Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.12.007
Brazilian Journal of Anesthesiology
Scientific Article

Perioperative warming with a thermal gown prevents maternal temperature loss during elective cesarean section. A randomized clinical trial

O aquecimento no perioperatório com avental cirúrgico térmico impede a perda de temperatura materna durante a cesariana eletiva. Estudo clínico randômico

Ricardo Caio Gracco de Bernardis; Monica Maria Siaulys; Joaquim Edson Vieira; Lígia Andrade Silva Telles Mathias

http://dx.doi.org/10.1016/j.bjane.2014.12.007 Braz J Anesthesiol, vol.66, n5, p.451-455, 2016
PDF English
PDF Português
Downloads: 0
Views: 641

Abstract

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 30 min 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 30 min before (baseline) spinal anesthesia, right after it (time zero) and every 15 min 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 30 min before spinal anesthesia and during surgery prevented a fall in body temperature in full-term pregnant women during elective cesarean delivery.

Keywords

Body temperature, Perioperative care, Anesthesia, Spinal, Cesarean section, Intraoperative complications/prevention and control

Resumo

Resumo Justificativa e objetivos: A redução da temperatura corporal é comum durante a anestesia tanto geral quanto regional. O sistema de ar forçado aquecido no intraoperatório durante a cesariana sob anestesia peridural não parece conseguir impedi-la. A hipótese considera que o aquecimento ativo antes do período intraoperatório evita a perda de temperatura durante a cesariana. Métodos: Quarenta pacientes grávidas, saudáveis, submetidas à cesariana eletiva com anestesia espinal receberam aquecimento ativo de um avental térmico na unidade de cuidados pré-operatórios 30 minutos antes da anestesia e durante a cirurgia (Go, n = 20) ou nenhum aquecimento ativo a qualquer momento (Ct, n = 20). Após a indução da anestesia espinhal, o avental térmico foi colocado sobre o tórax e os membros superiores e mantido durante o estudo. Temperatura ambiente, saturação de hemoglobina, frequência cardíaca, pressão arterial e temperatura corporal timpânica foram registradas 30 minutos antes (fase basal) da anestesia espinhal, logo após a anestesia (tempo zero) e a cada 15 minutos subsequentemente. Resultados: Não houve diferença de temperatura na fase basal, mas as diferenças foram significativas ao longo do estudo (p < 0,0001; Ancova de medida repetida). A temperatura timpânica na fase basal foi de 36,6 ± 0,3 °C, mediu 36,5 ± 0,3 °C no tempo zero e atingiu 36,1 ± 0,2 °C no grupo avental, enquanto a temperatura basal do grupo controle foi de 36,4 ± 0,4 °C, mediu 36,3 ± 0,3 °C no tempo zero e atingiu 35,4 ± 0,4 °C (F = 32,53; IC de 95% 0,45-0,86, p < 0,001). A hemodinâmica não diferiu ao longo do estudo em ambos os grupos de pacientes. Conclusão: O aquecimento ativo 30 minutos antes da anestesia espinhal e durante a cirurgia evitou a queda da temperatura corporal em mulheres grávidas a termo durante a cesariana eletiva.

Palavras-chave

Temperatura corporal, Cuidados no perioperatório, Anestesia, Espinhal, Cesariana, Complicações no intraoperatório/prevenção e controle

References

Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109:318-38.

Sessler DI, Sladen RN. Mild perioperative hypothermia. N Engl J Med. 1997;336:1730-7.

Sessler DI, Schroeder M, Merrifield B. Optimal duration and temperature of pre-warming. Anesthesiology. 1995;82:674-81.

Insler SR, Sessler DI. Perioperative thermoregulation and temperature monitoring. Anesthesiol Clin. 2006;24:823-37.

Carpenter L, Baysinger CL. Maintaining perioperative normothermia in the patient undergoing cesarean delivery. Obstet Gynecol Surv. 2012;67:436-46.

Andrzejowski J, Hoyle J, Eapen G. Effect of prewarming on post-induction core temperature and the incidence of inadvertent perioperative hypothermia in patients undergoing general anaesthesia. Br J Anaesth. 2008;101:627-31.

Sessler DI. Temperature monitoring and management during neuraxial anesthesia. Anesth Analg. 1999;88:243-5.

Macario A, Dexter F. What are the most important risk factors for a patient's developing intraoperative hypothermia?. Anesth Analg. 2002;94:215-20.

Frank SM, El-Rahmany HK, Cattaneo CG. Predictors of hypothermia during spinal anesthesia. Anesthesiology. 2000;92:1330-4.

Kurz A, Sessler DI, Schroeder M. Thermoregulatory response thresholds during spinal anesthesia. Anesth Analg. 1993;77:721-6.

Doufas AG. Consequences of inadvertent perioperative hypothermia. Best Pract Res Clin Anaesthesiol. 2003;17:535-49.

Frank SM, Nguyen JM, Garcia CM. Temperature monitoring practices during regional anesthesia. Anesth Analg. 1999;88:373-7.

NICE Clinical Guideline 65. Inadvertent perioperative hypothermia. The management of inadvertent perioperative hypothermia in adults. 2008.

Buggy DJ, Crossley AW. Thermoregulation, mild perioperative hypothermia and post-anaesthetic shivering. Br J Anaesth. 2000;84:615-28.

Eberhart LHJ, Döderlein F, Eisenhardt G. Independent risk factors for postoperative shivering. Anesth Analg. 2005;101:1849-57.

Reynolds L, Beckmann J, Kurz A. Perioperative complications of hypothermia. Best Pract Res Clin Anaesthesiol. 2008;22:645-57.

Horn EP, Schroeder F, Gottschalk A. Active warming during cesarean delivery. Anesth Analg. 2002;94:409-14.

Butwick AJ, Lipman SS, Carvalho B. Intraoperative forced air-warming during cesarean delivery under spinal anesthesia does not prevent maternal hypothermia. Anesth Analg. 2007;105:1413-9.

Wrench IJ, Cavill G, Ward JE. Comparison between alfentanil, pethidine and placebo in the treatment of post-anaesthetic shivering. Br J Anaesth. 1997;79:541-2.

Taguchi A, Arkilic CF, Ahluwalia A. Negative pressure rewarming vs. forced air warming in hypothermic postanesthetic volunteers. Anesth Analg. 2001;92:261-6.

Ng SF, Oo CS, Loh KH. A comparative study of three warming interventions to determine the most effective technique for maintaining perioperative normothermia. Anesth Analg. 2003;96:171-6.

Sessler AI. Complications and treatment of mild hypothermia. Anesthesiology. 2001;95:531-43.

Yokoyama K, Suzuki M, Shimada Y. Effect of the administration of pre-warmed intravenous fluids on the frequency of hypothermia following spinal anesthesia for cesarean delivery. J Clin Anesth. 2009;21:242-8.

Camus Y, Delva E, Sessler DI. Pre-induction skin-surface warming minimizes intraoperative core hypothermia. J Clin Anesth. 1995;7:384-8.

De Bernardis RCG, Silva MP, Gozzani JL. Use of forced-air to prevent intraoperative hypothermia. Rev Assoc Med Bras. 2009;55:421-6.

Shinn H, Lim H, Kwak Y. Pre-anesthetic active warming reduces hypothermia without delaying anesthesia in cardiac surgery. Anesth Analg. 2004;98:123-34.

Ryan KF, Price JW, Warriner CB. Persistent hypothermia after intrathecal morphine: case report and literature review. Can J Anaesth. 2012;59:384-8.

Hui CK, Huang CH, Lin CJ. A randomised double-blind controlled study evaluating the hypothermic effect of 150 microg morphine during spinal anaesthesia for Caesarean section. Anaesthesia. 2006;61:29-31.

Woolnough M, Allam J, Hemingway C. Intra-operative fluid warming in elective caesarean section: a blind, randomised controlled trial. Int J Obstet Anesth. 2009;18:346-51.

Aluri S, Wrench IJ. Enhanced recovery from obstetric surgery: a UK survey of practice. Int J Obstet Anesth. 2013.

Hooper VD, Andrews JO. Accuracy of noninvasive core temperature measurement in acutely ill adults: the state of the science. Biol Res Nurs. 2006;8:24-34.

Ro Y, Huh J, Min S. Phenylephrine attenuates intra-operative hypothermia during spinal anaesthesia. J Int Med Res. 2009;37:1701-8.

5dcd663c0e88259e56bf58f1 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections