Relationship between Spinal Anesthesia and Hypothermia Incidence among Post Operative Patients in the Operating Recovery Room "JIH" Hospital Yogyakarta

Introduction: Complications of surgery may lead the patient to experience ill and even death. One of the complications in the patient after surgery with spinal anesthesia is the incidence of hypothermia. Hypothermia can occur as a result of a combination of anesthesia and surgery that causes disturbance in body temperature regulation that can make decreasing body temperature. Method: This research uses a descriptive correlational method with a retrospective approach, with total sampling technique amount of 106 respondents, using a checklist sheet research instrument.Data analysis techniques spearman rank. Results: The characteristics of surgery patients with spinal anesthesia in the operating room of Yogyakarta "JIH" Hospital were mostly female, 87.9%, most of whom were adults 74.1%, the highest frequency of surgery with spinal anesthesia duration >2 hours 55.7% and had an incidence of hypothermia 54.7%. Correlational statistical analysis obtained a Cramer's value of 0.371, a correlation coefficient value of 0.348 with a probability value (p-value) of 0.000. Conclusion: There is a relationship between spinal anesthesia and hypothermia incidence among postoperative patients in the operating recovery room "JIH" Hospital Yogyakarta. The direction of the correlation is positive and closeness is sufficient.


Introduction
Based on data obtained from the World Health Organization (WHO), the number of patients undergoing surgery has increased significantly from year to year. It was recorded that in 2011 there were 140 million patients in all hospitals in the world. In 2012 the data increased by 148 million people, while for the Asian region, surgery patients reached 77 million people in 2012 (Rihiantoro, 2017). In studies in industrialized countries, the incidence of complications of surgery and anesthesia is estimated at 3-16% with a mortality of 0.4-0.8%. The high rate of complications and mortality is a global health concern, assuming a 3% complication rate and a 0.55% mortality rate, nearly seven million patients experience major complications including one million people who die during or after surgery and anesthesia each year (Weiser et al., 2008).
In Indonesia, which is a developing country, according to the 2009 national tabulation data from the Ministry of Health of the Republic of Indonesia, surgery ranks 11th out of 50 disease patterns in Indonesia with a percentage of 12.8%. At RSUP dr. Sardjito Yogyakarta in 2010 -2011 patients who underwent anesthesia as many as 18,007 patients, 17 patients died perioperatively and 9 of them were related to anesthesia. The mortality rate per 10,000 anesthesia at Dr. Sardjito Hospital for perioperative (9.44) is lower than the average developed country (17.68) while anesthesia-related mortality (5) is higher than the average developed country (2.813) (Pujiono, et al, 2013). This makes special attention to surgical cases that have various complications that cause morbidity and mortality. Complications of surgery include hypothermia.
Hypothermia can be defined as body temperature less than 360C (Tamsuri, 2007).
Patients who undergo surgery are at risk of developing hypothermia (Setiyanti, 2016).
In surgery, previously performed anesthesia or anesthesia. Spinal anesthesia is one way to eliminate motor sensation by inserting anesthetic drugs into the subarachnoid space.
In spinal anesthesia there is a block in the sympathetic system resulting in vasodilation, this results in heat transfer from the central to peripheral compartments which causes hypothermia (Fauzi, 2014). Spinal anesthesia produces sympathetic block and sensory block to peripheral temperature receptors thereby inhibiting the compensatory response Maryudella Afrida, Erika Nurwidiyanti, Marfuah: Relationship between Spinal Anesthesia and Hypothermia Incidence… to temperature, the impact that often occurs after spinal anesthesia is shivering (Masithoh, 2018).
Hypothermia that occurs in surgical patients with spinal anesthesia is caused by 3 mechanisms, namely: redistribution of body heat, heat loss, and inhibition of sympathetic and somatic temperature regulation centers. The higher the block, the greater the thermoregulatory disturbance that occurs. The core body temperature threshold decreased by 0.15oC for each dermatome that had a block (Manunggal, 2014).
A preliminary study that was conducted at the Yogyakarta "JIH" Hospital in December 2019, of 15 surgical patients with spinal anesthesia, 40-45% experienced hypothermia in the operating room recovery room at the Yogyakarta "JIH" Hospital. Based on the description above, researchers are interested in researching the relationship between spinal anesthesia and the incidence of hypothermia in postoperative patients in the operating room recovery room at the Yogyakarta "JIH" Hospital.

Method
This type of research is a quantitative research type, with a descriptive design using a retrospective approach, namely conducting a documentation study that has occurred in the past. This study aims to identify the relationship between two variables, namely the variable spinal anesthesia with the incidence of hypothermia in the operating room induction room "JIH" Hospital Yogyakarta. The study was conducted at the Yogyakarta "JIH" Hospital by taking secondary data from the medical records of operating patients in the operating room whose operations were carried out in July-December 2020 and data collection was carried out in December 2020. The sampling technique in this study was total sampling, namely taking samples where the number of samples is the same as the population (Sugiyono, 2016). The data obtained in this study came from secondary data, namely registers and patient medical records.

Result
The results of the study of the relationship between spinal anesthesia and the incidence of hypothermia in postoperative patients in the operating room recovery room at the Yogyakarta "JIH" Hospital are as follows: Source: Primary Data, 2020 On the results of the distribution of the frequency of respondents, the sex of the majority of respondents is female, namely 72 people (67.9%). When viewed from the age group, most of the respondents were adults, namely 68 people (64.2%). Source: Primary Data, 2020 Based on the results of the frequency distribution of spinal anesthesia variables, the most respondents with spinal anesthesia were 59 people (55.7%).     The results of the frequency distribution of age characteristics in this study were mostly adults (26-45 years), as many as 68 of 106 patients (64.2%). The results of cross-tabulation of respondents who experienced the highest incidence of hypothermia were mostly adults (24-45 years), namely 43 of 106 patients (40.5%).
In Mubarokah's research (2017), there is a relationship between age and the incidence of hypothermia with a p-value of 0.011. The incidence of hypothermia in addition to being related to age is also influenced by the extent of surgery or the type of major surgery that opens the body cavity, for example in orthopedic surgery, thoracic and abdominal cavities. Abdominal surgery is known as a cause of hypothermia because it is associated with a long operation, large incisions require fluid to clean the peritoneum (Buggy & Crossley, 2000).

b. Gender
The results of the characteristic frequency distribution in this study were mostly female respondents, as many as 72 of 106 patients (67.9%). The results of the crosstabulation of respondents who experienced hypothermia the most respondents experienced hypothermia were female, as many as 51 of 106 patients (48.1%). This is by research conducted by Harahap (2014), the number of hypothermia is more common in women than men.
According to Saito (2013), the incidence of hypothermia is more common in women than men because women tend to have weaker muscle strength. A larger body surface area and less muscle mass may make women more susceptible to heat loss. Muscle mass is associated with heat production, and smaller muscle mass will cause a lower heat production capacity and a risk of hypothermia (Prado et al., 2015). The theory put forward by Rosjidi & Isroain (2014), that women are more susceptible to disease/surgical complications than men.
2. Operation with spinal anesthesia in the operating room of the Hospital "JIH"

Yogyakarta
The results of the analysis of the frequency distribution of spinal anesthesia in this study were 59 of 106 patients (55.7%). This shows that most of the operations in the operating room of the "JIH" hospital using spinal anesthesia with a duration of >2 hours. In this study, the inclusion criteria for surgery in the major category of the abdominal area, generally this category takes >2 hours. Spinal anesthesia is the anesthesia that is performed on patients who are still conscious to eliminate the conduction process at the ends or sensory nerve fibers in certain body parts (Rochimah, et al, 2011). The purpose of spinal anesthesia according to According to Lissauer (2013), the mechanism of heat loss decreases human body temperature during anesthetic action following a certain pattern/phase, including the redistribution phase. Anesthesia will cause vasodilation. This occurs through two mechanisms, namely anesthetic drugs directly cause vasodilation of blood vessels and anesthetics to lower the vasoconstriction threshold by inhibiting central thermoregulatory function. This vasodilation will result in body heat from the central part of the core temperature flowing to the periphery. Redistribution of body heat causes an increase in peripheral temperature but causes a decrease in core temperature. The decrease in core temperature in this phase occurs rapidly. The core temperature dropped 1-1.5°C during the first hour. The manifestation that occurs in this phase is hypothermia (Lissauer, 2013).
The results of statistical tests in this study showed that 71.2% of respondents who underwent surgery with spinal anesthesia duration >2 hours experienced hypothermia. In Mubarokah's research (2017), the incidence of hypothermia also occurred in patients who underwent surgery for >2 hours, which was 88.9%.
According to Chintamani (2008), the duration of surgery and anesthesia has the potential to have an effect, especially anesthetic drugs with higher concentrations in blood and tissue (especially fat), solubility, and longer duration of anesthesia, so that these agents try to achieve balance with these tissues. . In the theory of the Republic of Indonesia's Ministry of Health (2009), a long duration of surgery causes anesthesia to be longer and increases the length of time exposed to a temperature in the operating room which is constant at 16-18 0 C.

Conclusion
According with the purpose of this study, the researchers concluded that the characteristics of respondents/patients operating with spinal anesthesia who experienced hypothermia in the operating room of the Yogyakarta "JIH" Hospital were the majority of women. The frequency of surgery with spinal anesthesia duration > 2 hours in the operating room at the Yogyakarta "JIH" Hospital was more frequent than the duration of spinal anesthesia 1 -<2 hours. In addition, it was found that most postoperative patients with spinal anesthesia in the operating room recovery room at the "JIH" Hospital Yogyakarta experienced hypothermia events and found a moderate relationship between spinal anesthesia and the incidence of hypothermia in postoperative patients in the operating room recovery room Hospital " JIH" Yogyakarta.