Pre-induction skin-surface warming minimizes intraoperative core hypothermia

Camus, Y.; Delva, E.; Sessler, Daniel I.; Lienhart, A

doi:10.1016/0952-8180(95)90071-3

Cited by 35 publications

(62 citation statements)

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“…We did not use active prewarming, since the study was designed to simply compare two intraoperative, convective warming strategies. active prewarming, for approximately 30 min prior to induction of general anesthesia, has been shown to warm the skin surface, thereby minimizing redistribution hypothermia [12][13][14] and enhancing any other temperature management strategy. convective warming systems, which consist of an electrical heater and a fan (power unit) connected to a disposable blanket via an air delivery hose, vary with respect to air flow, heat flow, and heat exchange.…”

Section: Discussionmentioning

confidence: 99%

Comparison of two convective warming systems during major abdominal and orthopedic surgery

Wagner

Swanson

Raymond

et al. 2008

Can J Anesth/J Can Anesth

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Purpose: Convective warming is routinely employed to maintain perioperative normothermia. However, due to differences in nozzle temperature and air flow of the power units, there are clinically relevant differences in heat transfer among convective warming systems. The purpose of this study was to evaluate the use of a quieter, convective warming system (WarmAir, sound pressure level 49 dba, air flow 35 cfm). The WarmAir system was compared to the standard, higher air flow system (Bair Hugger Model 750, sound pressure level 55 dba, air flow 48 cfm) with regards to temperature outcome. Methods:Patients undergoing general anesthesia for major abdominal and orthopedic surgery were randomized into one of two groups: WarmAir or Bair Hugger. Both groups received an upper body, convective blanket using coverage appropriate for the given surgical procedure. Convective warming, at the high setting, was started after prepping and draping, and distal esophageal or nasopharyngeal temperature was measured intraoperatively. Sublingual temperature was measured preoperatively and on admission to the postanesthesia care unit. Results:The WarmAir (n = 89) and Bair Hugger (n = 95) groups were similar with respect to age, gender, body mass index, ASA status, fluid balance, and duration of surgery. There was no difference in temperature outcomes between groups. In the WarmAir group, preoperative, lowest intraoperative, end of surgery, and postanesthesia care unit admission temperatures were (means ± SD); 36.3 ± 0.5, 35.4 ± 1.1, 36.4 ± 0.7, and 36.4 ± 0.6°C, respectively. Corresponding temperatures in the Bair Hugger group were; 36.3 ± 0.6, 35.6 ± 1.0, 36.5 ± 0.6, and 36.4 ± 0.5°C, respectively. Conclusion:Despite differences in heating characteristics, both convective warming systems were effective in maintaining perioperative normothermia in patients undergoing major abdominal and orthopedic surgery. Therefore, choice of warming system is dependent on other factors such as ergonomics and cost.

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Section: Discussionmentioning

confidence: 99%

Comparison of two convective warming systems during major abdominal and orthopedic surgery

Wagner

Swanson

Raymond

et al. 2008

Can J Anesth/J Can Anesth

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“…This benefit of pre-operative warming has been demonstrated in several studies during regional [10] and general anaesthesia [8,11,12]. The administration of pre-operative warming has even been shown to abolish completely the need for any additional intra-operative warming in certain patient populations [13,14].There is, however, another potential benefit of preoperative warming: it may reduce anxiety. In four recent studies, minor trauma victims [15], patients with lower back pain [16], patients with renal colic [17] and cholelithiasis pain [18] were assigned to passive insulation or carbon-fibre warming: The warmed patients had improved thermal comfort, less pain, and were significantly less anxious.…”

mentioning

confidence: 93%

The effect of skin surface warming on pre‐operative anxiety in neurosurgery patients*

2007

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SummarySkin surface warming of patients not only improves thermal comfort, but has been shown to reduce anxiety in a pre-hospital setting. We tested the hypothesis that pre-operative warming can reduce pre-operative anxiety as effectively as a conventional dose of intravenous midazolam in patients undergoing neurosurgery. We randomly allocated 80 patients to four groups in the pre-operative holding area. Treatment was applied for 30-45 min with (1) passive insulation and placebo; (2) passive insulation and intravenous midazolam (30 lg.kg )1 ); (3) warming with forced-air and placebo; and (4) warming with forced-air and intravenous midazolam (30 lg.kg )1 ). Thermal comfort levels (VAS 0-100 mm) and anxiety levels (VAS 0-100 mm, Spielberger State-Trait Anxiety Inventory) were assessed twice: before the designated treatment was started and before induction of anaesthesia. In the midazolam and the midazolam ⁄ warming groups, anxiety VAS and Spielberger state anxiety scores decreased by ) 19 (95% CI: ) 29 to ) 9, p < 0.01) and ) 10 (95% CI: ) 14 to ) 6, p < 0.01), respectively. In the warming and the combined groups, thermal VAS increased by + 26 (95% CI: 17-34, p < 0.01). [7], and prolonged hospitalisation [5]. Pre-operative warming before induction can prevent redistribution hypothermia and can improve thermal comfort by keeping the patient warm during the preoperative period [8,9]. This benefit of pre-operative warming has been demonstrated in several studies during regional [10] and general anaesthesia [8,11,12]. The administration of pre-operative warming has even been shown to abolish completely the need for any additional intra-operative warming in certain patient populations [13,14].There is, however, another potential benefit of preoperative warming: it may reduce anxiety. In four recent studies, minor trauma victims [15], patients with lower back pain [16], patients with renal colic [17] and cholelithiasis pain [18] were assigned to passive insulation or carbon-fibre warming: The warmed patients had improved thermal comfort, less pain, and were significantly less anxious.For the reduction of pre-operative anxiety, patients typically receive medications such as oral or intravenous benzodiazepines, yet these medications are not always effective and can be associated with respiratory depression and delayed discharge [19][20][21][22][23]. Thus, several non-pharmacological methods to reduce pre-operative anxiety have been considered, including music therapy [24,25], supply of in-depth information with leaflets [26] or videos

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“…Não há consenso na literatura sobre o melhor método de aquecimento ativo perioperatório 4,5,16,17,19,24,25 , sendo assim foi escolhida a manta térmica porque está disponível em todas as salas do hospital onde o estudo foi realizado.…”

Section: Discussionunclassified

“…A maioria dos estudos que avaliou a eficácia de métodos de aquecimento pré-operatório, na prevenção de hipotermia intraoperatória, utilizou tempo de aquecimento no período pré-operatório, de 45 a 120 min 5,13,15,16,24 . O estudo atual mostrou que, com 30 min de aquecimento no período pré-operatório e manutenção no intraoperatório, foi possível evitar a ocorrência de hipotermia em cirurgia ortopédica de 60 min de duração.…”

Section: Discussionunclassified

Uso da manta térmica na prevenção da hipotermia intraoperatória

Bernardis¹,

Silva²,

Gozzani³

et al. 2009

Rev. Assoc. Med. Bras.

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IntroduçãoHipotermia é definida como temperatura corporal central menor que 36°C e ocorre frequentemente durante procedimento anestésico, devido à inibição do centro termorregulador, aumento da exposição corporal ao ambiente e diminuição do metabolismo e da produção de calor [1][2][3][4] . A diminuição da temperatura corporal ocorre imediatamente após a indução de anestesia geral 5 ou regional 6 , decorrente da redistribuição de calor do compartimento central para o periférico. Nas intervenções cirúrgicas em que há exposição de cavidades corporais a perda de calor é maior [5][6][7][8] . Sessler 8 defendeu que o aquecimento do paciente antes da indução anestésica provoca aquecimento dos tecidos periféricos reduzindo a hipotermia por dois mecanismos: (1 diminuição do gradiente de temperatura central e periférico; (2 estimulação de vasodilatação, como se o sistema de termorregulação estivesse ativado para manter a dissipação do calor.Nos pacientes cirúrgicos de alto risco, a manutenção de normotermia central no período intra-operatório é recomendável com base em estudos que demonstram redução das complicações nesses pacientes [8][9][10][11][12]30 . O método mais efetivo de manutenção da normotermia intraoperatória é a prevenção por meio de aquecimento prévio, com o objetivo de aquecer a temperatura periférica em maior escala que a temperatura central e promover, após a indução anestésica, menor gradiente entre a temperatura central e periférica, menor redistribuição de calor, resultando em menor hipotermia [13][14][15][16][17][18] . Na tentativa de prevenir a hipotermia por redistribuição, Sessler et al. 5 , avaliaram em sete voluntários adultos a temperatura e o tempo ideal de permanência com a manta térmica que não causasse desconforto ao paciente e fosse eficaz na prevenção Resumo objetIvo. A hipotermia é prejudicial no período perioperatório. Não há consenso sobre o melhor método de aquecimento ativo e nem sobre o melhor período para fazê-lo. Este estudo teve como objetivo primário verificar a eficácia de diferentes períodos de utilização da manta térmica à temperatura de 38°C, como método de prevenção da hipotermia intraoperatória. Como objetivo secundário avaliou-se os efeitos adversos do uso da manta térmica na temperatura de 38°C. Métodos. Foram comparados quatro grupos de 15 pacientes submetidos a operações ortopédicas. No grupo controle (Gcont) os pacientes não utilizaram manta térmica, nos grupos pré (Gpré), intra (Gintra) e total (Gtotal), os pacientes utilizaram manta térmica a 38ºC, respectivamente, durante 30 minutos antes da indução anestésica, após a indução anestésica até 120 minutos e antes e após a indução. Foram avaliados: temperatura central (timpânica), periférica (pele), da sala cirúrgica, variação das condições hemodinâmicas e efeitos adversos do aquecimento. resultados. O Gtotal foi o único grupo que não teve variação significativa da temperatura central. A temperatura central dos pacientes do grupo Gtotal foi significativamente maior (p <0,05) do que a dos outros grupos aos 60 e 120 min a...

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Pre-induction skin-surface warming minimizes intraoperative core hypothermia

Cited by 35 publications

References 0 publications

Comparison of two convective warming systems during major abdominal and orthopedic surgery

Comparison of two convective warming systems during major abdominal and orthopedic surgery

The effect of skin surface warming on pre‐operative anxiety in neurosurgery patients*

Uso da manta térmica na prevenção da hipotermia intraoperatória

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