1
|
DeLeon AM, Lu S, Gaston I, Samworth AG, Lopez C, Farrer J. Midazolam for the Successful Treatment of Refractory Spinal-Anesthesia-Associated Hypothermia After Cesarean Delivery. Cureus 2023; 15:e39492. [PMID: 37250603 PMCID: PMC10212551 DOI: 10.7759/cureus.39492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 05/31/2023] Open
Abstract
Cesarean deliveries receiving spinal anesthesia with intrathecal morphine are associated with post-operative hypothermia. Lorazepam has been proposed as a reversal agent for treating intrathecal morphine-associated post-cesarean hypothermia. Midazolam is a benzodiazepine familiar to most anesthesia providers and is frequently administered in the perioperative period. We present a post-cesarean delivery spinal anesthesia-associated hypothermia patient successfully treated with intravenous midazolam.
Collapse
Affiliation(s)
| | - Samantha Lu
- Obstetric Anesthesia, Northwestern Memorial Hospital, Chicago, USA
| | - Ian Gaston
- Obstetric Anesthesia, Northwestern Memorial Hospital, Chicago, USA
| | - Alexander G Samworth
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Carmen Lopez
- Obstetric Anesthesia, Northwestern Memorial Hospital, Chicago, USA
| | - Jason Farrer
- Anesthesiology, Northwestern Memorial Hospital, Chicago, USA
| |
Collapse
|
2
|
Tubog TD, Kane TD, Ericksen AM. Combined Forced Air Warming and Warm Intravenous Fluid Strategy for Perioperative Hypothermia in Cesarean Delivery: A Systematic Review and Meta-Analysis. J Perianesth Nurs 2023; 38:21-32. [PMID: 35914983 DOI: 10.1016/j.jopan.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Evaluate the effect of a combined forced-air warming (FAW) and warm intravenous fluid (IVF) modality on maternal and neonatal outcomes in cesarean delivery under neuraxial anesthesia. DESIGN Systematic Review and Meta-analysis. METHODS An extensive search was conducted using PubMed, Cochrane Library, MEDLINE, CINAHL, Google Scholar, and other grey literature. Only randomized controlled trials examining the combined modality on maternal temperatures were included. Risk ratio (RR), mean difference (MD), and standardized mean difference (SMD) were used to estimate outcomes with suitable effect models. Quality of evidence was assessed using the Risk of Bias and GRADE system. FINDINGS Nine trials involving 595 patients were included. Combined strategy showed a smaller change in maternal temperature from baseline by 0.42°C (MD, -0.42; 95% CI, -0.62 to -0.22; P < .0001), higher temperature on PACU arrival (MD, 0.46; 95% CI, 0.11-0.82; P = .01), 15 minutes (MD, 0.43; 95% CI, 0.19-0.67; P = .0004) and 30 minutes after surgery (MD, 0.38; 95% CI, 0.12-0.64; P = .005). Combined strategy also reduced the incidence of hypothermia (RR, 0.55; 95% CI, 0.31-0.95; P = .03), and shivering (RR, 0.40; 95% CI, 0.28-0.58; P < .00001) with improvement in maternal comfort score (SMD; 0.38; 95% CI, 0.08-0.69; P = .01). However, there were no differences in clinical indicators of adverse neonatal outcomes. Lack of participants blinding, and substantial heterogeneity were limitations of this review. CONCLUSION The use of combined FAW and warm IVF is an effective strategy in mitigating perioperative hypothermia in cesarean delivery under neuraxial anesthesia.
Collapse
Affiliation(s)
- Tito D Tubog
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX.
| | - Terri D Kane
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| | - Ashlee M Ericksen
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| |
Collapse
|
3
|
Clark-Price SC, Fischer BL, Kirwin KL, Keating SCJ, Auckburally A, Flaherty D. Multicenter study to investigate factors associated with change in rectal temperature during anesthesia in dogs. J Am Vet Med Assoc 2021; 258:64-71. [PMID: 33314972 DOI: 10.2460/javma.258.1.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine factors associated with change in rectal temperature (RT) of dogs undergoing anesthesia. ANIMALS 507 dogs. PROCEDURES In a prospective observational study, the RT of dogs undergoing anesthesia at 5 veterinary hospitals was recorded at the time of induction of anesthesia and at the time of recovery from anesthesia (ie, at the time of extubation). Demographic data, body condition score, American Society of Anesthesiologists (ASA) physical status classification, types of procedure performed and medications administered, duration of anesthesia, and use of heat support were also recorded. Multiple regression analysis was performed to determine factors that were significantly associated with a decrease or an increase (or no change) in RT. Odds ratios were calculated for factors significantly associated with a decrease in RT. RESULTS Among the 507 dogs undergoing anesthesia, RT decreased in 89% (median decrease, -1.2°C [-2.2°F]; range, -0.1°C to -5.7°C [-0.2°F to -10.3°F]), increased in 9% (median increase, 0.65°C [1.2°F]; range, 0.1°C to 2.1°C [3.8°F]), and did not change in 2%. Factors that significantly predicted and increased the odds of a decrease in RT included lower weight, ASA classification > 2, surgery for orthopedic or neurologic disease, MRI procedures, use of an α2-adrenergic or μ-opioid receptor agonist, longer duration of anesthesia, and higher heat loss rate. Lack of μ-opioid receptor agonist use, shorter duration of anesthesia, and lower heat loss rate were significantly associated with an increase in RT. CONCLUSIONS AND CLINICAL RELEVANCE Multiple factors that were associated with a decrease in RT in dogs undergoing anesthesia were identified. Knowledge of these factors may help identify dogs at greater risk of developing inadvertent perianesthetic hypothermia.
Collapse
|
4
|
Vera G, Girón R, Martín-Fontelles MI, Abalo R. Radiographic dose-dependency study of loperamide effects on gastrointestinal motor function in the rat. Temporal relationship with nausea-like behavior. Neurogastroenterol Motil 2019; 31:e13621. [PMID: 31117152 DOI: 10.1111/nmo.13621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/09/2019] [Accepted: 04/24/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Loperamide is a potent mu opioid receptor agonist available over the counter to treat diarrhea. Although at therapeutic doses loperamide is devoid of central effects, it may exert them if used at high doses or combined with drugs that increase its systemic and/or central bioavailability. Recently, public health and scientific interest on loperamide has increased due to a growing trend of misuse and abuse, and consequent reports on its toxicity. Our aim was to evaluate in the rat the effects of increasing loperamide doses, with increasing likelihood to induce central effects, on gastrointestinal motor function (including gastric dysmotility and nausea-like behavior). METHODS Male Wistar rats received an intraperitoneal injection of vehicle or loperamide (0.1, 1, or 10 mg kg-1 ). Three sets of experiments were performed to evaluate: (a) central effects (somatic nociceptive thresholds, immobility time, core temperature, spontaneous locomotor activity); (b) general gastrointestinal motility (serial X-rays were taken 0-8 hours after intragastric barium administration and analyzed semiquantitatively, morphometrically, and densitometrically); and (c) bedding intake (a rodent indirect marker of nausea). Animals from sets 1 and 3 were used to evaluate gastric dysmotility ex vivo at 2 and 4 hours after administration, respectively. KEY RESULTS Loperamide significantly induced antinociception, hypothermia, and hypolocomotion (but not catalepsy) at high doses and dose-dependently reduced gastrointestinal motor function, with the intestine exhibiting higher sensitivity than the stomach. Whereas bedding intake occurred early and transiently, gastric dysmotility was much more persistent. CONCLUSIONS AND INFERENCES Our results suggest that loperamide-induced nausea and gastric dysmotility might be temporally dissociated.
Collapse
Affiliation(s)
- Gema Vera
- Departamento de Ciencias Básicas de la Salud, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Spain.,Grupo de Excelencia Investigadora URJC-Banco de Santander-Grupo Multidisciplinar de Investigación y Tratamiento del Dolor (i+DOL), Alcorcón, Spain.,Unidad Asociada I+D+i al Instituto de Química Médica (IQM), Centro Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Rocío Girón
- Departamento de Ciencias Básicas de la Salud, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Spain.,Grupo de Excelencia Investigadora URJC-Banco de Santander-Grupo Multidisciplinar de Investigación y Tratamiento del Dolor (i+DOL), Alcorcón, Spain.,Unidad Asociada I+D+i al Instituto de Química Médica (IQM), Centro Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - María Isabel Martín-Fontelles
- Departamento de Ciencias Básicas de la Salud, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Spain.,Grupo de Excelencia Investigadora URJC-Banco de Santander-Grupo Multidisciplinar de Investigación y Tratamiento del Dolor (i+DOL), Alcorcón, Spain.,Unidad Asociada I+D+i al Instituto de Química Médica (IQM), Centro Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Raquel Abalo
- Departamento de Ciencias Básicas de la Salud, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Spain.,Grupo de Excelencia Investigadora URJC-Banco de Santander-Grupo Multidisciplinar de Investigación y Tratamiento del Dolor (i+DOL), Alcorcón, Spain.,Unidad Asociada I+D+i al Instituto de Química Médica (IQM), Centro Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| |
Collapse
|
5
|
Cantürk M, Cantürk FK, Kocaoğlu N, Hakki M. The effects of crystalloid warming on maternal body temperature and fetal outcomes: a randomized controlled trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2019. [PMID: 30448094 PMCID: PMC9391735 DOI: 10.1016/j.bjane.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background and objectives Hypothermia occurs in about 60% of patients under anesthesia and is generally not managed properly during short lasting surgical procedures. Hypothermia is associated with adverse clinical outcomes. The current study is designed to assess the effects of crystalloid warming on maternal and fetal outcomes in patients undergoing elective cesarean section with spinal anesthesia. Methods In this prospective randomized controlled trial, sixty parturients scheduled for elective cesarean section with spinal anesthesia were randomly allocated to receive crystalloid at room temperature or warmed at 37 °C. Spinal anesthesia was performed at L3–L4 interspace with 10 mg of hyperbaric bupivacaine without adding opioids. Core temperature, shivering, and hemodynamic parameters were measured every minute until 10th minute and 5-min intervals until the end of operation. The primary outcome was maternal core temperature at the end of cesarean section. Results There was no difference for baseline tympanic temperature measurements but the difference was significant at the end of the operation (p = 0.004). Core temperature was 36.8 ± 0.5 °C at baseline and decreased to 36.3 ± 0.5 °C for isothermic warmed crystalloid group and baseline tympanic core temperature was 36.9 ± 0.4 °C and decreased to 35.8 ± 0.7 °C for room temperature group at the end of the operation. Shivering was observed in 43.3% in the control group. Hemodynamic parameter changes and demographic data were not significant between groups. Conclusions Isothermic warming crystalloid prevents the decrease in core temperature during cesarean section with spinal anesthesia in full-term parturients. Fetal Apgar scores at first and fifth minute are higher with isothermic warming.
Collapse
|
6
|
Cantürk M, Cantürk FK, Kocaoğlu N, Hakki M. [The effects of crystalloid warming on maternal body temperature and fetal outcomes: a randomized controlled trial]. Rev Bras Anestesiol 2018; 69:13-19. [PMID: 30448094 DOI: 10.1016/j.bjan.2018.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 08/08/2018] [Accepted: 09/04/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Hypothermia occurs in about 60% of patients under anesthesia and is generally not managed properly during short lasting surgical procedures. Hypothermia is associated with adverse clinical outcomes. The current study is designed to assess the effects of crystalloid warming on maternal and fetal outcomes in patients undergoing elective cesarean section with spinal anesthesia. METHODS In this prospective randomized controlled trial, sixty parturients scheduled for elective cesarean section with spinal anesthesia were randomly allocated to receive crystalloid at room temperature or warmed at 37°C. Spinal anesthesia was performed at L3-L4 interspace with 10mg of hyperbaric bupivacaine without adding opioids. Core temperature, shivering, and hemodynamic parameters were measured every minute until 10th minute and 5-min intervals until the end of operation. The primary outcome was maternal core temperature at the end of cesarean section. RESULTS There was no difference for baseline tympanic temperature measurements but the difference was significant at the end of the operation (p=0.004). Core temperature was 36.8±0.5°C at baseline and decreased to 36.3±0.5°C for isothermic warmed crystalloid group and baseline tympanic core temperature was 36.9±0.4°C and decreased to 35.8±0.7°C for room temperature group at the end of the operation. Shivering was observed in 43.3% in the control group. Hemodynamic parameter changes and demographic data were not significant between groups. CONCLUSIONS Isothermic warming crystalloid prevents the decrease in core temperature during cesarean section with spinal anesthesia in full-term parturients. Fetal Apgar scores at first and fifth minute are higher with isothermic warming.
Collapse
Affiliation(s)
- Mehmet Cantürk
- Ahi Evran University Training and Research Hospital, Department of Anesthesiology and Reanimation, Kırsehir, Turquia.
| | - Fusun Karbancioglu Cantürk
- Ahi Evran University Training and Research Hospital, Department of Obstetrics and Gynecology, Kırsehir, Turquia
| | - Nazan Kocaoğlu
- Ahi Evran University Training and Research Hospital, Department of Anesthesiology and Reanimation, Kırsehir, Turquia
| | - Meltem Hakki
- Ahi Evran University Training and Research Hospital, Department of Anesthesiology and Reanimation, Kırsehir, Turquia
| |
Collapse
|
7
|
Abdolrazaghnejad A, Banaie M, Tavakoli N, Safdari M, Rajabpour-Sanati A. Pain Management in the Emergency Department: a Review Article on Options and Methods. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2018; 2:e45. [PMID: 31172108 PMCID: PMC6548151 DOI: 10.22114/ajem.v0i0.93] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CONTEXT The aim of this review is to recognizing different methods of analgesia for emergency medicine physicians (EMPs) allows them to have various pain relief methods to reduce pain and to be able to use it according to the patient's condition and to improve the quality of their services. EVIDENCE ACQUISITION In this review article, the search engines and scientific databases of Google Scholar, Science Direct, PubMed, Medline, Scopus, and Cochrane for emergency pain management methods were reviewed. Among the findings, high quality articles were eventually selected from 2000 to 2018, and after reviewing them, we have conducted a comprehensive comparison of the usual methods of pain control in the emergency department (ED). RESULTS For better understanding, the results are reported in to separate subheadings including "Parenteral agents" and "Regional blocks". Non-opioids analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are commonly used in the treatment of acute pain. However, the relief of acute moderate to severe pain usually requires opioid agents. Considering the side effects of systemic drugs and the restrictions on the use of analgesics, especially opioids, regional blocks of pain as part of a multimodal analgesic strategy can be helpful. CONCLUSION This study was designed to investigate and identify the disadvantages and advantages of using each drug to be able to make the right choices in different clinical situations for patients while paying attention to the limitations of the use of these analgesic drugs.
Collapse
Affiliation(s)
- Ali Abdolrazaghnejad
- Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Banaie
- Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Trauma and Injury research center, Iran university of medical sciences, Tehran, Iran
| | - Mohammad Safdari
- Department of Neurosurgery, Khatam-Al-Anbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | | |
Collapse
|
8
|
Ferraz S, Caria T, Da Silva AV, Candeias MJ, Cenicante T. Persistent Hypothermia and Excessive Sweating Following Intrathecal Morphine Administration in a Teenage Boy: A Case Report. Anesth Pain Med 2018; 8:e66724. [PMID: 29868463 PMCID: PMC5970363 DOI: 10.5812/aapm.66724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/17/2018] [Indexed: 01/23/2023] Open
Abstract
Introduction Opioids are used intrathecally to manage surgical pain. There are few reports of hypothermia after spinal morphine injection, none in the pediatric population. We present a teenager's case of mild hypothermia. Case Presentation A 15-year-old boy was scheduled for elective abdominal laparotomy. General anesthesia was combined with spinal anesthesia, using levobupivacaine and morphine. In the recovery room, he presented a decreased tympanic temperature (34.4°C) associated with excessive sweating, hyperglycemia, and complained of feeling hot. All other vital signs were normal. It was decided to maintain clinical vigilance and hourly monitoring of temperature and glycaemia values. Despite active warming, he remained hypothermic for 16 hours, with gradual remission of symptoms and normalization of glycemic values. It is unknown how intrathecal morphine causes hypothermia. The most viable hypothesis is its effect on the hypothalamus. In our case the most probable causes of post anesthesia hypothermia were excluded; therefore, we can admit that the cause of hypothermia was the spinal administration of morphine. Some reports used naloxone and lorazepam successfully. In our report, they disappeared spontaneously 16 hours later, which corroborates our diagnosis. Conclusions Children undergoing subarachnoid block with with intrathecal morphine may develop a disruption on thermoregulation, leading to a resistant postoperative hypothermia associated with excessive sweating.
Collapse
Affiliation(s)
- Sara Ferraz
- Anaesthesiology Department of Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Corresponding author: Sara Ferraz, Anesthesiology trainee at Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Jose Joaquim Gomes da Silva, 59 - 6º Direito; 4460-171 Matosinhos, Porto, Portugal. Tel: +35-1917468963, E-mail:
| | - Telma Caria
- Anaesthesiology Department of Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Aline Vaz Da Silva
- Pediatric Surgery Department of Centro Hospitalar Lisboa Central, Hospital Dona Estefânia, Lisboa, Portugal
| | - Maria Jose Candeias
- Anaesthesiology Department of Centro Hospitalar Lisboa Central, Hospital Dona Estefânia, Lisboa, Portugal
| | - Teresa Cenicante
- Anaesthesiology Department of Centro Hospitalar Lisboa Central, Hospital Dona Estefânia, Lisboa, Portugal
| |
Collapse
|
9
|
Munday J, Osborne S, Yates P. Intrathecal Morphine-Related Perioperative Hypothermia in Women Undergoing Cesarean Delivery: A Retrospective Case-Control Study. J Perianesth Nurs 2018; 33:3-12. [PMID: 29362044 DOI: 10.1016/j.jopan.2016.04.142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 03/30/2016] [Accepted: 04/02/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Rates of inadvertent perioperative hypothermia among women undergoing spinal anesthesia for cesarean delivery are reported to be high. Intrathecal morphine has been noted to have a potentially potent effect on thermoregulation. This retrospective case-control study sought to investigate the incidence of perioperative hypothermia in women undergoing cesarean delivery with and without intrathecal morphine and to describe any clinical factors associated with the condition, the identification of which would provide direction for nursing priorities in the care of the condition. DESIGN A retrospective case-controlled study design was used. METHODS The charts of 358 women who had undergone emergency or elective cesarean delivery under spinal anesthesia were reviewed: 179 having received intrathecal morphine and 179 having received spinal anesthesia without intrathecal morphine (control group). SPSS (IBM, Armonk, New York), version 22, was used for data analysis, including logistic regression to predict the outcome of hypothermia across the study population. FINDINGS There was no significant difference (P = .62; 95% confidence interval, -0.09 to 0.15) in mean postoperative temperature for the morphine group (mean postanesthesia care unit arrival temperature, 35.91°C; standard deviation, 0.59) and the no morphine group (mean postanesthesia care unit arrival temperature, 35.88°C; standard deviation, 0.52). However, within groups, the temperature decline preoperatively to postoperatively was statistically (and clinically) significant. CONCLUSIONS The results refute the suggestion that intrathecal morphine contributes to greater core temperature decline in this population; however, it does confirm that perioperative hypothermia is a prevalent concern for women undergoing cesarean delivery and that pre-emptive measures should be routinely considered by health care providers.
Collapse
|
10
|
Bernardis RCGD, Siaulys MM, Vieira JE, Mathias LAST. O aquecimento no perioperatório com avental cirúrgico térmico impede a perda de temperatura materna durante a cesariana eletiva. Estudo clínico randômico. Rev Bras Anestesiol 2016; 66:451-5. [DOI: 10.1016/j.bjan.2015.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/30/2014] [Indexed: 11/29/2022] Open
|
11
|
Excessive sweating following intrathecal μ agonists: Effective atropine management. EGYPTIAN JOURNAL OF ANAESTHESIA 2016. [DOI: 10.1016/j.egja.2016.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
12
|
de Bernardis RCG, Siaulys MM, Vieira JE, Mathias LAST. Perioperative warming with a thermal gown prevents maternal temperature loss during elective cesarean section. A randomized clinical trial. Braz J Anesthesiol 2015; 66:451-5. [PMID: 27591457 DOI: 10.1016/j.bjane.2014.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/30/2014] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Decrease in body temperature is common during general and regional anesthesia. Forced-air warming intraoperative during cesarean section under spinal anesthesia seems not able to prevent it. The hypothesis considers that active warming before the intraoperative period avoids temperature loss during cesarean. METHODS Forty healthy pregnant patients undergoing elective cesarean section with spinal anesthesia received active warming from a thermal gown in the preoperative care unit 30min before spinal anesthesia and during surgery (Go, n=20), or no active warming at any time (Ct, n=20). After induction of spinal anesthesia, the thermal gown was replaced over the chest and upper limbs and maintained throughout study. Room temperature, hemoglobin saturation, heart rate, arterial pressure, and tympanic body temperature were registered 30min before (baseline) spinal anesthesia, right after it (time zero) and every 15min thereafter. RESULTS There was no difference for temperature at baseline, but they were significant throughout the study (p<0.0001; repeated measure ANCOVA). Tympanic temperature baseline was 36.6±0.3°C, measured 36.5±0.3°C at time zero and reached 36.1±0.2°C for gown group, while control group had baseline temperature of 36.4±0.4°C, measured 36.3±0.3°C at time zero and reached 35.4±0.4°C (F=32.53; 95% CI 0.45-0.86; p<0.001). Hemodynamics did not differ throughout the study for both groups of patients. CONCLUSION Active warming 30min before spinal anesthesia and during surgery prevented a fall in body temperature in full-term pregnant women during elective cesarean delivery.
Collapse
Affiliation(s)
| | - Monica Maria Siaulys
- Hospital Central da Irmandade da Santa Casa de Misericórdia de Sao Paulo, São Paulo, SP, Brazil
| | - Joaquim Edson Vieira
- Departamento de Cirurgia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | |
Collapse
|
13
|
Safrany-Fark A, Petrovszki Z, Kekesi G, Keresztes C, Benedek G, Horvath G. Telemetry monitoring for non-invasive assessment of changes in core temperature after spinal drug administration in freely moving rats. J Pharmacol Toxicol Methods 2015; 72:19-25. [PMID: 25595603 DOI: 10.1016/j.vascn.2015.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/08/2014] [Accepted: 01/05/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION There are no data available about the effects of spinally administered drugs on thermoregulation in freely moving animals. The first goal of the present study was to throw light on the consequences of intrathecally administered saline as a vehicle on core temperature and motor activity in unrestrained conditions. The second goal was to characterize the effects of morphine on these parameters as a widely used antinociceptive drug in spinal anesthesia, and reveal the potential role of the N-methyl-d-aspartate (NMDA) receptors in these processes. METHODS For these purposes, male Wistar rats were catheterized intrathecally, and E-Mitter battery-free transponders were implanted intraabdominally to continuously monitor core temperature and locomotor activity. RESULTS Saline induced a short-lasting hyperactivity accompanied by significant and prolonged hyperthermia that was blunted by systemic paracetamol administration. Morphine had no impact on motor activity; however, it caused high but equivalent degree hyperthermia in a wide dose range (1-15 μg), suggesting that it reached its peak effect. In the highest applied dose (25 μg), the NMDA receptor antagonist kynurenic acid blunted the saline-induced hyperthermia, and all doses caused higher hyperactivity compared to vehicle or morphine injections. In combination, kynurenic acid significantly inhibited the morphine-induced hyperthermia. DISCUSSION These data suggest that this method might be a valuable tool for investigating the thermoregulatory and locomotor effects of different drugs at spinal level; however, the prolonged effects of intrathecal vehicle injections should also be considered. The results point out that morphine is a very potent hyperthermic drug that may act primarily on the efferent limb of thermoregulation, at least partially, via an indirect NMDA-receptor mediated action mechanism.
Collapse
Affiliation(s)
- A Safrany-Fark
- Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, University of Szeged, Tisza L. krt. 64, H-6720 Szeged, Hungary.
| | - Z Petrovszki
- Department of Physiology, Faculty of Medicine, University of Szeged, Dóm tér 10, H-6720 Szeged, Hungary.
| | - G Kekesi
- Department of Physiology, Faculty of Medicine, University of Szeged, Dóm tér 10, H-6720 Szeged, Hungary.
| | - C Keresztes
- Department of Medical Communication and Translation, Faculty of Medicine, University of Szeged, Szentháromság u. 5, H-6720 Szeged, Hungary.
| | - G Benedek
- Department of Physiology, Faculty of Medicine, University of Szeged, Dóm tér 10, H-6720 Szeged, Hungary.
| | - G Horvath
- Department of Physiology, Faculty of Medicine, University of Szeged, Dóm tér 10, H-6720 Szeged, Hungary.
| |
Collapse
|
14
|
DeSousa KA, Chandran R. Intrathecal morphine for postoperative analgesia: Current trends. World J Anesthesiol 2014; 3:191-202. [DOI: 10.5313/wja.v3.i3.191] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/31/2014] [Accepted: 07/14/2014] [Indexed: 02/07/2023] Open
Abstract
The practice of anesthesiology has always been governed by evidence-based medicine. The quick turnover rate of patients in the operating room and patient safety and satisfaction, have also further changed the way we practice anesthesia. The use of intrathecal (IT) opiates as an effective form of postoperative pain relief has been established for many years. Morphine was the first opioid used by IT route. In clinical practice, morphine is regarded as the gold standard, or benchmark, of analgesics used to relieve intense pain. Perhaps for this reason, IT morphine has been used for over 100 years for pain relief. IT morphine is one of the easiest, cost-effective and reliable techniques for postoperative analgesia and technical failures are rare. And yet there is no consensus amongst anesthesiologists regarding the dose of IT morphine. Like all other methods of pain relief, IT morphine also has some side effects and some of them are serious though not very common. This review article looks into some of the key aspects of the use of IT morphine for post-operative analgesia and various doses for different procedures are discussed. This article also describes the side effects of IT morphine and how to treat and prevent them.
Collapse
|
15
|
Opioid analgesics and narcotic antagonists. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/b978-0-444-62635-6.00008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
|
16
|
Harkouk H, de Préville G, Benhamou D. Hypothermie profonde après rachianesthésie et morphine intrathécale après césarienne : un nouveau cas clinique. ACTA ACUST UNITED AC 2013; 32:53-5. [DOI: 10.1016/j.annfar.2012.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
|