The role of perioperative warming in surgery: a systematic review

Abstract

OBJECTIVE: The objective of this review was to systematically analyze the trials on the effectiveness of perioperative warming in surgical patients. METHODS:A systematic review of the literature was undertaken. Clinical trials on perioperative warming were selected according to specific criteria and analyzed to generate summative data expressed as standardized mean difference (SMD). RESULTS:Twenty-five studies encompassing 3,599 patients in various surgical disciplines were retrieved from the electronic databases. Nineteen randomized trials on 1785 patients qualified for this review. The no-warming group developed statistically significant hypothermia. In the fixed effect model, the warming group had significantly less pain and lower incidence of wound infection, compared with the no-warming group. In the random effect model, the warming group was also associated with lower risk of post-anesthetic shivering. Both in the random and the fixed effect models, the warming group was associated with significantly less blood loss. However, there was significant heterogeneity among the trials.CONCLUSION: Perioperative warming of surgical patients is effective in reducing postoperative wound pain, wound infection and shivering. Systemic warming of the surgical patient is also associated with less perioperative blood loss through preventing hypothermia-induced coagulopathy. Perioperative warming may be given routinely to all patients of various surgical disciplines in order to counteract the consequences of hypothermia. RESUMOOBJETIVO: O objetivo desta revisão é analisar sistematicamente os ensaios sobre a eficácia do aquecimento perioperatório em pacientes cirúrgicos. MÉTODOS:Uma revisão sistemática da literatura foi realizada. Ensaios clínicos sobre aquecimento perioperatório foram selecionados segundo critérios específicos e analisados para gerar dados sumativo expresso na diferença média padronizada (standardized mean difference, SMD). RESULTADOS:Vinte e cinco estudos englobando 3.599 pacientes de várias disciplinas de cirurgia foram obtidos a partir de bases de dados eletrônicas.Dezenove ensaios aleatórios em 1.785 pacientes qualificados para esta revisão. Nenhum grupo de aquecimento desenvolveu estatisticamente significativa hipotermia. No modelo de efeito fixo, grupo de aquecimento tiveram significativamente menos dor e menor incidência de infecção na ferida quando comparado com o grupo de não-aquecimento. No modelo de efeito aleatório, grupo de aquecimento também foi associado a um menor risco de tremores pós-anestesia. Em ambos os modelos de efeitos fixos e aleatórios, o aquecimento foi significativamente associado com menor perda de sangue. No entanto, houve significativa heterogeneidade entre os ensaios.CONCLUSÃO: O aquecimento perioperatório de pacientes cirúrgicos é eficaz na redução da dor pós-operatória ferida, infecção ferida, e tremores. O aquecimento sistêmico do paciente cirúrgico também está associado com menor perda de sangue no perioperatório prevenindo hipotermia e induzindo coagulopatia. O ...

Complex modulation of the cold receptor TRPM8 by volatile anaesthetics and its role in complications of general anaesthesia

“…Furthermore, it delays postoperative recovery and prolongs the effect of almost all anaesthetic drugs (Kurz, 2008). This side effect could be reduced by perioperative warming, and recent evidence suggests that perioperative warming could be given routinely to all patients of various surgical disciplines in order to counteract the consequences of hypothermia (Sajid et al, 2009). Overall, these data show that the perioperative warming of surgical patients reduces postoperative wound pain, wound infection and shivering but does not entirely solve this problem (Sajid et al, 2009).…”

“…This side effect could be reduced by perioperative warming, and recent evidence suggests that perioperative warming could be given routinely to all patients of various surgical disciplines in order to counteract the consequences of hypothermia (Sajid et al, 2009). Overall, these data show that the perioperative warming of surgical patients reduces postoperative wound pain, wound infection and shivering but does not entirely solve this problem (Sajid et al, 2009). As a consequence, a better understanding of this multifactorial side effect could be very relevant in medical practice.…”

Approach to Perioperative Hypothermia by Anaesthesiology and Reanimation Specialist in Turkey: A Survey Investigation

“…Vücudumuzdan ısı kaybı yaş, cins, vücut yüzeyi, ameliyatın tipi, süresi, ortamın sıcaklığı ve mekanik ventilasyon uygulama süresi ile doğrudan ilişkilidir (7). İntravenöz ve inhalasyon anestezikleri hipotalamusu inhibe eder.…”

Práticas baseadas em evidências publicadas no Brasil: identificação e reflexão na área da prevenção em saúde humana

“…Thus, there were studies that only focused on the prevalence or incidence of health problem events (I) (12)(13)27,32,45,(47)(48)67,81,(83)(84)(85)(86)90,92) ; others to iden fy and/or associate risk factors (II) ( ; and s ll others to correlate interven ons with preven on, prophylaxis or reduc on of events (III) (14)(15)(17)(18)20,23,33,46,(50)(51)(53)(54)(55)58,62,(64)(65)(68)(69)(70)(71)(72)(73)(74)(75)(76)(79)(80)82,89,91,(93)(94) .…”