Original Article| Volume 36, ISSUE 12, P4320-4326, December 2022

Hypothermia and Prolonged Time From Procedure End to Extubation After Endovascular Thoracic Aortic Surgery

Published:September 11, 2022DOI:


      Perioperative hypothermia (core temperature <36°C) occurs in 50%-to-80% of patients recovering from thoracic aortic surgery, though its effects have not been described fully in this context. The authors, therefore, sought to characterize the incidence of perioperative hypothermia and its association with time from procedure end to extubation in endovascular aortic surgical patients.


      A retrospective cohort study.


      At a single academic tertiary center.


      Patients recovering from thoracic aortic surgery with lumbar drains.



      Measurements and Main Results

      A total of 196 patients were included in this study, 55 of whom were hypothermic with temperatures <35.0°C at the end of surgery. Though the unadjusted time to extubation was not statistically different in the hypothermic group (median 8 minutes, IQR 5-13.5 minutes) compared to the normothermic group (median 7 minutes, IQR 4-12 minutes; p = 0.062), multivariate predictors of increased time from procedure end to extubation included hypothermia (p = 0.011), age (p = 0.009), diabetes (p = 0.015), history of carotid disease (p = 0.040), and crystalloid volume (p = 0.019).


      Hypothermia in patients recovering from endovascular aortic surgery was associated with prolonged time from procedure end to extubation. Because of the retrospective observational nature of the authors’ analysis, it was not possible to determine the extent to which prolonged mechanical ventilation was influenced by low temperature.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Cardiothoracic and Vascular Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sari S
        • Aksoy SM
        • But A.
        The incidence of inadvertent perioperative hypothermia in patients undergoing general anesthesia and an examination of risk factors.
        Int J Clin Pract. 2021; 75: e14103
        • Alfonsi P
        • Bekka S
        • Aegerter P
        • et al.
        Prevalence of hypothermia on admission to recovery room remains high despite a large use of forced-air warming devices: Findings of a non-randomized observational multicenter and pragmatic study on perioperative hypothermia prevalence in France.
        PLoS One. 2019; 14e0226038
        • Horosz B
        • Malgorzata Malec-Milewska
        Inadvertent intraoperative hypothermia.
        Anaesthesiol Intensive Ther. 2013; 45: 38-43
        • Sessler DI.
        Perioperative thermoregulation and heat balance.
        Lancet. 2016; 387: 2655-2664
        • Sessler DI.
        Perioperative temperature monitoring.
        Anesthesiology. 2021; 134: 111-118
        • Rauch S
        • Miller C
        • Bräuer A
        • et al.
        Perioperative hypothermia-a narrative review.
        Int J Environ Res Public Health. 2021; 18: 8749
        • Riley C
        • Andrzejowski J.
        Inadvertent perioperative hypothermia.
        BJA Educ. 2018; 18: 227-233
        • Tanaka M
        • Nagasaki G
        • Nishikawa T.
        Moderate hypothermia depresses arterial baroreflex control of heart rate during, and delays its recovery after, general anesthesia in humans.
        Anesthesiology. 2001; 95: 51-55
        • Jeyadoss J
        • Thiruvenkatarajan V
        • Watts RW
        • et al.
        Intraoperative hypothermia is associated with an increased intensive care unit length-of-stay in patients undergoing elective open abdominal aortic aneurysm surgery: A retrospective cohort study.
        Anaesth Intensive Care. 2013; 41: 759-764
        • Agrawal N
        • Sewell DA
        • Griswold ME
        • et al.
        Hypothermia during head and neck surgery.
        Laryngoscope. 2003; 113: 1278-1282
        • Nathan HJ
        • Parlea L
        • Dupuis JY
        • et al.
        Safety of deliberate intraoperative and postoperative hypothermia for patients undergoing coronary artery surgery: A randomized trial.
        J Thorac Cardiovasc Surg. 2004; 127: 1270-1275
        • Aucoin VJ
        • Eagleton MJ
        • Farber MA
        • et al.
        Spinal cord protection practices used during endovascular repair of complex aortic aneurysms by the U.S. Aortic Research Consortium.
        J Vasc Surg. 2021; 73: 323-330
        • Bayman EO
        • Dexter F
        • Todd MM.
        Prolonged operative time to extubation is not a useful metric for comparing the performance of individual anesthesia providers.
        Anesthesiology. 2016; 124: 322-338
        • MacIntyre NR.
        Evidence-based guidelines for weaning and discontinuing ventilatory support: A collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine.
        Chest. 2001; 120: 375S-395S
        • Lin HT
        • Ting PC
        • Chang WY
        • et al.
        Predictive risk index and prognosis of postoperative reintubation after planned extubation during general anesthesia: A single-center retrospective case-controlled study in Taiwan from 2005 to 2009.
        Acta Anaesthesiol Taiwan. 2013; 51: 3-9
        • Stewart PA
        • Liang SS
        • Li QS
        • et al.
        The impact of residual neuromuscular blockade, oversedation, and hypothermia on adverse respiratory events in a postanesthetic care unit: A prospective study of prevalence, predictors, and outcomes.
        Anesth Analg. 2016; 123: 859-868
        • Lenhardt R
        • Marker E
        • Goll V
        • et al.
        Mild intraoperative hypothermia prolongs postanesthetic recovery.
        Anesthesiology. 1997; 87: 1318-1323
        • Sessler DI
        • Pei L
        • Li K
        • et al.
        Aggressive intraoperative warming versus routine thermal management during non-cardiac surgery (PROTECT): A multicentre, parallel group, superiority trial.
        Lancet. 2022; 399: 1799-1808
        • Gal J
        • Hunter S
        • Reich D
        • et al.
        Delayed extubation in spine surgery is associated with increased postoperative complications and hospital episode-based resource utilization.
        J Clin Anesth. 2022; 77110636
        • Ghiani A
        • Tsitouras K
        • Paderewska J
        • et al.
        Tracheal stenosis in prolonged mechanically ventilated patients: Prevalence, risk factors, and bronchoscopic management.
        BMC Pulm Med. 2022; 22: 24
        • Goligher EC
        • Dres M
        • Fan E
        • et al.
        Mechanical ventilation–induced diaphragm atrophy strongly impacts clinical outcomes.
        Am J Respir Crit Care Med. 2017; 197: 204-213
        • Zilberberg MD
        • Nathanson BH
        • Ways J
        • et al.
        Characteristics, hospital course, and outcomes of patients requiring prolonged acute versus short-term mechanical ventilation in the United States, 2014-2018*.
        Crit Care Med. 2020; 48: 1587-1594
        • DeSart K
        • Scali ST
        • Feezor RJ
        • et al.
        Fate of patients with spinal cord ischemia complicating thoracic endovascular aortic repair.
        J Vasc Surg. 2013; 58 (e2): 635-642
        • Matsukawa T
        • Sessler DI
        • Sessler AM
        • et al.
        Heat flow and distribution during induction of general anesthesia.
        Anesthesiology. 1995; 82: 662-673

      Linked Article

      • Earlier studies of prolonged times to tracheal extubation after end of surgery
        Journal of Cardiothoracic and Vascular AnesthesiaVol. 37Issue 1
        • Preview
          Arora and colleagues examined time to extubation after thoracic aortic surgery.1 In their very interesting study, they found negligible differences in median times to extubation between normothermic patients (7 minutes [95% confidence interval (CI) 6-to-8 minutes]) versus hypothermic patients (8 minutes [95% confidence interval 7-to-12 minutes]).1 There were significantly greater incidences of prolonged times to extubation among hypothermic patients (hazard ratio 2.06 [95% confidence interval 1.18-to-3.59]).
        • Full-Text
        • PDF