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Akdag Topal C, Yucel Ozcirpan C, Ozyuncu O. The effect of forced-air warming in the cesarean section on maternal hypothermia, shivering, and thermal comfort: A randomized controlled trial. Health Care Women Int 2023:1-18. [PMID: 37566684 DOI: 10.1080/07399332.2023.2245366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/15/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023]
Abstract
This trial was carried out to investigate the effect of forced air warming in various body areas of women on hypothermia during cesarean delivery. The patients in the study groups (n = 76) were assigned to the full-body warming group, upper-extremity warming group, lower-extremity warming group, and control groups. The intervention groups received forced-air warming 30 min before the surgery and continued until 30 min after surgery. The incidence of hypothermia was significantly higher in the control group than in the other groups at the 60th minute of the operation (p < 0.01). The intervention and control groups showed significant differences in the frequency of shivering at the entrance to the PACU (p = 0.001). Thermal comfort scores have significant difference between the control group and all of the intervention groups (p<.001). It is said that the full-body forced-air warming technique prevents hypothermia, shivering, and thermal discomfort in women Cesarean Section (CS).
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Affiliation(s)
- Cansu Akdag Topal
- Nursing Department, Faculty of Health Sciences Baskent University, Ankara, Turkey
| | | | - Ozgur Ozyuncu
- Faculty of Medicine, Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
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2
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Dibiasi C, Agibetov A, Kapral L, Zeiner S, Kimberger O. Predicting Intraoperative Hypothermia Burden during Non-Cardiac Surgery: A Retrospective Study Comparing Regression to Six Machine Learning Algorithms. J Clin Med 2023; 12:4434. [PMID: 37445469 DOI: 10.3390/jcm12134434] [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: 05/15/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Inadvertent intraoperative hypothermia is a common complication that affects patient comfort and morbidity. As the development of hypothermia is a complex phenomenon, predicting it using machine learning (ML) algorithms may be superior to logistic regression. METHODS We performed a single-center retrospective study and assembled a feature set comprised of 71 variables. The primary outcome was hypothermia burden, defined as the area under the intraoperative temperature curve below 37 °C over time. We built seven prediction models (logistic regression, extreme gradient boosting (XGBoost), random forest (RF), multi-layer perceptron neural network (MLP), linear discriminant analysis (LDA), k-nearest neighbor (KNN), and Gaussian naïve Bayes (GNB)) to predict whether patients would not develop hypothermia or would develop mild, moderate, or severe hypothermia. For each model, we assessed discrimination (F1 score, area under the receiver operating curve, precision, recall) and calibration (calibration-in-the-large, calibration intercept, calibration slope). RESULTS We included data from 87,116 anesthesia cases. Predicting the hypothermia burden group using logistic regression yielded a weighted F1 score of 0.397. Ranked from highest to lowest weighted F1 score, the ML algorithms performed as follows: XGBoost (0.44), RF (0.418), LDA (0.406), LDA (0.4), KNN (0.362), and GNB (0.32). CONCLUSIONS ML is suitable for predicting intraoperative hypothermia and could be applied in clinical practice.
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Affiliation(s)
- Christoph Dibiasi
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Währinger Straße 104/10, 1180 Vienna, Austria
| | - Asan Agibetov
- Center for Medical Statistics, Informatics and Intelligent Systems, Institute of Artificial Intelligence, Medical University of Vienna, Währinger Straße 25a, 1090 Vienna, Austria
| | - Lorenz Kapral
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Währinger Straße 104/10, 1180 Vienna, Austria
| | - Sebastian Zeiner
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Oliver Kimberger
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Währinger Straße 104/10, 1180 Vienna, Austria
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Zhuo Q, Xu JB, Zhang J, Ji B. Effect of active and passive warming on preventing hypothermia and shivering during cesarean delivery: a systematic review and meta-analysis of randomized controlled trials. BMC Pregnancy Childbirth 2022; 22:720. [PMID: 36131231 PMCID: PMC9494806 DOI: 10.1186/s12884-022-05054-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Perioperative hypothermia and shivering commonly occur in pregnant women undergoing cesarean section. The warming method is usually used to prevent hypothermia and shivering. However, the effect of active warming (AW) prior to passive warming (PW) on the perioperative outcomes of pregnant women and their offspring remains controversial. Methods This study aimed to investigate the effects of AW and PW on maternal and newborn perioperative outcomes during cesarean delivery. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PubMed, Embase, Scopus, and the Cochrane Library were used to search for randomized controlled trials (RCTs) up to August 7, 2022. The Cochrane risk of bias assessment tool was used to assess articles selected for the systematic review. Continuous data were analyzed using weighted mean differences (WMDs) with 95% confidence intervals (CIs), and categorical data were analyzed by the random-effects model. Results A total of 1241 participants from twelve RCTs were selected for the final meta-analysis. AW was associated with a lower risk of maternal hypothermia (RR: 0.77, 95% CI: 0.63–0.93, P = 0.007) and shivering (RR: 0.56, 95% CI: 0.37–0.85; P = 0.007). AW was associated with high maternal temperature (WMD: 0.27, 95%CI: 0.14 to 0.40, P < 0.001). No significant difference was observed between AW and PW in terms of hypothermia (RR: 0.60, 95% CI: 0.24–1.51, P = 0.278), temperature (WMD: 0.31, 95% CI: − 0.00 to 0.62; P = 0.050), and umbilical vein PH in newborns (WMD: -0.00; 95% CI: − 0.02 to 0.02, P = 0.710). Conclusions These findings suggested that AW can better prevent maternal hypothermia and shivering than PW. In contrast, no significant effect was observed in newborns. Overall, the quality of the included studies is high due to RCTs, low risk of bias, consistency, and precision. We identified the quality of the overall evidence from the survey to be GRADE I. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05054-7.
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Affiliation(s)
- Qing Zhuo
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jia-Bin Xu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jing Zhang
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Bin Ji
- Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Chataule SM, Hazarika A, jain K, Chauhan R, Luthra A, Meena S, Aggarwal S, Sethi S. Preoperative Forced-Air Warming Strategy: Is It Effective in Averting Intraoperative Hypothermia in Elderly Trauma Surgical Patients? Cureus 2022; 14:e29305. [DOI: 10.7759/cureus.29305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/05/2022] Open
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Koh W, Chakravarthy M, Simon E, Rasiah R, Charuluxananan S, Kim TY, Chew STH, Bräuer A, Ti LK. Perioperative temperature management: a survey of 6 Asia-Pacific countries. BMC Anesthesiol 2021; 21:205. [PMID: 34399681 PMCID: PMC8365903 DOI: 10.1186/s12871-021-01414-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/17/2021] [Indexed: 12/31/2022] Open
Abstract
Background Anesthesia leads to impairments in central and peripheral thermoregulatory responses. Inadvertent perioperative hypothermia is hence a common perioperative complication, and is associated with coagulopathy, increased surgical site infection, delayed drug metabolism, prolonged recovery, and shivering. However, surveys across the world have shown poor compliance to perioperative temperature management guidelines. Therefore, we evaluated the prevalent practices and attitudes to perioperative temperature management in the Asia–Pacific region, and determined the individual and institutional factors that lead to noncompliance. Methods A 40-question anonymous online questionnaire was distributed to anesthesiologists and anesthesia trainees in six countries in the Asia–Pacific (Singapore, Malaysia, Philippines, Thailand, India and South Korea). Participants were polled about their current practices in patient warming and temperature measurement across the preoperative, intraoperative and postoperative periods. Questions were also asked regarding various individual and environmental barriers to compliance. Results In total, 1154 valid survey responses were obtained and analyzed. 279 (24.2%) of respondents prewarm, 508 (44.0%) perform intraoperative active warming, and 486 (42.1%) perform postoperative active warming in the majority of patients. Additionally, 531 (46.0%) measure temperature preoperatively, 767 (67.5%) measure temperature intraoperatively during general anesthesia, and 953 (82.6%) measure temperature postoperatively in the majority of patients. The availability of active warming devices in the operating room (p < 0.001, OR 10.040), absence of financial restriction (p < 0.001, OR 2.817), presence of hospital training courses (p = 0.011, OR 1.428), and presence of a hospital SOP (p < 0.001, OR 1.926) were significantly associated with compliance to intraoperative active warming. Conclusions Compliance to international perioperative temperature management guidelines in Asia–Pacific remains poor, especially in small hospitals. Barriers to compliance were limited temperature management equipment, lack of locally-relevant standard operating procedures and training. This may inform international guideline committees on the needs of developing countries, or spur local anesthesiology societies to publish their own national guidelines. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01414-6.
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Affiliation(s)
- Wenjun Koh
- Department, of Anaesthesia, National University Hospital, Singapore, Singapore
| | - Murali Chakravarthy
- Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospital, Bangalore, Karnataka, India
| | - Edgard Simon
- Department of Anesthesiology, Philippine General Hospital, University of the Philippines, Ermita, Manila, Philippines
| | - Raveenthiran Rasiah
- Department of Anesthesiology, Avisena Specialist Hospital, Shah Alam, Selangor, Malaysia
| | - Somrat Charuluxananan
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Tae-Yop Kim
- Department of Anesthesiology, Konkuk University Medical Center, Gwangjin-gu, Seoul, Republic of Korea
| | - Sophia T H Chew
- Department of Anaesthesia, Singapore General Hospital, Singapore, Singapore
| | - Anselm Bräuer
- Department of Anesthesiology, University Hospital Goettingen, Goettingen, Germany
| | - Lian Kah Ti
- Department, of Anaesthesia, National University Hospital, Singapore, Singapore. .,Department of Anaesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Thorburn PT, Monteiro R, Chakladar A, Cochrane A, Roberts J, Mark Harper C. Maternal temperature in emergency caesarean section (MATES): an observational multicentre study. Int J Obstet Anesth 2021; 46:102963. [PMID: 33773300 DOI: 10.1016/j.ijoa.2021.102963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/16/2020] [Accepted: 01/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Temperature regulation in women undergoing emergency caesarean section is a complex topic about which there is a paucity of evidence-based recommendations. The adverse effects of inadvertent peri-operative hypothermia are well described. Hyperthermia is also associated with adverse neonatal outcomes, an increased risk of obstetric intervention and increased treatment for suspected sepsis. We conducted a multi-centre observational cohort study to identify the prevalence of hypothermia and hyperthermia during emergency caesarean section. S: Participants undergoing emergency caesarean section were recruited across 14 sites in the UK. The primary end point was maternal temperature in the recovery room. Temperature was measured using a zero heat-flux temperature monitoring device. RESULTS Two hundred and sixty-five participants were recruited over a 12-month period. The prevalence of hypothermia (<36.0°C) was 10.7% and the prevalence of hyperthermia (>37.5°C) was 14.7% on admission to recovery. The prevalence of hypothermia, normothermia, and hyperthermia differed among type of anaesthesia: 71.4% of the hypothermic group had received a spinal anaesthetic whereas 76.9% of the hyperthermic group had received epidural top-up anaesthesia. There was a significant decrease in maternal temperature between the time of delivery and admission to the recovery room of 0.20°C (95% CI 0.15 to 0.25, P<0.001). CONCLUSIONS Both hypothermia and hyperthermia are prevalent findings in mothers who undergo emergency caesarean section. Therefore, accurate temperature measurement is essential to ensure that an appropriate intra-operative temperature management strategy is employed.
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Affiliation(s)
- P T Thorburn
- Department of Anaesthesia, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK.
| | - R Monteiro
- Department of Anaesthesia, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - A Chakladar
- Department of Anaesthesia, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - A Cochrane
- Department of Anaesthesia, St Helens and Knowsley Teaching Hospital NHS Trust, St Helens, UK
| | - J Roberts
- Department of Anaesthesia, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - C Mark Harper
- Department of Anaesthesia, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
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Moellhoff N, Broer PN, Heidekrueger PI, Ninkovic M, Ehrl D. Impact of Intraoperative Hypothermia on Microsurgical Free Flap Reconstructions. J Reconstr Microsurg 2020; 37:174-180. [PMID: 32862415 DOI: 10.1055/s-0040-1715880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients requiring microsurgical defect reconstruction are highly susceptible to intraoperative hypothermia, given oftentimes long operative times and exposure of large skin surface areas. While the impact of hypothermia has been extensively studied across various surgical fields, its role in the setting of microsurgical free flap reconstruction remains elusive. This study evaluates the effects of hypothermia on outcomes of free flap reconstructions. METHODS Within 7 years, 602 patients underwent 668 microvascular free flap reconstructions. The cases were divided into two groups regarding the minimal core body temperature during free flap surgery: hypothermia (HT; < 36.0°C) versus normothermia (NT; ≥36.0°C). The data were retrospectively screened for patients' demographics, perioperative details, flap survival, surgical complications, and outcomes. RESULTS Our data revealed no significant difference with regard to the rate of major and minor surgical complications, or the rate of revision surgery between both groups (p > 0.05). However, patients in the HT group showed significantly higher rates of total flap loss (6.6% [HT] vs. 3.0% [NT], p < 0.05) and arterial thrombosis (4.6% [HT] vs. 1.9% [NT], p < 0.05). This translated into a significantly longer hospitalization of patients with reduced core body temperature (HT: mean 16.8 days vs. NT: mean 15.1 days; p < 0.05). CONCLUSION Hypothermia increases the risk for arterial thrombosis and total flap loss. While free flap transfer is feasible also in hypothermic patients, surgeons' awareness of core body temperature should increase. Taken together, we suggest that the mean intraoperative minimum temperature should range between 36 and 36.5°C during free flap surgery as a pragmatic guideline.
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Affiliation(s)
- Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Peter Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
| | - Paul I Heidekrueger
- Department of Plastic, Hand, and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Milomir Ninkovic
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
| | - Denis Ehrl
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
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8
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Smith N, Abernethy C, Allgar V, Foster L, Martinson V, Stones E. An open-label, randomised controlled trial on the effectiveness of the Orve + wrap ® versus Forced Air Warming in restoring normothermia in the postanaesthetic care unit. J Clin Nurs 2020; 29:1085-1093. [PMID: 31889367 DOI: 10.1111/jocn.15159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/29/2019] [Accepted: 12/20/2019] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To determine the clinical effectiveness and safety of the Orve + wrap® thermal blanket. BACKGROUND Inadvertent perioperative hypothermia is a common problem in postanaesthetic care units and can have significant effects on patients' postoperative morbidity. Despite its commercial availability, there is no clinical evidence on the effectiveness of Orve + wrap®. DESIGN A single centre prospective, open-label, noninferiority randomised controlled trial. METHODS Postoperative hypothermic (35.0-35.9°C) patients who had undergone elective surgery were randomised to receive either Orve + wrap® or Forced Air Warming during their PACU stay. Patient temperatures were recorded every 10 min using zero-heat-flux thermometry. This study is reported using CONSORT Extension checklist for noninferiority and equivalence trials. RESULTS Between December 2016-October 2018, 129 patients were randomised to receive either Orve + wrap® blanket (n = 65, 50.3%) or Forced Air Warming (n = 64, 49.7%). The mean 60-min postoperative temperature of patients receiving Orve + wrap® blanket was 36.2 and 36.3°C for the patients receiving Forced Air Warming. The predefined noninferiority margin of a mean difference in temperature of 0.3°C was not reached between the groups at 60 min. Additionally, there were no statistical differences between adverse event rates across these groups. CONCLUSIONS In the context of this study, warming patients with the Orve + wrap® was noninferior to Forced Air Warming. There were comparable rates of associated postoperative consequences of warming (shivering, hypotension, arrhythmias or surgical site infections), between the groups. RELEVANCE TO CLINICAL PRACTICE The Orve + wrap® potentially provides an alternative warming method to Forced Air Warming for patients requiring short-term postoperative warming. However, there are still a number of unknowns regarding the Orve + wrap® performance and further exploration is required.
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Affiliation(s)
- Neil Smith
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | | | - Louise Foster
- Hull University Teaching Hospitals NHS Trust, Hull, UK
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Shah A, Palmer AJR, Klein AA. Strategies to minimize intraoperative blood loss during major surgery. Br J Surg 2020; 107:e26-e38. [DOI: 10.1002/bjs.11393] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 09/12/2019] [Indexed: 12/19/2022]
Abstract
Abstract
Background
Reducing operative blood loss improves patient outcomes and reduces healthcare costs. The aim of this article was to review current surgical, anaesthetic and haemostatic intraoperative blood conservation strategies.
Methods
This narrative review was based on a literature search of relevant databases up to 31 July 2019 for publications relevant to reducing blood loss in the surgical patient.
Results
Interventions can begin early in the preoperative phase through identification of patients at high risk of bleeding. Directly acting anticoagulants can be stopped 48 h before most surgery in the presence of normal renal function. Aspirin can be continued for most procedures. Intraoperative cell salvage is recommended when anticipated blood loss is greater than 500 ml and this can be continued after surgery in certain situations. Tranexamic acid is safe, cheap and effective, and routine administration is recommended when anticipated blood loss is high. However, the optimal dose, timing and route of administration remain unclear. The use of topical agents, tourniquet and drains remains at the discretion of the surgeon. Anaesthetic techniques include correct patient positioning, avoidance of hypothermia and regional anaesthesia. Permissive hypotension may be beneficial in selected patients. Promising haemostatic strategies include use of pharmacological agents such as desmopressin, prothrombin complex concentrate and fibrinogen concentrate, and use of viscoelastic haemostatic assays.
Conclusion
Reducing perioperative blood loss requires a multimodal and multidisciplinary approach. Although high-quality evidence exists in certain areas, the overall evidence base for reducing intraoperative blood loss remains limited.
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Affiliation(s)
- A Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A J R Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - A A Klein
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
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10
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Pich J. Intravenous nutrients for preventing inadvertent perioperative hypothermia in adults. J Perioper Pract 2019; 30:11-12. [PMID: 31694469 DOI: 10.1177/1750458919883745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jacqueline Pich
- Faculty of Health, University of Technology Sydney, Sydney, Australia.,A member of the Cochrane Nursing Care (CNC)
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11
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Jack JM, Ellicott H, Jones CI, Bremner SA, Densham I, Harper CM. Determining the accuracy of zero-flux and ingestible thermometers in the peri-operative setting. J Clin Monit Comput 2019; 33:1113-1118. [DOI: 10.1007/s10877-019-00252-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/03/2019] [Indexed: 01/22/2023]
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Boet S, Etherington C, Nicola D, Beck A, Bragg S, Carrigan ID, Larrigan S, Mendonca CT, Miao I, Postonogova T, Walker B, De Wit J, Mohamed K, Balaa N, Lalu MM, McIsaac DI, Moher D, Stevens A, Miller D. Anesthesia interventions that alter perioperative mortality: a scoping review. Syst Rev 2018; 7:218. [PMID: 30497505 PMCID: PMC6267894 DOI: 10.1186/s13643-018-0863-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/30/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND With over 230 million surgical procedures performed annually worldwide, better application of evidence in anesthesia and perioperative medicine may reduce widespread variation in clinical practice and improve patient care. However, a comprehensive summary of the complete available evidence has yet to be conducted. This scoping review aims to map the existing literature investigating perioperative anesthesia interventions and their potential impact on patient mortality, to inform future knowledge translation and ultimately improve perioperative clinical practice. METHODS Searches were conducted in MEDLINE, EMBASE, CINAHL, and the Cochrane Library databases from inception to March 2015. Study inclusion criteria were adult patients, surgical procedures requiring anesthesia, perioperative intervention conducted/organized by a professional with training in anesthesia, randomized controlled trials (RCTs), and patient mortality as an outcome. Studies were screened for inclusion, and data was extracted in duplicate by pairs of independent reviewers. Data were extracted, tabulated, and reported thematically. RESULTS Among the 10,505 publications identified, 369 RCTs (n = 147,326 patients) met the eligibility criteria. While 15 intervention themes were identified, only 7 themes (39 studies) had a significant impact on mortality: pharmacotherapy (n = 23), nutritional (n = 3), transfusion (n = 4), ventilation (n = 5), glucose control (n = 1), medical device (n = 2), and dialysis (n = 1). CONCLUSIONS By mapping intervention themes, this scoping review has identified areas requiring further systematic investigation given their potential value for reducing patient mortality as well as areas where continued investment may not be cost-effective given limited evidence for improving survival. This is a key starting point for future knowledge translation to optimize anesthesia practice.
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Affiliation(s)
- Sylvain Boet
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada.
| | - Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - David Nicola
- Family Medicine, McGill University, Montreal, Canada
| | - Andrew Beck
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Susan Bragg
- Department of Anesthesia, University of Toronto, Toronto, Canada
| | - Ian D Carrigan
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Sarah Larrigan
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.,University of Ottawa, Ottawa, Canada
| | - Cassandra T Mendonca
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
| | - Isaac Miao
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
| | | | - Benjamin Walker
- Department of Anesthesia, University of Utah, Salt Lake City, UT, 84132, USA
| | - José De Wit
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
| | - Karim Mohamed
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
| | - Nadia Balaa
- Department of Family Medicine, Montfort Hospital, University of Ottawa, Ottawa, Canada
| | - Manoj Mathew Lalu
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Canada.,Clinical Epidemiology and Regenerative Medicine Programs, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, K1G 5Z3, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Adrienne Stevens
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Donald Miller
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
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Boet S, Bryson GL, Taljaard M, Pigford AA, McIsaac DI, Brehaut J, Forster A, Mohamed K, Clavel N, Pysyk C, Grimshaw JM. Effect of audit and feedback on physicians’ intraoperative temperature management and patient outcomes: a three-arm cluster randomized-controlled trial comparing benchmarked and ranked feedback. Can J Anaesth 2018; 65:1196-1209. [DOI: 10.1007/s12630-018-1205-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/19/2018] [Accepted: 05/20/2018] [Indexed: 11/28/2022] Open
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Griffiths JD, Popham PA, De Silva SR. Interventions for preventing hypothermia during caesarean delivery under regional anaesthesia. Hippokratia 2018. [DOI: 10.1002/14651858.cd013058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- James D Griffiths
- Royal Women's Hospital; Department of Anaesthesia; Flemington Road Parkville Victoria Australia 3052
| | - Phil A Popham
- Royal Women's Hospital; 20 Flemington Road Parkville Australia 3052
| | - Shyahani R De Silva
- St Helens and Knowsley Teaching Hospitals NHS Trust; Department of Anaesthesia; Whiston Hospital, Warrington Road Prescot Liverpool UK L35 5DR
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15
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Cobb B, Abir G, Carvalho B. Preoperative anterior thigh temperature does not correlate with perioperative temporal hypothermia during cesarean delivery with spinal anesthesia: Secondary analysis of a randomized control trial. Int J Obstet Anesth 2018; 33:40-45. [DOI: 10.1016/j.ijoa.2017.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/01/2017] [Accepted: 08/13/2017] [Indexed: 10/19/2022]
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16
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Bindu B, Bindra A, Rath G. Temperature management under general anesthesia: Compulsion or option. J Anaesthesiol Clin Pharmacol 2017; 33:306-316. [PMID: 29109627 PMCID: PMC5672515 DOI: 10.4103/joacp.joacp_334_16] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Administration of general anesthesia requires continuous monitoring of vital parameters of the body including body temperature. However, temperature continues to be one of the least seriously monitored parameters perioperatively. Inadvertent perioperative hypothermia is a relatively common occurrence with both general and regional anesthesia and can have significant adverse impact on patients' outcome. While guidelines for perioperative temperature management have been proposed, there are no specific guidelines regarding the best site or best modality of temperature monitoring and management intraoperatively. Various warming and cooling devices are available which help maintain perioperative normothermia. This article discusses the physiology of thermoregulation, effects of anesthesia on thermoregulation, various temperature monitoring sites and methods, perioperative warming devices, guidelines for perioperative temperature management and inadvertent temperature complications (hypothermia/hyperthermia) and measures to control it in the operating room.
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Affiliation(s)
- Barkha Bindu
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Bindra
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Girija Rath
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Warttig S, Alderson P, Lewis SR, Smith AF. Intravenous nutrients for preventing inadvertent perioperative hypothermia in adults. Cochrane Database Syst Rev 2016; 11:CD009906. [PMID: 27875631 PMCID: PMC6464313 DOI: 10.1002/14651858.cd009906.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Inadvertent perioperative hypothermia (a drop in core temperature to below 36°C) occurs because normal temperature regulation is disrupted during surgery, mainly because of the effects of anaesthetic drugs and exposure of the skin for prolonged periods. Many different ways of maintaining body temperature have been proposed, one of which involves administration of intravenous nutrients during the perioperative period that may reduce heat loss by increasing metabolism, thereby increasing heat production. OBJECTIVES To assess the effectiveness of preoperative or intraoperative intravenous nutrients in preventing perioperative hypothermia and its complications during surgery in adults. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; November 2015) in the Cochrane Library; MEDLINE, Ovid SP (1956 to November 2015); Embase, Ovid SP (1982 to November 2015); the Institute for Scientific Information (ISI) Web of Science (1950 to November 2015); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCO host; 1980 to November 2015), as well as the reference lists of identified articles. We also searched the Current Controlled Trials website and ClincalTrials.gov. SELECTION CRITERIA Randomized controlled trials (RCTs) of intravenous nutrients compared with control or other interventions given to maintain normothermia in adults undergoing surgery. DATA COLLECTION AND ANALYSIS Two review authors extracted data and assessed risk of bias for each included trial, and a third review author checked details if necessary. We contacted some study authors to request additional information. MAIN RESULTS We included 14 trials (n = 565), 13 (n = 525) of which compared intravenous administration of amino acids to a control (usually saline solution or Ringer's lactate). The remaining trial (n = 40) compared intravenous administration of fructose versus a control. We noted much variation in these trials, which used different types of surgery, variable durations of surgery, and different types of participants. Most trials were at high or unclear risk of bias owing to inappropriate or unclear randomization methods, and to unclear participant and assessor blinding. This may have influenced results, but it is unclear how results might have been influenced.No trials reported any of our prespecified primary outcomes, which were risk of hypothermia and major cardiovascular events. Therefore, we decided to analyse data related to core body temperature instead as a primary outcome. It was not possible to conduct meta-analysis of data related to amino acid infusion for the 60-minute and 120-minute time points, as we observed significant statistical heterogeneity in the results. Some trials showed that higher temperatures were associated with amino acids, but not all trials reported statistically significant results, and some trials reported the opposite result, where the amino acid group had a lower core temperature than the control group. It was possible to conduct meta-analysis for six studies (n = 249) that provided data relating to the end of surgery. Amino acids led to a statistically significant increase in core temperature in comparison to those receiving control (MD = 0.46°C 95% CI 0.33 to 0.59; I2 0.0%; random-effects; moderate quality evidence).Three trials (n = 155) reported shivering as an outcome. Meta-analysis did not show a clear effect, and so it is uncertain whether amino acids reduce the risk of shivering (RR 0.36, 95% CI 0.13 to 1.00; I2 = 93%; random-effects model; very low-quality evidence). AUTHORS' CONCLUSIONS Intravenous amino acids may keep participants up to a half-degree C warmer than the control. This difference was statistically significant at the end of surgery, but not at other time points. However, the clinical importance of this finding remains unclear. It is also unclear whether amino acids have any effect on the risk of shivering and if intravenous nutrients confer any other benefits or harms, as high-quality data about these outcomes are lacking.
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Affiliation(s)
- Sheryl Warttig
- National Institute for Health and Care ExcellenceLevel 1A, City TowerPiccadilly PlazaManchesterUKM1 4BD
| | - Phil Alderson
- National Institute for Health and Care ExcellenceLevel 1A, City TowerPiccadilly PlazaManchesterUKM1 4BD
| | - Sharon R Lewis
- Royal Lancaster InfirmaryPatient Safety Research DepartmentPointer Court 1, Ashton RoadLancasterUKLA1 1RP
| | - Andrew F Smith
- Royal Lancaster InfirmaryDepartment of AnaesthesiaAshton RoadLancasterLancashireUKLA1 4RP
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Schroeck H, Lyden AK, Benedict WL, Ramachandran SK. Time Trends and Predictors of Abnormal Postoperative Body Temperature in Infants Transported to the Intensive Care Unit. Anesthesiol Res Pract 2016; 2016:7318137. [PMID: 27777585 PMCID: PMC5061937 DOI: 10.1155/2016/7318137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/24/2016] [Accepted: 09/08/2016] [Indexed: 11/18/2022] Open
Abstract
Background. Despite increasing adoption of active warming methods over the recent years, little is known about the effectiveness of these interventions on the occurrence of abnormal postoperative temperatures in sick infants. Methods. Preoperative and postoperative temperature readings, patient characteristics, and procedural factors of critically ill infants at a single institution were retrieved retrospectively from June 2006 until May 2014. The primary endpoints were the incidence and trend of postoperative hypothermia and hyperthermia on arrival at the intensive care units. Univariate and adjusted analyses were performed to identify factors independently associated with abnormal postoperative temperatures. Results. 2,350 cases were included. 82% were normothermic postoperatively, while hypothermia and hyperthermia each occurred in 9% of cases. During the study period, hypothermia decreased from 24% to 2% (p < 0.0001) while hyperthermia remained unchanged (13% in 2006, 8% in 2014, p = 0.357). Factors independently associated with hypothermia were higher ASA status (p = 0.02), lack of intraoperative convective warming (p < 0.001) and procedure date before 2010 (p < 0.001). Independent associations for postoperative hyperthermia included lower body weight (p = 0.01) and procedure date before 2010 (p < 0.001). Conclusions. We report an increase in postoperative normothermia rates in critically ill infants from 2006 until 2014. Careful monitoring to avoid overcorrection and hyperthermia is recommended.
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Affiliation(s)
- Hedwig Schroeck
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Angela K. Lyden
- Department of Anesthesiology, University of Michigan Health System, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Wendy L. Benedict
- Department of Anesthesiology, University of Michigan Health System, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Satya Krishna Ramachandran
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
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Chapman RA, Halliday P. Do on-demand irrigation warmers provide an adequate intraoperative rate of irrigation for holmium enucleation of the prostate? JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415815623123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: On-demand irrigation warmers are widely used to provide a convenient way of irrigating warmed fluids for endoscopic procedure. However, concern has been raised that flow rates via these devices are inadequate for safe operating. Holmium enucleation of prostate (HoLEP) requires significant volume and flow rate of irrigation. Poiseuille’s Law states the resistance of a tube will result in reduced flow and a reduction in pressure across the tube. The aim was to compare the irrigation rates provided by one such warming device compared to a standard giving set whilst simulating HoLEP and to monitor intravesical pressure. Methods: A simulated apparatus was set up to replicate HoLEP surgery. Simulated design rather than ‘real-life’ apparatus was used to allow for repeated testing in a more controlled environment and to avoid other variables due to operative differences. Comparison of irrigation rate and pressure difference was measured whilst using a standard irrigation set (Fresenius Kabi) with pre-warmed fluid and the Ranger irrigation warming system (3M). Pressure was measured using a pressure line passed via the working channel of the laser resectoscope. Results: The standard giving set demonstrated lower resistance and higher irrigation rates. The irrigation rate was 31% higher (7.2 vs 5.5 ml/s). A lower change in pressure across the standard giving set was found (20 vs 38 cm H2O). The resistance therefore is much higher in the Ranger irrigation system, which gave a much slower flow and greater drop in pressure. Conclusion: This unique demonstration has led to a quantitative assessment of commonly used giving sets and has shown irrigation rates via a standard giving set are 31% greater than through the Ranger irrigation warming system. On-demand fluid warmers are felt to result in poor intraoperative vision and pose a potential risk to patient safety during HoLEP and other urological procedures requiring high fluid volumes.
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Menzel M, Grote R, Leuchtmann D, Lautenschläger C, Röseler C, Bräuer A. Umsetzung eines Wärmemanagementkonzeptes zur Vermeidung von perioperativer Hypothermie. Anaesthesist 2016; 65:423-9. [DOI: 10.1007/s00101-016-0158-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 01/15/2016] [Accepted: 02/23/2016] [Indexed: 02/04/2023]
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Hilton EJ, Wilson SH, Wolf BJ, Hand W, Roberts L, Hebbar L. Effect of Intraoperative Phenylephrine Infusion on Redistribution Hypothermia During Cesarean Delivery Under Spinal Anesthesia. ACTA ACUST UNITED AC 2016; 1. [PMID: 32500108 PMCID: PMC7272055 DOI: 10.16966/2470-9956.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
An observational clinical study to evaluate the effect of phenylephrine infusion on maternal temperatures during scheduled cesarean delivery under spinal anaesthesia was conducted in 40 ASA physical status II parturients. Following placement of spinal anesthesia, phenylephrine infusion was initiated at 40 μg/min and titrated to maintain mean arterial pressure within 20 percent of baseline. Maternal oral temperature, heart rate, and blood pressure were measured at baseline, spinal placement, every 10 minutes thereafter for 60 minutes. Phenylephrine dose received was documented every ten minutes. The range in maternal temperature change was 0.06-0.29°C. The lowest recorded temperature was 36.3°C. Decreased maternal temperature was associated with duration of anesthesia and cumulative phenylephrine dose in a univariate model (P<0.001 for all). The multivariable model showed an association between a greater decrease in maternal temperature with larger doses of phenylephrine being administered.
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Affiliation(s)
- E J Hilton
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, USA
| | - S H Wilson
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, USA
| | - B J Wolf
- Department on Public Health Sciences, Medical University of South Carolina, USA
| | - W Hand
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, USA
| | - L Roberts
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, USA
| | - L Hebbar
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, USA
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Lewis SR, Nicholson A, Smith AF, Alderson P. Alpha-2 adrenergic agonists for the prevention of shivering following general anaesthesia. Cochrane Database Syst Rev 2015; 2015:CD011107. [PMID: 26256531 PMCID: PMC9221859 DOI: 10.1002/14651858.cd011107.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Shivering after general anaesthesia is common. It is unpleasant but can also have adverse physiological effects. Alpha-2 (α-2) adrenergic agonist receptors, which can lead to reduced sympathetic activity and central regulation of vasoconstrictor tone, are a group of drugs that have been used to try to prevent postoperative shivering. OBJECTIVES To assess the following: the effects of α-2 agonists on the prevention of shivering and subsequent complications after general anaesthesia in people undergoing surgery; the effects of α-2 agonists on the risk of inadvertent perioperative hypothermia; and whether any adverse effects are associated with these interventions. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE on 13 June 2014. Our search terms were relevant to the review question and limited to studies that assessed shivering or hypothermia. We also carried out searches of clinical trials registers, and forward and backward citation tracking. SELECTION CRITERIA We considered all randomized controlled trials, quasi-randomized studies, and cluster-randomized studies with adult participants undergoing surgery with general anaesthesia in which an α-2 agonist was compared with another α-2 agonist or a placebo for the prevention of shivering. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data, consulting a third review author in the case of disagreements. We used standard Cochrane methodological procedures, including an assessment of risk of bias and use of GRADEpro software to interpret findings. MAIN RESULTS We included 20 studies with 1401 surgical participants comparing an α-2 agonist against a control. Thirteen studies compared clonidine with a control, whilst seven compared dexmedetomidine with a control. The doses, methods, and time of administration varied between studies: three studies gave the drug orally or as an intravenous bolus preoperatively and nine intraoperatively; one study gave the drug as an infusion starting preoperatively and seven started at varying points from anaesthetic induction to the end of surgery. Whilst all the studies were described as randomized, many provided insufficient detail on methods used. We had anticipated that attempts would be made to reduce performance bias by blinding of personnel and participants, however this was detailed in only six of the papers. Similarly, in some studies detail was lacking on methods to reduce the risk of detection bias. We therefore downgraded the quality of evidence in our 'Summary of findings' table by one level for risk of bias using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.All 20 included studies presented outcome data for postoperative shivering, and in meta-analysis α-2 agonists were shown to significantly reduce the risk of shivering (Mantel-Haenszel risk ratio 0.28, 95% confidence interval 0.18 to 0.43, P value < 0.0001). We found significant evidence of heterogeneity (I(2) = 80%) for this result that was not explained by sensitivity or subgroup analysis; we therefore downgraded the inconsistency of the evidence by one level. Although we did not feel that there were concerns with imprecision or indirectness of the data, we downgraded the quality of the evidence for the risk of publication bias following visual analysis of a funnel plot. Using GRADEpro, we rated the overall quality of the data for shivering as very low. Only one study reported the incidence of core hypothermia, whilst 12 studies measured core temperature. However, as the results for core temperature were reported in different styles, pooling the results was inappropriate. We found no studies with participant-reported outcomes such as experience of shivering or participant satisfaction. We found limited data for the outcomes of length of stay in the postanaesthetic care unit (three studies, 200 participants) and the following adverse effects: sedation (nine studies, 875 participants), bradycardia (eight studies, 716 participants), and hypotension (seven studies, 688 participants). Unpooled analysis suggested that sedation and bradycardia were significantly more common with dexmedetomidine than placebo, with all seven dexmedetomidine studies and none of the clonidine studies reporting statistically significantly higher levels of sedation as an adverse effect. AUTHORS' CONCLUSIONS There is evidence that clonidine and dexmedetomidine can reduce postoperative shivering, but patients given dexmedetomidine may be more sedated. However, our assessment of the quality of this evidence is very low.
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Affiliation(s)
- Sharon R Lewis
- Royal Lancaster InfirmaryPatient Safety ResearchPointer Court 1, Ashton RoadLancasterUKLA1 1RP
| | - Amanda Nicholson
- University of LiverpoolLiverpool Reviews and Implementation GroupSecond FloorWhelan Building, The Quadrangle, Brownlow HillLiverpoolUKL69 3GB
| | - Andrew F Smith
- Royal Lancaster InfirmaryDepartment of AnaesthesiaAshton RoadLancasterLancashireUKLA1 4RP
| | - Phil Alderson
- National Institute for Health and Care ExcellenceLevel 1A, City Tower,Piccadilly PlazaManchesterUKM1 4BD
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Campbell G, Alderson P, Smith AF, Warttig S. Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia. Cochrane Database Syst Rev 2015; 2015:CD009891. [PMID: 25866139 PMCID: PMC6769178 DOI: 10.1002/14651858.cd009891.pub2] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Inadvertent perioperative hypothermia (a drop in core temperature to below 36°C) occurs because of interference with normal temperature regulation by anaesthetic drugs, exposure of skin for prolonged periods and receipt of large volumes of intravenous and irrigation fluids. If the temperature of these fluids is below core body temperature, they can cause significant heat loss. Warming intravenous and irrigation fluids to core body temperature or above might prevent some of this heat loss and subsequent hypothermia. OBJECTIVES To estimate the effectiveness of preoperative or intraoperative warming, or both, of intravenous and irrigation fluids in preventing perioperative hypothermia and its complications during surgery in adults. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 2), MEDLINE Ovid SP (1956 to 4 February 2014), EMBASE Ovid SP (1982 to 4 February 2014), the Institute for Scientific Information (ISI) Web of Science (1950 to 4 February 2014), Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCOhost (1980 to 4 February 2014) and reference lists of identified articles. We also searched the Current Controlled Trials website and ClinicalTrials.gov. SELECTION CRITERIA We included randomized controlled trials or quasi-randomized controlled trials comparing fluid warming methods versus standard care or versus other warming methods used to maintain normothermia. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from eligible trials and settled disputes with a third review author. We contacted study authors to ask for additional details when needed. We collected data on adverse events only if they were reported in the trials. MAIN RESULTS We included in this review 24 studies with a total of 1250 participants. The trials included various numbers and types of participants. Investigators used a range of methods to warm fluids to temperatures between 37°C and 41°C. We found that evidence was of moderate quality because descriptions of trial design were often unclear, resulting in high or unclear risk of bias due to inappropriate or unclear randomization and blinding procedures. These factors may have influenced results in some way. Our protocol specified the risk of hypothermia as the primary outcome; as no trials reported this, we decided to include data related to mean core temperature. The only secondary outcome reported in the trials that provided useable data was shivering. Evidence was unclear regarding the effects of fluid warming on bleeding. No data were reported on our other specified outcomes of cardiovascular complications, infection, pressure ulcers, bleeding, mortality, length of stay, unplanned intensive care admission and adverse events.Researchers found that warmed intravenous fluids kept the core temperature of study participants about half a degree warmer than that of participants given room temperature intravenous fluids at 30, 60, 90 and 120 minutes, and at the end of surgery. Warmed intravenous fluids also further reduced the risk of shivering compared with room temperature intravenous fluidsInvestigators reported no statistically significant differences in core body temperature or shivering between individuals given warmed and room temperature irrigation fluids. AUTHORS' CONCLUSIONS Warm intravenous fluids appear to keep patients warmer during surgery than room temperature fluids. It is unclear whether the actual differences in temperature are clinically meaningful, or if other benefits or harms are associated with the use of warmed fluids. It is also unclear if using fluid warming in addition to other warming methods confers any benefit, as a ceiling effect is likely when multiple methods of warming are used.
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Affiliation(s)
| | - Phil Alderson
- National Institute for Health and Care ExcellenceLevel 1A, City Tower,Piccadilly PlazaManchesterUKM1 4BD
| | - Andrew F Smith
- Royal Lancaster InfirmaryDepartment of AnaesthesiaAshton RoadLancasterUKLA1 4RP
| | - Sheryl Warttig
- National Institute for Health and Care ExcellenceLevel 1A, City Tower,Piccadilly PlazaManchesterUKM1 4BD
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24
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Abstract
BACKGROUND Inadvertent postoperative hypothermia (a drop in core body temperature to below 36°C) occurs as an effect of surgery when anaesthetic drugs and exposure of the skin for long periods of time during surgery result in interference with normal temperature regulation. Once hypothermia has occurred, it is important that patients are rewarmed promptly to minimise potential complications. Several different interventions are available for rewarming patients. OBJECTIVES To estimate the effectiveness of treating inadvertent perioperative hypothermia through postoperative interventions to decrease heat loss and apply passive and active warming systems in adult patients who have undergone surgery. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 2), MEDLINE (Ovid SP) (1956 to 21 February 2014), EMBASE (Ovid SP) (1982 to 21 February 2014), the Institute for Scientific Information (ISI) Web of Science (1950 to 21 February 2014) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EBSCO host (1980 to 21 February 2014), as well as reference lists of articles. We also searched www.controlled-trials.com and www.clincialtrials.gov. SELECTION CRITERIA Randomized controlled trials of postoperative warming interventions aiming to reverse hypothermia compared with control or with each other. DATA COLLECTION AND ANALYSIS Three review authors identified studies for inclusion in this review. One review author extracted data and completed risk of bias assessments; two review authors checked the details. Meta-analysis was conducted when appropriate by using standard methodological procedures as expected by The Cochrane Collaboration. MAIN RESULTS We included 11 trials with 699 participants. Ten trials provided data for analysis. Trials varied in the numbers and types of participants included and in the types of surgery performed. Most trials were at high or unclear risk of bias because of inappropriate or unclear randomization procedures, and because blinding of assessors and participants generally was not possible. This may have influenced results, but it is unclear how the results may have been influenced. Active warming was found to reduce the mean time taken to achieve normothermia by about 30 minutes in comparison with use of warmed cotton blankets (mean difference (MD) -32.13 minutes, 95% confidence interval (CI) -42.55 to -21.71; moderate-quality evidence), but no significant difference in shivering was noted. Active warming was found to reduce mean time taken to achieve normothermia by almost an hour and a half in comparison with use of unwarmed cotton blankets (MD -88.86 minutes, 95% CI -123.49 to -54.23; moderate-quality evidence), and people in the active warming group were less likely to shiver than those in the unwarmed cotton blanket group (Relative Risk=0.61 95% CI= 0.42 to 0.86; low quality evidence). There was no effect on mean temperature difference in degrees celsius at 60 minutes (MD=0.18°C, 95% CI=-0.10 to 0.46; moderate quality evidence), and no data were available in relation to major cardiovascular complications. Forced air warming was found to reduce time taken to achieve normothermia by about one hour in comparison to circulating hot water devices (MD=-54.21 minutes 95% CI= -94.95, -13.47). There was no statistically significant difference between thermal insulation and cotton blankets on mean time to achieve normothermia (MD =-0.29 minutes, 95% CI=-25.47 to 24.89; moderate quality evidence) or shivering (Relative Risk=1.36 95% CI= 0.69 to 2.67; moderate quality evidence), and no data were available for mean temperature difference or major cardiovascular complications. Insufficient evidence was available about other comparisons, adverse effects or any other secondary outcomes. AUTHORS' CONCLUSIONS Active warming, particularly forced air warming, appears to offer a clinically important reduction in mean time taken to achieve normothermia (normal body temperature between 36°C and 37.5°C) in patients with postoperative hypothermia. However, high-quality evidence on other important clinical outcomes is lacking; therefore it is unclear whether active warming offers other benefits and harms. High-quality evidence on other warming methods is also lacking; therefore it is unclear whether other rewarming methods are effective in reversing postoperative hypothermia.
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Affiliation(s)
- Sheryl Warttig
- National Institute for Health and Care ExcellenceLevel 1A, City TowerPiccadilly PlazaManchesterUKM1 4BD
| | - Phil Alderson
- National Institute for Health and Care ExcellenceLevel 1A, City TowerPiccadilly PlazaManchesterUKM1 4BD
| | | | - Andrew F Smith
- Royal Lancaster InfirmaryDepartment of AnaesthesiaAshton RoadLancasterLancashireUKLA1 4RP
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Verbesserung des Operationsoutcomes in der Wirbelsäulenchirurgie. DER ORTHOPADE 2014; 43:1070-8. [DOI: 10.1007/s00132-014-3041-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Tekgul ZT, Pektas S, Yildirim U, Karaman Y, Cakmak M, Ozkarakas H, Gonullu M. A prospective randomized double-blind study on the effects of the temperature of irrigation solutions on thermoregulation and postoperative complications in percutaneous nephrolithotomy. J Anesth 2014; 29:165-9. [DOI: 10.1007/s00540-014-1888-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
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27
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Alderson P, Campbell G, Smith AF, Warttig S, Nicholson A, Lewis SR. Thermal insulation for preventing inadvertent perioperative hypothermia. Cochrane Database Syst Rev 2014:CD009908. [PMID: 24895945 DOI: 10.1002/14651858.cd009908.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Inadvertent perioperative hypothermia occurs because of interference with normal temperature regulation by anaesthetic drugs and exposure of skin for prolonged periods. A number of different interventions have been proposed to maintain body temperature by reducing heat loss. Thermal insulation, such as extra layers of insulating material or reflective blankets, should reduce heat loss through convection and radiation and potentially help avoid hypothermia. OBJECTIVES To assess the effects of pre- or intraoperative thermal insulation, or both, in preventing perioperative hypothermia and its complications during surgery in adults. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 2), MEDLINE, OvidSP (1956 to 4 February 2014), EMBASE, OvidSP (1982 to 4 February 2014), ISI Web of Science (1950 to 4 February 2014), and CINAHL, EBSCOhost (1980 to 4 February 2014), and reference lists of articles. We also searched Current Controlled Trials and ClinicalTrials.gov. SELECTION CRITERIA Randomized controlled trials of thermal insulation compared to standard care or other interventions aiming to maintain normothermia. DATA COLLECTION AND ANALYSIS Two authors extracted data and assessed risk of bias for each included study, with a third author checking details. We contacted some authors to ask for additional details. We only collected adverse events if reported in the trials. MAIN RESULTS We included 22 trials, with 16 trials providing data for some analyses. The trials varied widely in the type of patients and operations, the timing and measurement of temperature, and particularly in the types of co-interventions used. The risk of bias was largely unclear, but with a high risk of performance bias in most studies and a low risk of attrition bias. The largest comparison of extra insulation versus standard care had five trials with 353 patients at the end of surgery and showed a weighted mean difference (WMD) of 0.12 ºC (95% CI -0.07 to 0.31; low quality evidence). Comparing extra insulation with forced air warming at the end of surgery gave a WMD of -0.67 ºC (95% CI -0.95 to -0.39; very low quality evidence) indicating a higher temperature with forced air warming. Major cardiovascular outcomes were not reported and so were not analysed. There were no clear effects on bleeding, shivering or length of stay in post-anaesthetic care for either comparison. No other adverse effects were reported. AUTHORS' CONCLUSIONS There is no clear benefit of extra thermal insulation compared with standard care. Forced air warming does seem to maintain core temperature better than extra thermal insulation, by between 0.5 ºC and 1 ºC, but the clinical importance of this difference is unclear.
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Affiliation(s)
- Phil Alderson
- National Institute for Health and Care Excellence, Level 1A, City Tower,, Piccadilly Plaza, Manchester, UK, M1 4BD
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An Assessment by Calorimetric Calculations of the Potential Thermal Benefit of Warming and Humidification of Insufflated Carbon Dioxide. Surg Laparosc Endosc Percutan Tech 2014; 24:e106-9. [DOI: 10.1097/sle.0000000000000001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nicholson A, Lewis SR, Alderson P, Smith AF. Alpha-2 adrenergic agonists for the prevention of shivering following general anaesthesia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Affiliation(s)
- Ciara Donohue
- Specialist Registrar in Anaesthesia in the Centre for Anaesthesia, University College London Hospitals, London NW1 2BU
| | - Ben Hobson
- Medical Student at University College London, London
| | - Robert CM Stephens
- Consultant Anaesthetist, University College London Hospitals and Honorary Senior Lecturer in the Centre for Anaesthesia, University College London, London
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Manejo de la temperatura en el perioperatorio y frecuencia de hipotermia inadvertida en un hospital general. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.rca.2013.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Temperature management during the perioperative period and frequency of inadvertent hypothermia in a general hospital. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rcae.2013.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Temperature management during the perioperative period and frequency of inadvertent hypothermia in a general hospital☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1097/01819236-201341020-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Unplanned perioperative hypothermia and agreement between oral, temporal artery, and bladder temperatures in adult major surgery patients. J Perianesth Nurs 2012; 27:165-80. [PMID: 22612886 DOI: 10.1016/j.jopan.2012.01.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 12/14/2011] [Accepted: 01/18/2012] [Indexed: 11/23/2022]
Abstract
Accurate body core temperature measurement is essential in perioperative areas to quickly recognize and address abnormal temperatures. The purposes of this prospective, descriptive study were to accurately identify unplanned perioperative hypothermia (UPH) in 64 elective major surgery patients; to describe factors that increased the risk of UPH; to describe active/passive warming measures; to describe thermal comfort in patients with and without UPH; and to compare oral, temporal artery, and bladder temperatures. Based on bladder temperatures, 52% of the patients had UPH in the operating room (OR) and 42% on postanesthesia care unit (PACU) admission. The temporal artery thermometer did not detect any hypothermia. Descriptive data and Bland-Altman plots showed lack of agreement between the temporal artery thermometer readings and those of the oral and bladder thermometers. The patient's thermal comfort report did not accurately reflect hypothermia. Factors found to increase the risk of UPH included older age, BMI lower than 30, and OR ambient temperature lower than 68°F. All but one patient had active warming in the OR; active warming was infrequently used in the PACU. Based on our findings and findings in previous studies, we do not recommend using the temporal artery thermometer in perioperative areas. To prevent UPH, we recommend aggressive use of convective and conductive warming measures in perioperative areas and increasing OR ambient temperatures.
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Belani KG, Albrecht M, McGovern PD, Reed M, Nachtsheim C. Patient warming excess heat: the effects on orthopedic operating room ventilation performance. Anesth Analg 2012; 117:406-11. [PMID: 22822191 DOI: 10.1213/ane.0b013e31825f81e2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patient warming has become a standard of care for the prevention of unintentional hypothermia based on benefits established in general surgery. However, these benefits may not fully translate to contamination-sensitive surgery (i.e., implants), because patient warming devices release excess heat that may disrupt the intended ceiling-to-floor ventilation airflows and expose the surgical site to added contamination. Therefore, we studied the effects of 2 popular patient warming technologies, forced air and conductive fabric, versus control conditions on ventilation performance in an orthopedic operating room with a mannequin draped for total knee replacement. METHODS Ventilation performance was assessed by releasing neutrally buoyant detergent bubbles ("bubbles") into the nonsterile region under the head-side of the anesthesia drape. We then tracked whether the excess heat from upper body patient warming mobilized the "bubbles" into the surgical site. Formally, a randomized replicated design assessed the effect of device (forced air, conductive fabric, control) and anesthesia drape height (low-drape, high-drape) on the number of bubbles photographed over the surgical site. RESULTS The direct mass-flow exhaust from forced air warming generated hot air convection currents that mobilized bubbles over the anesthesia drape and into the surgical site, resulting in a significant increase in bubble counts for the factor of patient warming device (P < 0.001). Forced air had an average count of 132.5 versus 0.48 for conductive fabric (P = 0.003) and 0.01 for control conditions (P = 0.008) across both drape heights. Differences in average bubble counts across both drape heights were insignificant between conductive fabric and control conditions (P = 0.87). The factor of drape height had no significant effect (P = 0.94) on bubble counts. CONCLUSIONS Excess heat from forced air warming resulted in the disruption of ventilation airflows over the surgical site, whereas conductive patient warming devices had no noticeable effect on ventilation airflows. These findings warrant future research into the effects of forced air warming excess heat on clinical outcomes during contamination-sensitive surgery.
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Affiliation(s)
- Kumar G Belani
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA
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Campbell G, Alderson P, Smith AF, Warttig S. Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Warttig S, Alderson P, Lewis SR, Smith AF. Intravenous nutrients for preventing inadvertent perioperative hypothermia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Alderson P, Campbell G, Smith AF, Warttig S, Nicholson A, Lewis SR. Thermal insulation for preventing inadvertent perioperative hypothermia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Interventions for treating inadvertent postoperative hypothermia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Vasdev N, Hussein HK, Davidson A, Wood H, O’Riordan A, Soomro NA. Radical renal surgery (laparoscopic and open) in octogenarians. Surgeon 2011; 9:135-41. [DOI: 10.1016/j.surge.2010.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 08/14/2010] [Accepted: 08/18/2010] [Indexed: 10/19/2022]
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Albrecht M, Gauthier RL, Belani K, Litchy M, Leaper D. Forced-air warming blowers: An evaluation of filtration adequacy and airborne contamination emissions in the operating room. Am J Infect Control 2011; 39:321-8. [PMID: 21095041 DOI: 10.1016/j.ajic.2010.06.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 06/14/2010] [Accepted: 06/16/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Forced-air warming (FAW) is widely used to prevent hypothermia during surgical procedures. The airflow from these blowers is often vented near the operative site and should be free of contaminants to minimize the risk of surgical site infection. Popular FAW blowers contain a 0.2-μm rated intake filter to reduce these risks. However, there is little evidence that the efficiency of the intake filter is adequate to prevent airborne contamination emissions or protect the internal air path from microbial contamination buildup. METHODS Five new intake filters were obtained directly from the manufacturer (Bair Hugger 505, model 200708D; Arizant Healthcare, Eden Prairie, MN), and 5 model 200708C filters currently in hospital use were removed from FAW devices. The retention efficiency of these filters was assessed using a monodisperse sodium chloride aerosol. In the same hospitals, internal air path surface swabs and hose outlet particle counts were performed on 52 forced-air warming devices (all with the model 200708C filter) to assess internal microbial buildup and airborne contamination emissions. RESULTS Intake filter retention efficiency at 0.2 μm was 93.8% for the 200708C filter and 61.3% at for the 200708D filter. The 200708D filter obtained directly from the manufacturer has a thinner filtration media than the 200708C filter in current hospital use, suggesting that the observed differences in retention efficiency were due to design changes. Fifty-eight percent of the FAW blowers evaluated were internally generating and emitting airborne contaminants, with microorganisms detected on the internal air path surfaces of 92.3% of these blowers. Isolates of Staphylococcus aureus, coagulase-negative Staphylococcus, and methicillin-resistant S aureus were detected in 13.5%, 3.9%, and 1.9% of FAW blowers, respectively. CONCLUSION The design of popular FAW devices using the 200708C filter was found to be inadequate for preventing the internal buildup and emission of microbial contaminants into the operating room. Substandard intake filtration allowed airborne contaminants (both viable and nonviable) to penetrate the intake filter and reversibly attach to the internal surfaces within the FAW blowers. The reintroduction of these contaminants into the FAW blower air stream was detected and could contribute to the risk of cross-infection. Given the deficiencies identified with the 200708C intake filter, the introduction of a new filter (model 200708D) with substantially lower retention efficiency is of concern.
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Affiliation(s)
- Mark Albrecht
- Augustine Biomedical and Design, Eden Prairie, MN, USA.
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Jin Y, Tian J, Sun M, Yang K. A systematic review of randomised controlled trials of the effects of warmed irrigation fluid on core body temperature during endoscopic surgeries. J Clin Nurs 2011; 20:305-16. [DOI: 10.1111/j.1365-2702.2010.03484.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Andrzejowski JC, Turnbull D, Nandakumar A, Gowthaman S, Eapen G. ORIGINAL ARTICLE: A randomised single blinded study of the administration of pre-warmed fluid vs active fluid warming on the incidence of peri-operative hypothermia in short surgical procedures*. Anaesthesia 2010; 65:942-5. [DOI: 10.1111/j.1365-2044.2010.06473.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Radauceanu DS, Dragnea D, Craig J. NICE guidelines for inadvertent peri-operative hypothermia. Anaesthesia 2009; 64:1381-2. [DOI: 10.1111/j.1365-2044.2009.06141_18.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ross-Anderson DJ, Patel A. A NICE idea or a high price to pay? Local assessment of national guidelines. Anaesthesia 2009; 64:330-1. [DOI: 10.1111/j.1365-2044.2009.05876.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Williams C, Harrison G. NICE and warm. Br J Anaesth 2008; 101:879-80; author reply 880. [PMID: 19004918 DOI: 10.1093/bja/aen302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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