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

Abstract

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

Maternal hypothermia during elective caesarean delivery: A prospective observational study

“…In the present study, almost a third of the women (32.5%) undergoing an elective CD developed hypothermia (<36.0 C) in the perioperative phase. This is lower than the incidence of 47% in the study of Cotoia and co-workers 23 and 56% in the study of Ni and co-workers, 10 both of elective CDs. Although data from small patient populations in different settings should be compared with caution, it may be that Our hypothermia incidence is three times higher than reported in the observational multicentre study by Thorburn and colleagues involving 265 participants undergoing emergency CD.…”

“…In the present study, almost a third of the women (32.5%) undergoing an elective CD developed hypothermia (<36.0°C) in the perioperative phase. This is lower than the incidence of 47% in the study of Cotoia and co‐workers 23 and 56% in the study of Ni and co‐workers, 10 both of elective CDs. Although data from small patient populations in different settings should be compared with caution, it may be that aspects of patient care in the hospital of the present study, for example, preoperative dressing, adequate OR ambient temperature and warmed intravenous fluids; have been beneficial in this context, however not sufficient.…”

“…9 Spinal anaesthesia causes redistribution of blood in the area of the block from the core to peripheral tissues, although less than the full body effects of general anaesthesia induction. 2 Hypothermia in women undergoing CD, has been studied previously in randomized controlled trials (RCTs) comparing various measures of active and passive warming 10,11 and in retrospective observational studies. 12,13 In one previous RCT, the incidences of hypothermia in women undergoing CD were 64% in the group receiving active warming compared to 91% in the control group.…”

Intervensi Non Farmakologi untuk Mencegah Hipotermi pada Pasien Post Operasi

“…Selain itu, terapi cairan ini juga dapat mengurangi komplikasi hemodinamik pasca operasi (Kameda & Okada, 2023;Lauronen et al, 2021). Namun, sebagian besar penelitian mengungkapkan bahwa pemberian cairan intravena hangat akan lebih efektif apabila dikombinasikan dengan intervensi lain seperti penggunaan selimut elektrik Aprianti et al, (2022) maupun air forced warmer (Cotoia et al, 2021).…”

Consensus on the Southeast Asian management of hypotension using vasopressors and adjunct modalities during cesarean section under spinal anesthesia

“…In these patients it significantly impairs thermal autoregulation by inhibiting vasomotor responses and tremors, even beyond the level of sensory block, causing thermal redistribution of heat from the core to peripheral tissues [97,98]. In the absence of strategies to preserve normothermia, patients become hypothermic in the first 30-40 min of surgery and remain hypothermic postoperatively [99]. Hypothermia increases the risk of cardiovascular events, such as arrhythmias, myocardial ischemia, coagulopathy, greater blood loss, requiring transfusions, wound infections that show delayed healing due to decreased antibody and cell-mediated immune responses, and oxygen availability in peripheral wound tissues.…”