Preventing hypothermia in outpatient plastic surgery by self-warming or forced-air-warming blanket

Tyvold, Stig Sverre

doi:10.1097/eja.0000000000001087

Cited by 12 publications

(13 citation statements)

References 24 publications

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“…To avoid intraoperative hypothermia, the surgical and anesthesia literature have elucidated ways in which to maintain intraoperative normothermia such as aggressive preoperative warming, use of warm intravenous fluids/blood products, forced overbody and/or underbody warming, and maintaining intraoperative ambient temperatures above 21°C 35,36,41,51,52 . However, it is imperative that perioperative normothermia is addressed via multiple approaches by the surgical, nursing, and anesthesia teams 49,53 …”

Section: Discussionmentioning

confidence: 99%

Impact of Intraoperative Hypothermia on Autologous Breast Reconstruction

et al. 2023

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Objective: Studies have identified perioperative hypothermia as a risk factor for impaired wound healing, increased hospital length of stay, and surgical site infection. This study examines the effect of intraoperative hypothermia on postoperative outcomes in autologous microvascular free flap breast reconstruction. Methods: This was a retrospective review of 55 patients who experienced intraoperative hypothermia, defined as less than 35.0°C core body temperature and 99 normothermic patients who underwent autologous-based microvascular free flap breast reconstruction from 2013 to 2021. Demographics, comorbidities, smoking status, intraoperative warming devices, type of autologous reconstruction, hypothermia (and its duration), and length of surgery were collected. The outcomes assessed were infection rate, reoperation within 90 days, skin necrosis, wound healing complications, hematoma, seroma, and readmission within 90 days. Results: In the study population of 154 consecutive patients, 8.4% had type 1 or type 2 diabetes and 3.2% were current smokers. A total of 90.3% of patients (139) underwent deep inferior epigastric perforator flap reconstruction, 7.1% (11) superficial inferior epigastric artery flap reconstruction, and 4 (2.6%) another free flap type. A total of 35.7% of the patients (55) experienced intraoperative hypothermia defined as less than 35.0°C. In the hypothermic group, a higher proportion of patients had wound healing complications (52.7% vs 29.3%, P < 0.05), hematoma (16.4% vs 5.1%, P < 0.05), and readmission for postoperative complications (34.5% vs 14.1%, P < 0.05). There was also a trend toward higher incidence of seroma (7.3% vs 5.1%), surgical site infection (12.7% vs 9.1%), skin necrosis (12.7% vs 9.1%), and unplanned reoperation within 90 days (10.9% vs 7.1%). Further analysis via Firth logistic regression demonstrated intraoperative hypothermia predicted postoperative hematoma (odds ratio [OR], 3.68; 95% confidence interval [CI], 1.17-11.60; P < 0.05), readmission within 90 days (OR, 3.20; 95% CI, 1.45-7.08; P < 0.05), and wound healing complications (OR, 2.69; 95% CI, 1.36-5.33; P < 0.05). Conclusions: This study demonstrates that intraoperative hypothermia is a significant risk factor for postoperative wound healing complications, hematoma, and readmission within 90 days in autologous breast reconstruction. Because of a finite amount of donor sites, it is important to find ways to minimize the risk of postoperative complications. Our results support that maintaining strict normothermia during autologous breast reconstruction can significantly improve patient outcomes and reduce morbidity.

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Section: Discussionmentioning

confidence: 99%

Impact of Intraoperative Hypothermia on Autologous Breast Reconstruction

et al. 2023

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“…Perioperative hypothermia affects up to 20-50% of patients undergoing general anesthesia 13 . Once the temperature has decreased, treatment of redistribution hypothermia is difficult, since the application of heat to the superficial compartment takes a long time to reach the core compartment.…”

Section: Discussionmentioning

confidence: 99%

Effect of prewarming on body temperature in short-term bladder or prostatic transurethral resection under general anesthesia: A randomized, double-blind, controlled trial

Becerra

Valencia

Saavedra

et al. 2021

Sci Rep

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Perioperative hypothermia causes postoperative complications. Prewarming reduces body temperature decrease in long-term surgeries. We aimed to assess the effect of different time-periods of prewarming on perioperative temperature in short-term transurethral resection under general anesthesia. Randomized, double-blind, controlled trial in patients scheduled for bladder or prostatic transurethral resection under general anesthesia. Eligible patients were randomly assigned to receive no-prewarming or prewarming during 15, 30, or 45 min using a forced-air blanket in the pre-anesthesia period. Tympanic temperature was used prior to induction of anesthesia and esophageal temperature intraoperatively. Primary outcome was the difference in core temperature among groups from the induction of general anesthesia until the end of surgery. Repeated measures multivariate analysis of covariance modeled the temperature response at each observation time according to prewarming. We examined modeled contrasts between temperature variables in subjects according to prophylaxis. We enrolled 297 patients and randomly assigned 76 patients to control group, 74 patients to 15-min group, 73 patients to 30-min group, and 74 patients to the 45-min group. Temperature in the control group before induction was 36.5 ± 0.5 °C. After prewarming, core temperature was significantly higher in 15- and 30-min groups (36.8 ± 0.5 °C, p = 0.004; 36.7 ± 0.5 °C, p = 0.041, respectively). Body temperature at the end of surgery was significantly lower in the control group (35.8 ± 0.6 °C) than in the three prewarmed groups (36.3 ± 0.6 °C in 15-min, 36.3 ± 0.5 °C in 30-min, and 36.3 ± 0.6 °C in 45-min group) (p < 0.001). Prewarming prior to short-term transurethral resection under general anesthesia reduced the body temperature drop during the perioperative period. These time-periods of prewarming also reduced the rate of postoperative complications.Study Registration Registered at ClinicalTrials.gov (Identifier: NCT03630887).

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“…The superiority of the SW blanket over standard hospital clothing has been reported elsewhere 10 . However, other randomised controlled trials which have compared the peri‐operative use of the SW blanket with the FAW blanket under spinal anaesthesia (SA) or general anaesthesia (GA) have yielded conflicting results 11–13 …”

Section: Introductionmentioning

confidence: 95%

“…10 However, other randomised controlled trials which have compared the peri-operative use of the SW blanket with the FAW blanket under spinal anaesthesia (SA) or general anaesthesia (GA) have yielded conflicting results. [11][12][13] The aim of this trial was to investigate whether the SW blanket is non-inferior to the FAW blanket in maintaining normothermia in patients undergoing elective unilateral total knee arthroplasty (TKA).…”

Section: Introductionmentioning

confidence: 99%

Self‐warming blanket versus forced‐air warming blanket during total knee arthroplasty under spinal anaesthesia: A randomised non‐inferiority trial

Lauronen

Kalliovalkama

Aho

et al. 2023

Acta Anaesthesiol Scand

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BackgroundArthroplasty patients are at high risk of hypothermia. Pre‐warming with forced air has been shown to reduce the incidence of intraoperative hypothermia. There is, however, a lack of evidence that pre‐warming with a self‐warming (SW) blanket can reduce the incidence of perioperative hypothermia. This study aims to evaluate the effectiveness of an SW blanket and a forced‐air warming (FAW) blanket peri‐operatively. We hypothesised that the SW blanket is inferior to the FAW blanket.MethodsIn total, 150 patients scheduled for primary unilateral total knee arthroplasty under spinal anaesthesia were randomised to this prospective study. Patients were pre‐warmed with SW blanket (SW group) or upper‐body FAW blanket (FAW group) set to 38°C for 30 min before spinal anaesthesia induction. Active warming was continued with the allocated blanket in the operating room. If core temperature fell below 36°C, all patients were warmed using the FAW blanket set to 43°C. Core and skin temperatures were measured continuously. The primary outcome was core temperature on admission to the recovery room.ResultsBoth methods increased mean body temperature during pre‐warming. However, intraoperative hypothermia occurred in 61% of patients in the SW group and in 49% in the FAW group. The FAW method set to 43°C could rewarm hypothermic patients. Core temperature did not differ between groups on admission to the recovery room, p = .366 (CI: −0.18–0.06).ConclusionsStatistically, the SW blanket was non‐inferior to the FAW method. Yet, hypothermia was more frequent in the SW group, requiring rescue warming as we strictly held to the NICE guideline.Trial RegistrationClinicaltrials.gov identifier: NCT03408197.

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Preventing hypothermia in outpatient plastic surgery by self-warming or forced-air-warming blanket

Cited by 12 publications

References 24 publications

Impact of Intraoperative Hypothermia on Autologous Breast Reconstruction

Impact of Intraoperative Hypothermia on Autologous Breast Reconstruction

Effect of prewarming on body temperature in short-term bladder or prostatic transurethral resection under general anesthesia: A randomized, double-blind, controlled trial

Self‐warming blanket versus forced‐air warming blanket during total knee arthroplasty under spinal anaesthesia: A randomised non‐inferiority trial

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