The effectiveness of the newly designed thermal gown on hypothermic patients after spinal surgery

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

AIM

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

BACKGROUND

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

METHODS

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

FINDINGS

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

CONCLUSIONS

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

Perioperative Care of Patients Undergoing Major Complex Spinal Instrumentation Surgery: Clinical Practice Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

Evidence-based standardization of the perioperative management of patients undergoing complex spine surgery can improve outcomes such as enhanced patient satisfaction, reduced intensive care and hospital length of stay, and reduced costs. The Society for Neuroscience in Anesthesiology and Critical Care (SNACC) tasked an expert group to review existing evidence and generate recommendations for the perioperative management of patients undergoing complex spine surgery, defined as surgery on 2 or more thoracic and/or lumbar spine levels. Institutional clinical management protocols can be constructed based on the elements included in these clinical practice guidelines, and the evidence presented.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effects of postoperative active warming and early exercise on postoperative body temperature distribution: Non-blinded and randomized controlled trial

AIM

We tested a hypothesis that postoperative active warming and/or arm leg stretches reduce the difference between core and skin temperatures (primary variable) improving the peripheral circulation immediately after major abdominal surgery.

METHODS

Fifty-one patients undergoing major abdominal surgeries were randomly assigned to receive one of three interventions immediately after surgery; routine care (control group), mild intermittent exercise on the bed (exercise group), and forced-air warming (warming group). Core and skin temperatures and perfusion index were continuously measured from anesthesia induction to 12 h after arrival at the ward.

RESULTS

Core body temperature was maintained over 37°C with a relatively greater gap between core and skin temperatures over 1°C and reduced perfusion index in the early postoperative period in the control group. In the warming group, the reduced skin temperature at arrival at the ward approximated to the core temperature leading to significant reduction of the temperature gap and increasing the perfusion index to the preoperative level. Although less evident, both the temperature gap and peripheral perfusion significantly improved in the exercise group after 6 and 8 h after arrival at the ward, respectively.

CONCLUSIONS

Vasoconstriction in response to cessation after anesthesia and surgery serves to maintain core temperature, but impairs peripheral circulation. Active warming and intermittent mild exercise immediately after arrival at the ward reduces the temperature gap and improves peripheral circulation during the early postoperative period. While cost-effectiveness needs to be considered before clinical application of the intervention, the cost-free mild exercise may be a feasible option for improving postoperative patient care.