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

Bernardis, Ricardo Caio Gracco de; Siaulys, Monica; Vieira, Joaquim Edson; Mathias, L

doi:10.1016/j.bjane.2014.12.007

Cited by 15 publications

(16 citation statements)

References 27 publications

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“…Our results are similar to other previous studies evaluated the efficacy of active warming before neuraxial block administration in conjunction with upper body active warming during the procedure [9,18,28]. de Bernardis studied 40 patients undergoing elective cesarean delivery and evaluated the Bair Paws™ gown in both the preoperative (total body) and intraoperative arena (upper body) [18]. The spinal anesthesia and the volume of warmed fluids (37°C) was similar to our population but the duration of surgery was shorter at 60 min and BMI range smaller (29)(30).…”

Section: Discussionsupporting

confidence: 91%

“…Exclusion criteria were patients: < 18 years of age; active labor; a diagnosis of abnormal placentation; preeclampsia or eclampsia; significant cardiopulmonary comorbidities; temperature > 37°C, primary cesarean delivery or a diagnosis of/or clinical evidence suggesting a disorder of coagulation or infection. A sample size power analysis was performed using mean temperature differences (0.5°C) and SD (0.4-0.5) from studies evaluating passive warming and active warming during cesarean delivery [5,14,18,22]. Using an alpha = 0.05 and power = 0.80, and an unpaired two-tailed Student's t-test the projected sample size (GPower 3.1) was 50 (large effect size) to 60 (moderate effect size) for each group [23,24].…”

Section: Methodsmentioning

confidence: 99%

“…Numerous publications have documented favorable outcomes with forced-air warming, underbody warming blankets, and warmed intravenous/irrigation fluids [5,11,[13][14][15][16][17]. Inadvertent perioperative hypothermia is still common with intraoperative active warming and may be further ameliorated with 15-30 min of preoperative active warming [9,18,19].…”

Section: Introductionmentioning

confidence: 99%

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Improving intraoperative temperature management in elective repeat cesarean deliveries: a retrospective observational cohort study

et al. 2020

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Background: Inadvertent perioperative hypothermia (< 36°C) occurs frequently during elective cesarean delivery and most institutions do employ perioperative active warming. The purpose of this retrospective observational cohort study was to determine if the addition of preoperative forced air warming in conjunction with intraoperative underbody forced air warming improved core temperature and reducing inadvertent perioperative hypothermia during elective repeat elective cesarean delivery with neuraxial anesthesia. Methods: We evaluated the addition of perioperative active warming to standard passive warming methods (preheated intravenous/irrigation fluids and cotton blankets) in 120 parturients scheduled for repeat elective cesarean delivery (passive warming, n = 60 vs. active + passive warming, n = 60) in a retrospective observational cohort study. The primary outcomes of interest were core temperature at the end of the procedure and a decrease in inadvertent perioperative hypothermia (< 36°C). Secondary outcomes were surgical site infections and adverse markers of neonatal outcome. Results: The mean temperature at the end of surgery after instituting the active warming protocol was 36.0 ± 0.5°C (mean ± SD, 95% CI 35.9-36.1) vs. 35.4 ± 0.5°C (mean ± SD, 95% CI 35.3-35.5) compared to passive warming techniques (p < 0.001) and the incidence of inadvertent perioperative hypothermia at the end of the procedure was less in the active warming group-68% versus 92% in the control group (p < 0.001). There was no difference in surgical site infections or neonatal outcomes. Conclusions: Perioperative active warming in combination with passive warming techniques was associated with a higher maternal temperature and lower incidence of inadvertent perioperative hypothermia with no detectable differences in surgical site infections or indicators of adverse neonatal outcomes.

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Improving intraoperative temperature management in elective repeat cesarean deliveries: a retrospective observational cohort study

et al. 2020

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“…Various methods for controlling body temperature and preventing hypothermia during surgery have been investigated, as well as the effect of temperature on immune response [14][15][16][17][18][19][20][21][22][23]. In our previous study, the combination of warmed infusion fluids, warmed irrigation fluids and an insulation blanket was the most effective method for maintaining body temperature during surgery [20].…”

Section: Introductionmentioning

confidence: 99%

Control of body temperature and immune function in patients undergoing open surgery for gastric cancer

Shao

Pang

Yan

et al. 2018

Bosn J of Basic Med Sci

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The influence of mild perioperative hypothermia on the immune function and incidence of postoperative wound infections has been suggested, but the specific mechanism is unclear. This study aimed to analyze the body temperature, immune function, and wound infection rates in patients receiving open surgery for gastric cancer. Body temperature was controlled in each patient using one of four different methods: wrapping limbs, head and neck; insulated blankets; warming infusion fluids and insulated blankets; and warming fluids without insulated blankets. One hundred patients were randomly divided into four groups of 25 patients each, and every group received a different intraoperative treatment for maintaining normal body temperature. Nasopharyngeal and rectal temperatures, transforming growth factor beta (TGF-β), interleukin 10 (IL-10) levels, and cluster of differentiation (CD)3+T and CD4+/CD25+ regulatory T cell (Treg) counts were measured before surgery and at 2 and 4 hours postoperatively. Patients were evaluated at one week after surgery for signs of infection. Intraoperative body temperature and measures of immune function varied significantly between the four groups, with the largest temperature changes observed in the group in which only the limbs were wrapped in cotton pads to control the body temperature. The lowest temperature change (i.e., close to normal temperature) and cytokine response after surgery were observed in the group in which infusion fluids and transfused blood (if needed) were heated to 37℃, peritoneal irrigation fluid was heated to 37℃, and an insulation blanket was heated to 39℃ and placed under the patient. No intergroup differences were found in the infection rates at one week after surgery. In conclusion, body temperature variation during surgery affects the immune function of patients, and maintaining body temperature close to normal results in the least variation of immune function.

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“…The combined technique has the potential to minimize maternal temperature drops. Similarly, in a study by De Bernardiset al, thermal gowns and warmed intravenous fluids decreased the patient temperature drops and the incidence of shivering as compared to the same variables in the control group [26] . In contrast, in Munday et al's study, 20 minutes of preoperative forced-air warming with intravenous fluid warming did not prevent temperature drops in women undergoing cesarean delivery [27] .…”

Section: Discussionmentioning

confidence: 77%

Effects of Combined Warmed Preoperative Forced-air and Warmed Perioperative Intravenous Fluids on Maternal Temperature During Cesarean Section: a prospective, randomized, controlled clinical trial

Ni¹,

Zhou²,

He³

et al. 2020

Preprint

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Background: Preventing the frequent perioperative hypothermia incidents that occur during elective caesarean deliveries would be beneficial. This trial aimed at evaluating the effect of preoperative forced-air warming alongside perioperative intravenous fluid warming in women undergoing cesarean sections under spinal anesthesia. Methods: We randomly allocated135 women undergoing elective cesarean deliveries to either the intervention group (preoperative forced-air and intravenous fluid warmings, n = 69) or the control group (no active warming, n = 66). The primary outcome measure was the change from the core baseline temperature to that at the end of the procedure. Secondary outcomes included thermal comfort scores, the incidences of shivering and hypothermia (<36℃), the core temperature on arrival at the post-anesthesia care unit, neonatal axillary temperature at birth, and Apgar scores. Results: Two-way repeated measures ANOVA revealed significantly different core temperature changes (from the pre-spinal temperature to that at the end of the procedure) between groups ( F = 13.022, P <0.001). The thermal comfort scores were also higher in the intervention group than in the control group ( F = 9.847, P = 0.002). The overall incidence of perioperative hypothermia was significantly lower in the intervention group than in the control group (20.6% vs. 51.6%, P <0.0001). Conclusions: Warming preoperative forced-air and perioperative intravenous fluids may prevent maternal hypothermia, reduce maternal shivering, and improve maternal thermal comfort for patients undergoing cesarean sections under spinal anesthesia. Trial registration: The study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800019117) on October26, 2018. Keywords: Cesarean section, Spinal anesthesia, Warming

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

Abstract: Active warming 30min before spinal anesthesia and during surgery prevented a fall in body temperature in full-term pregnant women during elective cesarean delivery.

Cited by 15 publications

References 27 publications

Improving intraoperative temperature management in elective repeat cesarean deliveries: a retrospective observational cohort study

Improving intraoperative temperature management in elective repeat cesarean deliveries: a retrospective observational cohort study

Control of body temperature and immune function in patients undergoing open surgery for gastric cancer

Effects of Combined Warmed Preoperative Forced-air and Warmed Perioperative Intravenous Fluids on Maternal Temperature During Cesarean Section: a prospective, randomized, controlled clinical trial

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