title: Inadvertent Hypothermia After Procedural Sedation and Analgesia in a Cardiac Catheterization Laboratory: A Prospective Observational Study.
abstract: OBJECTIVE
  To identify the prevalence of and risk factors for inadvertent hypothermia after procedures performed with procedural sedation and analgesia in a cardiac catheterization laboratory.
  
  
  METHODS
  A single-center, prospective observational study.
  
  
  METHODS
  A tertiary-care private hospital in Australia.
  
  
  METHODS
  399 patients undergoing elective procedures with procedural sedation and analgesia were included. Propofol infusions were used when an anesthesiologist was present. Otherwise, bolus doses of either midazolam or fentanyl or a combination of these medications was used.
  
  
  METHODS
  None
  
  
  RESULTS
  Hypothermia was defined as a temperature<36.0°C. Multivariate logistic regression was used to identify risk factors. Hypothermia was present after 23.3% (n = 93; 95% confidence interval [CI] 19.2%-27.4%) of 399 procedures. Sedative regimens with the highest prevalence of hypothermia were any regimen that included propofol (n = 35; 40.2%; 95% CI 29.9%-50.5%) and the use of fentanyl combined with midazolam (n = 23; 20.3%; 95% CI 12.9%-27.7%). Difference in mean temperature from pre-procedure to post-procedure was -0.27°C (standard deviation 0.45). Receiving propofol (odds ratio [OR] 4.6 95% CI 2.5-8.6), percutaneous coronary intervention (OR 3.2; 95% CI 1.7-5.9), body mass index<25 (OR 2.5; 95% CI 1.4-4.4) and being hypothermic prior to the procedure (OR 4.9; 95% CI 2.3-10.8) were independent predictors of post-procedural hypothermia.
  
  
  CONCLUSIONS
  A moderate prevalence of hypothermia was observed. The small absolute change in temperature observed may not be a clinically important amount. More research is needed to increase confidence in the authors' estimates of hypothermia in sedated patients and its impact on clinical outcomes.
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University Technology, Kelvin Grove, QLD, Australia. Electronic address: aaron.conway@qut.edu.au.
authors.forename: Aaron
authors.initials: A
authors.lastname: Conway
authors.affiliation: Cardiac Catheter Laboratories, Princess Alexandra Hospital, Wooloongabba, QLD, Australia.
authors.forename: Wendy
authors.initials: W
authors.lastname: Kennedy
authors.affiliation: Coffs Harbour Health Campus and Rural Clinical School, Coffs Harbour, NSW, Australia.
authors.forename: Joanna
authors.initials: J
authors.lastname: Sutherland
mesh_terms: D000368:Aged; D000698:Analgesia / Q000009:adverse effects*; D001831:Body Temperature / Q000502:physiology*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D016292:Procedural Sedation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007035:Hypothermia / Q000453:epidemiology / Q000209:etiology*; D007755:Laboratories, Hospital; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors
keywords: cardiac catheterization laboratory; conscious sedation; deep sedation; hypothermia; monitoring; risk factors; temperature