Efficacy of forced-air warming for preventing perioperative hypothermia and related complications in patients undergoing laparoscopic surgery: A randomized controlled trial

The Effects of Actively Warming the Patient on Maternal and Infant Well-Being in a Cesarean Section Operation

PURPOSE

Intraoperative warming is recommended for surgical patients under anesthesia, but there are insufficient studies on this topic in cesarean delivery patients under spinal anesthesia. The purpose of this study was to determine the effects of active warming on the mother and newborn during elective cesarean section.

DESIGN

This research was carried out in an experimental design with a pretest-posttest randomized intervention and control group.

METHODS

The research was conducted with 34 women (17 intervention and 17 control), who gave birth by cesarean section. The study examined outcomes for both mother and newborn. Women in the intervention group were heated by both active (warmed with carbon fiber resistive underbody heaters during surgery) and passive heating (preoperative- socks, nonelectrified wool blankets, etc). Only passive heating methods were applied to the women in the control group (preoperative). Neonatal Activity - Pulse - Grimace - Appearence - Respiration (APGAR) score, body temperature, cortisol, and blood glucose levels in the intervention and control groups were evaluated, while body temperature and shivering conditions were evaluated in the mother.

FINDINGS

Body temperature and first minute APGAR score of the infants in the intervention and control groups after cesarean section were 36.88 ± 0.27, 36.52 ± 0.32 (P = .002); 7.00 ± 0.36, 7.47 ± 0.64 (P = .009), respectively. Cortisol and blood glucose levels in the intervention and control groups were 3.55 ± 1.09, 4.51 ± 0.70 (P = .010), 77.94 ± 7.07, 72.47 ± 10.24 (P > .05), respectively. The body temperatures of the women in the intervention and control groups at 15, 30, and 45 minutes were significantly different (P < .05), while they were similar (P > .05) at 60 minutes. Oxygen saturation measured at 30 minutes during the operation was 97.10 ± 1.41 in the intervention group and 95.20 ± 1.78 in the control group (P < .05).

CONCLUSIONS

Active warming before, during, and after cesarean section affected body temperature, pulse, respiration, blood pressure, and oxygen saturation of women, and while it increased the body temperature and APGAR score of newborns, it decreased cortisol level.

Intraoperative Patient Warming Instead of Gas on the Management of Postoperative Pain in Laparoscopic Colectomy and Cholecystectomy: A Randomized Controlled Trial

INTRODUCTION

Blurred lines remain in details of the association between patient warming with postoperative pain and a proper analgesic requirement. Therefore, the present study proposes to observe the effects of intraoperative patient warming and carbon dioxide insufflation duration in laparoscopic colectomy (LCol) and laparoscopic cholecystectomy (LChol) procedures on postoperative pain, analgesic requirements, and hemodynamics.

METHODS

The present study involved 80 cases aged 18-80 years with the American Society of Anesthesiologists I-III classification, possessing two initial groups primarily, one for LCol and one for LChol. Subsequently, each was divided into two through randomization for intraoperative warming. Postoperatively, pain perception, per se, was evaluated using the visual analog scale (VAS) score at the 30 minutes, 1st, 6th, 12th, and 24th hours, along with the impact of pain on hemodynamic parameters and side effects such as nausea/vomiting and the dosage of analgesics used.

RESULTS

Groups actively heated with warm air-blowing devices detected significantly higher intraoperative core and skin temperature measurements, and postoperative early pain perception was significantly lower in the warmed ones. Furthermore, a significant decrease in the VAS scores and the analgesic at the 12th and 24th hours compared to the first six hours was recognized between them.

CONCLUSION

Consequently, herewith, we postulate that so-called patient warming positively affects the VAS scores.

The Relationship of Perioperative Inadvertent Hypothermia with Anxiety and Comfort

The study aimed to investigate the relationship of perioperative inadvertent hypothermia with anxiety and thermal and general comfort in surgical patients. Inadvertent perioperative hypothermia occurs after surgery and affects many patient outcomes. However, the relationship between hypothermia and anxiety has been given little attention. The research is of descriptive type. A total of 117 surgical patients who met the inclusion criteria were sampled and divided into two groups: hypothermic (n = 54) and normothermic (n = 63). Patients undergoing surgery were monitored for body temperature, systolic and diastolic blood pressure, heart rate, pain intensity, anxiety (Numeric Rating Scale [NRS] and State Anxiety Scale [SAI]), and comfort (Perianesthesia Comfort Questionnaire) levels. The groups were similar in terms of descriptive characteristics (p > 0.05). Among the patients undergoing surgical intervention, 46.1% were hypothermic. Compared with the normothermic group, the hypothermic group had significantly lower body temperature until the second postoperative hour, lower thermal comfort score until the third postoperative hour, and higher heart rate and anxiety (NRS) score until the first postoperative day. Furthermore, there was a significant difference between the groups in terms of pain intensity up to the first 30 minutes after surgery (p < 0.05). Moreover, there was no significant difference between the groups in terms of pre and postoperative day one anxiety (SAI) and Periantesthesia Comfort Scale mean scores (p > 0.05). The study findings showed that hypothermia affected thermal comfort up to the first 3 hours after surgery, pain intensity up to the first 30 minutes, and heart rate and anxiety (NRS) levels up to the first day.

The effectiveness of warming approaches in preventing perioperative hypothermia: Systematic review and meta-analysis

AIM

To assess if experimental warming interventions are superior to routine warming interventions in preventing perioperative hypothermia.

BACKGROUND

Perioperative hypothermia is a critical issue for the complications of surgery. There are various kinds of perioperative warming interventions, including experimental and routine warming interventions.

METHODS

We performed a systematic literature review and meta-analysis for the randomized clinical trials of experimental warming interventions vs. routine warming interventions in the perioperative period.

FINDINGS

A total of 15 studies were included with 983 participants allocated to experimental warming interventions and 939 controls with routine warming interventions, who were receiving a variety of surgeries. The focused outcome was the intraoperative and postoperative body temperature. All included studies were randomized clinical trials. Among the participants receiving operations, the meta-analysis showed that routine warming intervention groups experienced lower intraoperative and postoperative body temperatures compared to the experimental warming groups. The meta-analysis results included positive mean differences, significant tests for overall effect and significant heterogeneity in the random-effects model.

CONCLUSIONS

In spite of significant heterogeneity, experimental warming interventions are likely to demonstrate superior warming effects when compared to routine warming interventions, as shown by the current meta-analysis results of randomized clinical trials.

Effects of Active Heating Methods on Body Temperature, Shivering, Thermal Comfort, Pain, Nausea and Vomiting During General Anesthesia: A Randomized Controlled Trial

To investigate the effect of forced-air warming and heated intravenous (IV) and irrigation fluids alone and in combination on body temperature, shivering, thermal comfort, pain, nausea and vomiting in adult patients undergoing surgery under general anesthesia in a prospective, four-group, randomized controlled trial. After induction of anesthesia, 120 patients were divided into the following groups: patients warmed with forced-air warming (n = 30), patients receiving warmed IV and irrigation fluid (n = 30), patients receiving warmed IV and irrigation fluid with forced-air warming (n = 30), and the control group without any intervention (n = 30). Body temperature, shivering, thermal comfort, pain, nausea and vomiting were monitored in the first 24 hours after surgery. The general characteristics of the groups, mean body temperature, length of stay, ambient temperature, and duration of surgery in the preoperative waiting unit were similar (p > 0.05). Compared with the other groups, patients in the control group had a significant decrease in body temperature from the 30th minute during surgery (p < 0.001), lower body temperature in the first 2 hours and thermal comfort in the first three hours after surgery (p < 0.01), and higher shivering levels in the first hour after surgery (p < 0.01). There was no significant difference between the groups in terms of postoperative pain, nausea and vomiting (p > 0.05). The study findings showed that normothermia was maintained in all three intervention groups during the surgery and in the first 24 hours after surgery. Moreover, postoperative thermal comfort increased and shivering levels decreased compared with the control group, but pain, nausea and vomiting levels were not affected. The study was registered on ClinicalTrials.gov (NCT04907617).

Barriers and Solutions in Implementing Evidence-Based Recommendations to Prevent Intraoperative Inadvertent Hypothermia: A Qualitative Study

In this study, it was aimed to understand the barriers and solutions for operating room (OR) nurses and anesthesiologists to implement evidence-based recommendations to prevent intraoperative inadvertent hypothermia (IIH). A qualitative, inductive, and descriptive study was conducted. This qualitative interview study was conducted face-to-face with 19 participants working in OR units between February and March 2023. The interviews were analyzed using qualitative content analysis. The COREQ checklist was followed. Two main themes and five sub-themes were identified as a result of content analysis. According to the participants, barriers to IIH prevention interventions are caused by individual and organizational inefficiencies and personal opinions, and the main solution is education. Participants reported many factors that hinder IIH prevention practices. The individual characteristics of OR staff and the opinions and behavior of the institution are very important for IIH prevention.

Comparative Efficacy of Six Active Warming Systems for Intraoperative Warming in Adult Patients Undergoing Laparoscopic Surgery: A Systematic Review and Network Meta-Analysis

Intraoperative hypothermia is very common and harmful in adult patients undergoing laparoscopic surgery. A variety of active warming systems has received close attention and has been researched by related scholars. However, the relative efficacy of these systems and which active warming system is preferred for such patients remain unclear. The aim of this study was to compare and rank six active warming systems regarding intraoperative warming efficacy in adult patients undergoing laparoscopic surgery. Following the PRISMA 2020 guidelines, relevant randomized controlled trials (RCTs) on the efficacy of different active warming systems in warming adult patients undergoing laparoscopic surgery were searched from five English databases and three Chinese databases. The quality of the studies was assessed using the Cochrane Risk of Bias tool (RoB2). The outcome was the final intraoperative core temperature. We estimated direct effects by using pairwise meta-analysis, estimated relative effects and ranking with the consistency model to conduct an NetworkMeta-Analysis (NMA). We used GRADE (Grading of Recommendations Assessment, Development, and Evaluation) to assess the certainty of the evidence. Sensitivity analysis was performed to test the robustness of the results. This study is registered with PROSPERO, with number CRD42022309057. In total, 19 RCTs involving 6 active warming systems and comprising 1364 patients were included in this NMA. The NMA once again confirmed the validity of forced-air warming (FAW) systems compared with other active warming systems, and further showed that underbody FAW was associated with more remarkable warming efficacy in different types of FAW systems. NMA was used to perform an exhaustive comparison of the warming efficacy of six active warming systems and indicated that underbody FAW was most likely to be the most effective warming system in adult patients undergoing laparoscopic surgery; however, considering the sparsity of the network, our results should be cautiously interpreted. Furthermore, a large number of high-quality RCTs comparing the warming efficacy of different competitive active warming systems are needed.

A qualitative study of nurse-perceived barriers to body temperature management in postoperative patients

Although evidence-based practices exist for preventing hypothermia in patients during surgery, few studies have focused on this concern in postoperative patients. The aim of this qualitative study was to explore the most challenging issues experienced by surgical ward nurses while managing the body temperature of adult surgical patients. To address this research gap, this study used a qualitative descriptive design to document barriers to body temperature management as reported by a sample of 16 perioperative nurses. The semi-structured, face-to-face interviews were digitally recorded, transcribed verbatim and analysed using inductive content analysis. The main barriers fell into three categories: professional nursing ability limitations, unfavourable working conditions and management of human resources. The eight subcategories were disadvantageous professional views, professional knowledge limitations, low motivation to provide nursing care, non-standard treatment environment, inadequate equipment and care protocols, heavy nursing care loads, inadequate staff training and ineffective staff supervision. These findings highlighted the importance of adequate resources, proper education and evidence-based care protocols in the effective delivery of body temperature management to postoperative patients.

The Effects of Active Warming on Core Body Temperature and Thermal Comfort in Patients After Transurethral Resection of the Prostate: A Randomized Clinical Trial

Prevention and treatment of hypothermia by active warming in perioperative period care is recommended but scientific evidence of its effectiveness in a clinical setting is scarce. The purpose of this study was to determine the effects of warmed intravenous fluids (WIVF) on the core body temperature and the patients' thermal comfort. Baseline data of 105 male patients undergoing TUR-P surgery and bladder irrigation were analyzed. The experimental group was warmed using active WIVF, and the control group's routine care was conducted using a cotton blanket. Body temperature was higher in patients in the experimental group than those in the control group. Repeated measures Manova revealed significantly different core temperature changes between groups (F = 34.446, p = .001). The thermal comfort scores were also higher in the experimental group than in the control group (x² = 203.552, p = .001). The findings indicated that WIVF can enhance body temperature and improve the thermal comfort of patients.

The Effectiveness of Active External Warming of Patient Concurrently With Ice Application on the Incision Site on Post-Thoracotomy Pain and Analgesic Consumption

The aim of study is to investigate the effects of active external warming of patient concurrently with application of ice to incision site on thoracotomy pain and analgesic consumption. The research is a quasi-experimental design with control and study groups. The study was conducted in 2018 and 2019. A total of 70 patients were included in the study: 35 in the control group and 35 in the study group. The mean verbal pain scale values were significantly lower in the intervention group (2.85 point) than in the control group (4.57 point; p < .001). Opioid consumption rate was high in control group patients (77.1% tramadol 30 mg; 45.7% morphine sulfate 5 mg) In contrast, the rate of opioid consumption was lower in patients in the intervention group (40% tramadol 30 mg; 17% morphine sulfate 5 mg). Active external warming and ice application on the incision area, could reduce the intensity of thoracotomy pain.

A Nomogram for Predicting Unplanned Intraoperative Hypothermia in Patients With Colorectal Cancer Undergoing Laparoscopic Colorectal Procedures

Unplanned intraoperative hypothermia is a complication that can lead to a variety of negative outcomes, such as cardiovascular events. We aimed to develop and validate an intraoperative hypothermia risk prediction nomogram for patients with colorectal cancer undergoing laparoscopic colorectal procedures. We conducted a prospective cohort study with 1,091 patients (ie, 765 in the training cohort, 326 in the validation cohort) from October 2020 to November 2021. We included six predictors in the nomogram model: body mass index, diabetes diagnosis, ambient temperature, ambient humidity, duration of surgery, and use of a forced-air warmer. The model performed well, and the area under the curve was 0.855. These results, together with an external validation value, mean that health care professionals can use the nomogram to calculate the intraoperative hypothermia risk for patients undergoing laparoscopic colorectal procedures and make clinical decisions based on the results.

Health Technology Assessment for the Prevention of Peri-Operative Hypothermia: Evaluation of the Correct Use of Forced-Air Warming Systems in an Italian Hospital

This study investigates the implications of using a system for the maintenance of normothermia in the treatment of patients undergoing surgery, determining whether the FAW (Forced-Air Warming) systems are more effective and efficient than the non-application of appropriate protocols (No Technology). We conducted Health Technology Assessment (HTA) analysis, using both real-world data and the data derived from literature, assuming the point of view of a medium-large hospital. The literature demonstrated that Inadvertent Perioperative Hypothermia (IPH) determines adverse events, such as surgical site infection (FAW: 3% vs. No Technology: 12%), cardiac events (FAW: 3.5% vs. No Technology: 7.6%) or the need for blood transfusions (FAW: 6.2% vs. No Technology: 7.4%). The correct use of FAW allows a medium saving of 16% per patient to be achieved, compared to the non-use of devices. The Cost Effectiveness Value (CEV) is lower in the hypothesis of FAW: it enables a higher efficacy level with a contextual optimization of patients' path costs. The social cost is reduced by around 30% and the overall hospital days are reduced by between 15% and 26%. The qualitative analyses confirmed the results. In conclusion, the evidence-based information underlines the advantages of the proper use of FAW systems in the prevention of accidental peri-operative hypothermia for patients undergoing surgery.

Effect of active forced air warming during the first hour after anesthesia induction and intraoperation avoids hypothermia in elderly patients

Background

The study aimed at exploring an optimal temperature model of forced air warming during the first hour after induction and intraoperation to prevent hyperthermia for elderly patients undergoing laparoscopic abdominal surgery.

Methods

There were 218 patients that were randomly divided into 3 groups warmed with a forced-air warmer during surgery: Group L (intraoperative warming set to 38 °C, n = 63), Group H (intraoperative warming set to 42 °C, n = 65) and Group LH (intraoperative warming set to 42 °C for the first hour then set to 38 °C, n = 65). Core temperature in the preoperative room and PACU was measured by a tympanic membrane thermometer and in the operation room, a nasopharyngeal temperature probe was recorded. The rate of perioperative hypothermia, defined as a reduction in body temperature to < 36 °C was recorded as the primary outcome. Intraoperative anesthetic dosage, recovery time, adverse events, thermal comfort and satisfaction score were measured as secondary outcome.

Results

The incidence of intraoperative and postoperative hypothermia was significantly lower in Group LH and Group H than Group L (18.75 and 15.62% vs 44.44%, P<0.001; 4.69 and 4.69% vs 20.63%, P<.05). Anesthetic dosage of rocuronium was lower in Group L than other two groups, with the opposite result of recovery time. The number of patients with shivering was higher in Group L but sweating was higher in Group H. Both of the thermal comfort and satisfaction score was highest in Group LH.

Conclusion

A temperature pattern of forced air warming set at 42 °C during the first hour after anesthesia induction and maintained with 38 °C was a suitable choice for elderly patients undergoing laparoscopic abdominal surgery lasting for more than 120 min.

Trial registration

Chictr.org.cn ChiCTR-2,100,053,211.

Impact of Postoperative Infectious Complications on Long-Term Outcomes for Patients Undergoing Simultaneous Resection for Colorectal Cancer Liver Metastases: A Propensity Score Matching Analysis

OBJECTIVE

To investigate the impact of postoperative infectious complications (POI) on the long-term outcomes of patients with colorectal cancer liver metastasis (CRLM) after simultaneous resection of colorectal cancer and liver metastases.

METHODS

Four hundred seventy-nine CRLM patients receiving simultaneous resection between February 2010 and February 2018 at our hospital were enrolled. A 1:3 propensity score matching analysis (PSM) analysis was performed to balance covariates and avoid selection bias. After PSM, 90 patients were distributed to the POI group, and 233 patients were distributed to the no POI group. A log-rank test was performed to compare the progression-free survival (PFS) and overall survival (OS) data. A multivariate Cox regression model was employed to identify prognostic factors influencing OS and PFS. A value of two-sided P<0.05 was considered statistically significant.

RESULTS

Compared to patients in the no POI group, patients in the POI group were more likely to have hepatic portal occlusion (78.9% vs. 66.3%, P=0.021), operation time ≥325 min (61.1% vs. 48.1%, P=0.026), and intraoperative blood loss ≥200 ml (81.1% vs. 67.6%, P=0.012). In multivariate analysis, intraoperative blood loss ≥200 ml (OR = 2.057, 95% CI: 1.165-3.634, P=0.013) was identified as the only independent risk factor for POI. Patients with POI had a worse PFS (P<0.001, median PFS: 7.5 vs. 12.7 months) and a worse OS (P=0.010, median OS: 38.8 vs. 59.0 months) than those without POI. After 1:3 PSM analysis, no differences in clinicopathologic parameters were detected between the POI group and the no POI group. Patients with POI had a worse PFS (P=0.013, median PFS: 7.5 vs. 11.1 months) and a worse OS (P=0.020, median OS: 38.8 vs. 59.0 months) than those without POI. Multivariate analysis showed that POI was an independent predictor for worse PFS (HR=1.410, 95% CI: 1.065-1.869, P=0.017) and worse OS (HR=1.682, 95% CI: 1.113-2.544, P=0.014).

CONCLUSIONS

POI can significantly worsen the long-term outcomes of CRLM patients receiving simultaneous resection of colorectal cancer and liver metastases and should be considered to improve postoperative management and make better treatment decisions for these patients.

Underbody blankets have a higher heating effect than overbody blankets in lithotomy position endoscopic surgery under general anesthesia: a randomized trial

BACKGROUND

Surgery under general anesthesia results in temperature decrease due to the effect of anesthetics and peripheral vasodilation on thermoregulatory centers. Perioperative temperature control is therefore an issue of high importance. In this study, we aimed to compare the warming effect of underbody and overbody blankets in patients undergoing surgery in the lithotomy position under general anesthesia.

METHODS

From September 2018 to October 2019, 99 patients undergoing surgery for colorectal cancer in the lithotomy position were included in this randomized controlled trial and assigned to the intervention group (underbody blanket) or control group (overbody blanket).

RESULTS

The central temperature was significantly higher in the underbody blanket group than in the overbody blanket group at 90 min after the beginning of the surgery (p = 0.02); also in this group, the peripheral temperature was significantly higher 60 min after the beginning of the surgery (p = 0.02). Regarding postoperative factors, the underbody blanket group had a significantly lower frequency of postoperative shivering (p < 0.01) and a significantly shorter postoperative hospital stay (p = 0.04) than the overbody blanket group.

CONCLUSIONS

We recommend the use of underbody blankets for intraoperative temperature control in patients undergoing surgery in the lithotomy position under general anesthesia. Underbody blankets showed improved rise and maintenance of central and peripheral temperature, decreased the incidence of postoperative shivering, and shortened the postoperative length of hospital stay.

Using a Normothermia Bundle With Perioperative Prewarming to Reduce Patient Hypothermia

PURPOSE

To determine if implementing a normothermia bundle, which includes preoperative forced-air warming blankets, reduces incidence of inadvertent perioperative hypothermia (IPH).

DESIGN

Intervention study using retrospective chart review.

METHODS

Patients received a preoperative forced-air warming blanket and temperature management with the normothermia bundle. Temperature status data was collected from patient charts to evaluate the incidences of IPH and findings from this data analysis was used to measure improvement in perioperative temperature management.

FINDINGS

Of 200 patients, 63 (31.5%) remained normothermic, 37 (18.5%) had at least one documented hypothermic temperature, and 100 (50%) had no documented temperature during the intraoperative phase of care. Although compliance with intraoperative temperature monitoring decreased by 13% postintervention, the incidence of documented IPH in reviewed records was decreased by 3.6-fold.

CONCLUSION

Implementing a normothermia bundle that includes a preoperative forced-air warming blanket may lower the incidences of IPH, especially in surgical cases lasting over 120 minutes.

Summary of the best evidence for the prevention of intraoperative unplanned hypothermia in patients undergoing laparoscopic surgery

Background

This study aimed to search, analyze, and summarize relevant evidence for the prevention of unplanned hypothermia in patients undergoing laparoscopic surgery, so as to reduce the incidence of unplanned hypothermia in patients undergoing laparoscopic surgery and provide a reference for clinical medical staff.

Methods

According to the evidence pyramid model, relevant literature were retrieved by computer in databases. Literature quality evaluation and the evidence grading system of the Australian JBI Evidence-Based Health Care Centre Evidence Recommendation Rating System were used to evaluate the literature quality and determine the level of evidence. The time limit for retrieval was from the establishment of the databases to March 31, 2021.

Results

A total of 12 studies were included in this study. Of these, 5 evidence items were finally extracted, and 15 pieces of best evidence were summarized, including the risk assessment of hypothermia in patients undergoing laparoscopic surgery, temperature monitoring, ambient temperature, passive insulation measures, and active insulation measures.

Conclusions

The evidence for the prevention of unplanned hypothermia in patients undergoing laparoscopic surgery provided evidence-based approaches for reducing the incidence of intraoperative hypothermia for clinical staffs. It is suggested that the cultural characteristics of China, medical resources, and patients' own conditions should be considered when applying the evidence.

Effect of nurse-initiated forced-air warming blanket on the reduction of hypothermia complications following coronary artery bypass grafting: a randomized clinical trial

AIMS

To evaluate the effect of postoperative forced-air warming (FAW) on the incidence of excessive bleeding (ExB), arrhythmia, acute myocardial infarction (AMI), and blood product transfusion in hypothermic patients following on-pump CABG and compare temperatures associated with the use of FAW and warming with a sheet and wool blanket.

METHODS AND RESULTS

A randomized clinical trial conducted with 200 patients undergoing isolated on-pump CABG from January to November 2018. Patients were randomly assigned into an Intervention Group (IG, FAW, n = 100) and Control Group (CG, sheet and blanket, n = 100). The tympanic temperature of all patients was measured over a 24-h period. ExB was the primary outcome, while arrhythmia, AMI, and blood product transfusion were secondary outcomes. The effect of the interventions on the outcomes was investigated through using bivariate logistic regression, with a level of significance of 5%. The IG was 79% less likely to experience bleeding than the CG [odds ratio (OR) = 0.21, confidence interval (CI) 95% 0.12-0.39, P < 0.001]; the occurrence of AMI in the IG was 94% lower than that experienced by the CG (OR = 0.06, CI 95% 0.01-0.48, P < 0.001); and the IG was also 77% less likely to experience arrhythmia than the CG (OR = 0.23, CI 95% 0.12-0.47, P < 0.001); no difference was found between groups in terms of blood product transfusion (P < 0.279).

CONCLUSIONS

These findings show that FAW can be used following CABG until patients reach normothermia to avoid undesirable clinical outcomes.

TRIAL REGISTRATION

REBeC RBR-5t582g.

Effects of Warmed and Humidified CO2 Surgical Site Insufflation in a Novel Experimental Model of Magnetic Compression Colonic Anastomosis

Background. Pneumoperitoneum insufflation with warmed and humidified carbon dioxide (WH-CO2) can prevent heat loss and increase tissue oxygenation. We evaluated the impact of localized WH-CO2 insufflation on the anastomotic healing process. Methods. Sixty male Wistar rats were randomized: Group 1 (control, n = 12), Group 2 (cold and dry CO2, CD-CO2, n = 24), and Group 3 (WH-CO2, n = 24). A magnetic compression side-to-side colonic anastomosis was performed under 60-minute local abdominal CO2 flow insufflation. Animal temperature was recorded. IL-1, IL-6, and CRP levels were assessed before and after insufflation and on postoperative day (POD) 7 and POD 10. Endoscopic follow-up was performed on POD 7 and POD 10. A burst pressure (BP) test of the specimen was performed on POD 10, and histopathological analysis was then performed. Metabolomics of the anastomotic site was determined. Results. Seven rats (5 CD-CO2 group, 1 WH-CO2 group, and 1 control group) died during the survival period. Necropsies revealed intestinal occlusions (n = 2). One additional rat from the CD-CO2 group was sacrificed on POD 7 due to intestinal perforation. The postoperative course was uneventful in the remaining cases. There was no difference in BP among the groups. Thermal monitoring confirmed that WH-CO2 insufflation was effective to reduce heat loss. IL-1 levels were statistically and significantly lower on POD 10 in the WH-CO2 group than the CD-CO2 group but not lower than the control group. CRP levels, histopathology, and metabolomics did not show any difference between the 3 groups. Conclusions. WH-CO2 was effective to preserve core temperature. However, it did not improve anastomotic healing.

Effects of a preoperative forced-air warming system for patients undergoing video-assisted thoracic surgery: A randomized controlled trial

BACKGROUND

The incidence of intraoperative hypothermia is still high despite the proposal of different preventive measures during thoracoscopic surgery. This randomized control study evaluated the effects of 30-minute prewarming combined with a forced-air warming system during surgery to prevent intraoperative hypothermia in patients undergoing video-assisted thoracic surgery under general anesthesia combined with erector spinae nerve block.

METHODS

Ninety-eight patients were randomly and equally allocated to prewarming or warming groups (n = 49 each). The primary outcome was the incidence of intraoperative hypothermia. Secondary outcomes were core temperature, irrigation and infused fluid, estimated blood loss, urine output, type of surgery, intraoperative anesthetic dosage, hemodynamics, recovery time, the incidence of postoperative shivering, thermal comfort, postoperative sufentanil consumption and pain intensity, patient satisfaction, and adverse events.

RESULTS

The incidence of intraoperative hypothermia was significantly lower in the prewarming group than the warming group (12.24% vs 32.65%, P = .015). Core temperature showed the highest decrease 30 minutes after surgery start in both groups; however, the rate was lower in the prewarming than in the warming group (0.31 ± 0.04°C vs 0.42 ± 0.06°C, P < .05). Compared with the warming group, higher core temperatures were recorded for patients in the prewarming group from T1 to T6 (P < .05). Significantly fewer patients with mild hypothermia were in the prewarming group (5 vs 13, P = .037) and recovery time was significantly reduced in the prewarming group (P < .05). Although the incidence of postoperative shivering was lower in the prewarming group, it was not statistically significant (6.12% vs 18.37%, P = .064). Likewise, the shivering severity was similar for both groups. Thermal comfort was significantly increased in the prewarming group, although patient satisfaction was comparable between the 2 groups (P > .05). No adverse events occurred associated with the forced-air warming system. Both groups shared similar baseline demographics, type of surgery, total irrigation fluid, total infused fluid, estimated blood loss, urine output, intraoperative anesthetic dosage, hemodynamics, duration of anesthesia and operation time, postoperative sufentanil consumption, and pain intensity.

CONCLUSION

In patients undergoing video-assisted thoracic surgery, prewarming for 30 minutes before the induction of anesthesia combined with a forced-air warming system may improve perioperative core temperature and the thermal comfort, although the incidence of postoperative shivering and severity did not improve.

Management of Ambulatory Anesthesia in Older Adults

The number of older patients is increasing globally. Combined with the growing number of ambulatory surgeries, many older patients will undergo ambulatory surgery in the future. The ambulatory setting offers many advantages: early mobilization, higher patient satisfaction, lower costs, and a low incidence of several complications such as infections and thromboembolic events. Moreover, cognitive recovery seems to be enhanced compared with in-hospital surgery, and both frail patients and patients with dementia can benefit from ambulatory surgery. This review provides suggestions for managing perioperative anesthesia for older patients in the ambulatory setting. Not all older patients are eligible for ambulatory surgery, and clinicians must be aware of risk factors for complications, especially frailty. Most anesthesia techniques and agents can be used in the ambulatory setting, but short-acting agents are preferred to ensure fast recovery. Both regional and general anesthesia are useful, but clinicians must be familiar with the physiological changes and specific implications in the older population. The older patients are more sensitive to anesthetic agents, meaning that a lower dose is needed to obtain the desired effect. However, they exhibit huge variation in pharmacodynamics and pharmacokinetics. Prolonged onset time may lead to overdosing and extended recovery. After surgery, effective pain management with opioid minimization is essential to ensure rapid recovery.

Nurse-Led Randomized Controlled Trials in the Perioperative Setting: A Scoping Review

PURPOSE

Nurses provide care at each phase of the complex, perioperative pathway and are well placed to identify areas of care requiring investigation in randomized controlled trials. Yet, currently, the scope of nurse-led randomized controlled trials conducted within the perioperative setting are unknown. This scoping review aims to identify areas of perioperative care in which nurse-led randomized controlled trials have been conducted, to identify issues impacting upon the quality of these trials and identify gaps for future investigation.

METHODS

This scoping review was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Searches were conducted in PubMed, Embase, Cumulative Index for Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials, with a date range of 2014-19. Sources of unpublished literature included Open Grey, and ProQuest Dissertation and Theses, Clinical Trials.gov and the Australian and New Zealand Clinical Trials Registry. After title and abstract checking, full-text retrieval and data extraction, studies were appraised using the Joanna Briggs Institute Critical Appraisal Checklists for randomized controlled trials. Data were synthesized according to the main objectives. Key information was tabulated.

RESULTS

From the 86 included studies, key areas where nurses have led randomized controlled trials include patient or caregiver anxiety; postoperative pain relief; surgical site infection prevention: patient and caregiver knowledge; perioperative hypothermia prevention; postoperative nausea and vomiting; in addition to other diverse outcomes. Issues impacting upon quality (including poorly reported randomization), and gaps for future investigation (including a focus on vulnerable populations), are evident.

CONCLUSION

Nurse-led randomized controlled trials in the perioperative setting have focused on key areas of perioperative care. Yet, opportunities exist for nurses to lead experimental research in other perioperative priority areas and within different populations that have been neglected, such as in the population of older adults undergoing surgery.

New Concept Air Conditioning System for the Operating Room to Minimize Patient Cooling and Surgeon Heating: A Historical Control Cohort Study

BACKGROUND

Intraoperative hypothermia is a common adverse event. For avoiding the complication due to hypothermia, many warming devices and methods have been used in perioperative period. It has been reported that more patients undergoing laparoscopic surgery tend to have hypothermia than with open surgery. To avoid intraoperative hypothermia, many kinds of warming tools have been used. But, it was also reported that some warming methods increased perceptions of distraction and physical demand.

METHODS

To achieve both patients' normothermia and surgeons' comfort, new air conditioning (AC) system was designed with considering the characteristics of laparoscopic surgery. The temperature of the airflows to the patient and to the surgeons can be adjusted independently in this new system. The new system has two parts. One controls the temperature of the central area over the operation table. The air from this part falls on the patients. The other part is the lateral area beside the operating table; the air from this part falls on the surgeons. The subjects of this study were 160 gastric cancer patients and 316 colorectal cancer patients undergoing laparoscopic surgery. The temperature of the central flow was set 23.5 °C, and the temperature of the lateral flow was set 22 °C just after the anesthesia. The number of timepoints the patient spent in hypothermic state, defined as a temperature cooler by 0.5 °C or more than that at the starting point of surgery, was determined in each patient.

RESULTS

In the results, the rate of hypothermic state in old operation rooms was 23.8% and that in new operation rooms was 2.7% in male gastric cancer patients (p < 0.01). And those were 37.1% in old operation rooms and 0.9% in new operation rooms in female gastric cancer patients (p < 0.01). The rate of hypothermic state in old operation rooms was 30.0% and that in new operation rooms was 9.5% in male colorectal cancer patients (p < 0.01). And those were 41.6% in old operation rooms and 8.9% in new operation rooms in female colorectal cancer patients (p < 0.01). The similar results were showed in the study, which subjects were limited the patients undergoing surgery in 2015 and 2016; which were the last year the old operation rooms were used and the first year the new operation rooms were used.

CONCLUSIONS

Thus, the usefulness of the new air conditioning system for achieving both patients' normothermia and comfort of surgeons could be verified in this study.

Effect of different carbon dioxide (CO2) insufflation for laparoscopic colorectal surgery in elderly patients: A randomized controlled trial

BACKGROUND

Evidence suggests that dry CO2 insufflation during laparoscopic colorectal surgery results in greater structural injury to the peritoneum and longer hospital stay than the use of warm, humidified CO2. We aimed to test the hypothesis that warm, humidified CO2 insufflation could reduce postoperative pain and improve recovery in laparoscopic colorectal surgery.

METHODS

One hundred fifty elderly patients undergoing laparoscopic colorectal surgery under general anesthesia from May 2017 to October 2018 were randomly divided into 3 groups. The primary outcomes were resting pain, cough pain, and consumption of sufentanil at 2, 4, 6, 12, 24, and 48 hours postoperatively. Quality of visual image, hemodynamic changes, esophageal temperature, mean skin temperature, mean body temperature, recovery time, days to first flatus and solid food intake, shivering, incidence of postoperative ileus, length of hospital stay, surgical site infections, patients and surgeon satisfaction scores, adverse events, prothrombin time, activated partial thromboplastin time, and thrombin time were recorded.

RESULTS

Group CE patients were associated with significantly higher early postoperative cough pain and sufentanil consumption than the other 2 groups (P < .05). Compared with group CE, patients in both groups WH and CF had significantly reduced intraoperative hypothermia, recovery time of PACU, days to first flatus and solid food intake, and length of hospital stay, while the satisfaction scores of both patients and surgeon were significantly higher (P < .05). Prothrombin time, activated partial thromboplastin time, and thrombin time were significantly higher in group CE from 60 minutes after pneumoperitoneum to the end of pneumoperitoneum than the other 2 groups (P < .05). The number of patients with a shivering grade of 0 was significantly lower and grade of 3 was significantly higher in group CE than in the other 2 groups (P < .05).

CONCLUSION

Use of either warm, humidified CO2 insufflations or 20°C, 0% relative humidity CO2 combined with forced-air warmer set to 38°C during insufflations can both reduce intraoperative hypothermia, dysfunction of coagulation, early postoperative cough pain, sufentanil consumption, days to first flatus, solid food intake, and length of hospital stay.