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Hypothermia Post Cardiac Surgery 9/11/10 SP Notes FANZCA Notes - common - multi-factorial: residual hypothermia post CPB, failure to rewarm, open thoracic cavity, cold OT, administration of cold fluids CARDIOVASCULAR - increased Q -> fall in Q when T<35 C increased SVR -> poor peripheral perfusion increased myocardial ischaemia and infarction (catecholamine release mediated) increased arrhythmia (AF and VT) hypotension on warming because of vasodilation RESPIRATORY - increased chance of laryngospasm increased O2 demand (shivering) shift of oxygen-Hb dissociation curve to left -> decreased O2 off loading bronchodilation -> increased dead space, decreased hypoxic pulmonary vasoconstriction longer time on mechanical ventilation CENTRAL NERVOUS SYSTEM - decreased sensitivity to hypoxia and hypercapnoea increased sensitivity to opioids and sedatives decreased LOC (agitation and confusion) decreased cerebral function decreased protection of airway NEUROMUSCULAR - increased duration of action of; NMBD, volatiles (increase in tissue solubility), propofol and fentanyl - increased shivering and shiver like tremor (thermal discomfort) -> increased metabolic rate, myocardial work, oxygen consumption RENAL - polyria (electrolyte loss) - decreased ADH - decreased RBF and GRF HAEMATOLOGICAL Jeremy Fernando (2011) - coagulation and increased blood loss – reduced number of platelet activators, release of circulating anti-coagulants - fibrinolysis -> increased bleeding and transfusion risk - increased viscosity -> increased VTE risk, poor microcirculation perfusion METABOLIC - hyperglycaemia (decrease peripheral utilisation of glucose) - acidosis from poor peripheral perfusion INFECTIONS/WOUND - increase in wound infections – vasoconstriction -> decreased O2 supply, impairs immune function - slow wound healing HEPATIC - decreased hepatic blood flow - decreased enzyme activity - slower drug metabolism RESOURCE ALLOCATION - longer ICU stay Jeremy Fernando (2011)