980-981. https://doi.org/10.1007/s00540-010-1031-1
  23. Wu X. The safe and efficient use of forced‐air warming systems. AORN J 2013; 97: 302-308. https://doi.org/10.1016/j.aorn.2012.12.008
  24. Zaza KJ, Hopf HW. Thermoregulation: Normal physiology, anesthetic effects, and perioperative considerations. Pharmacology and Physiology for Anesthesia (Second Edition) 2019; 300-310.