The effect of combination of warm intravenous fluid infusion and forced air warming versus forced air warming alone on maternal temperature and shivering during cesarian delivery under spinal anesthesia

Effects of Short Preoperative Warming Time on Transurethral Lithotripsy Surgery: A Randomized Controlled Trial

PURPOSE

Preoperative warming prevents inadvertent perioperative hypothermia (IPH). The aim of this study was to investigate the effect of preoperative warming (prewarming) on patient thermal protection and to explore the appropriate duration of preoperative warming for clinical practice.

DESIGN

Randomized controlled clinical trial.

METHODS

117 urological patients were randomized into no prewarming (NP), prewarming 15 minutes (P-15), and prewarming 30 minutes (P-30) groups. Patients' core temperature was monitored and the incidence of IPH, incidence of postoperative shivering, extubation time, length of stay in the postanesthesia care unit, and length of stay in hospital were recorded. The Consolidated Standards of Reporting Trials (CONSORT) checklist was followed.

FINDINGS

The intraoperative core temperature at all time points and the rise in temperature before induction of anesthesia were higher in the P-15 and P-30 groups than in the NP group, but there was no statistically significant difference between the P-15 and P-30 groups. The incidence of IPH was lower in the P-15 (33.3%) and P-30 (37.8%) groups than in the NP group (65.8%), but there was no statistically significant difference between the P-15 and P-30 groups. The incidence of shivering, extubation time, length of stay in the postanesthesia care unit, and length of stay in hospital did not differ between groups.

CONCLUSIONS

Prewarming can effectively maintain intraoperative core temperature in patients undergoing transurethral lithotripsy, and reduce the incidence of IPH. Prewarming 15 minutes before surgery can achieve beneficial clinical effects.

Combined Forced Air Warming and Warm Intravenous Fluid Strategy for Perioperative Hypothermia in Cesarean Delivery: A Systematic Review and Meta-Analysis

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.

Effectiveness of Combined Strategies for the Prevention of Hypothermia Measured by Noninvasive Zero-Heat Flux Thermometer During Cesarean Section

Background: Perioperative hypothermia (body temperature <36°C) is a common complication of anesthesia increasing the risk for maternal cardiovascular events and coagulative disorders, and can also influence neonatal health. The aim of our work was to evaluate the impact of combined warming strategies on maternal core temperature, measured with the SpotOn. We hypothesized that combined modalities of active warming prevent hypothermia in pregnant women undergoing cesarean delivery with spinal anesthesia. Methods: Seventy-eight pregnant women were randomly allocated into three study groups receiving warmed IV fluids and forced-air warming (AW), warmed IV fluids (WF), or no warming (NW). Noninvasive core temperature device (SpotOn) measured maternal core temperature intraoperatively and for 30 min after surgery. Maternal mean arterial pressure, incidence of shivering, thermal comfort and newborn's APGAR, axillary temperature, weight, and blood gas analysis were also recorded. Results: Incidence of hypothermia was of 0% in AW, 4% in WF, and 47% in NW. Core temperature in AW was constantly higher than WF and NW groups. Incidence of shivering in perioperative time was significantly lower in AW and WF groups compared with the NW group (p < 0.04). Thermal comfort was higher in both AW and WF groups compared with NW group (p = 0.02 and p = 0.008, respectively). There were no significant differences among groups for the other evaluated parameters. Conclusion: Combined modalities of active warming are effective in preventing perioperative hypothermia. The routine uses of combined AW are suggested in the setting of cesarean delivery.