Randomized clinical trial of perioperative systemic warming in major elective abdominal surgery

Wong, Peng F; Kumar, Senthil; Bohra, Ajay; Whetter, D.; Leaper, David

doi:10.1002/bjs.5631

Cited by 194 publications

(126 citation statements)

References 28 publications

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“…Nineteen randomized controlled trials [11][12]14,18-32 on 1,785 patients qualified for this review in accordance with the inclusion criteria (Figure 1). Six trials 16,17,[33][34][35][36] were excluded for the reasons mentioned in Figure 1. The characteristics of the trials included are given in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The duration of perioperative warming is also under review and prolonged exposure of surgical patients to warming systems has proven to be quite effective in major elective abdominal surgery. 17 The aim of this systematic review was to compare the efficacy of perioperative warming of surgical patients aimed at reducing the consequences of wound infection, coagulopathy, blood loss, postoperative pain and postoperative shivering, in relation to no warming.…”

Section: Introductionmentioning

confidence: 99%

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The role of perioperative warming in surgery: a systematic review

et al. 2009

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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 ...

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The role of perioperative warming in surgery: a systematic review

et al. 2009

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“…Furthermore, an earlier study assessing the clinical impact of extending peri-operative conductive warming during abdominal surgery has also shown that the mattresses are well tolerated and that pre-and postoperative conductive warming significantly reduces blood loss and complication rates [105].…”

Section: Resistive Heatingmentioning

confidence: 99%

Peri‐operative warming devices: performance and clinical application

2014

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SummarySince the adverse consequences of accidental peri-operative hypothermia have been recognised, there has been a rapid expansion in the development of new warming equipment designed to prevent it. This is a review of peri-operative warming devices and a critique of the evidence assessing their performance. Forced-air warming is a common and extensively tested warming modality that outperforms passive insulation and water mattresses, and is at least as effective as resistive heating. More recently developed devices include circulating water garments, which have shown promising results due to their ability to cover large surface areas, and negative pressure devices aimed at improving subcutaneous perfusion for warming. We also discuss the challenge of fluid warming, looking particularly at how devices' performance varies according to flow rate. Our ultimate aim is to provide a guide through the bewildering array of devices on the market so that clinicians can make informed and accurate choices for their particular hospital environment.

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“…81 In the context of colorectal surgery, warming with forced air blankets and intravenous fluids to maintain normothermia has been shown to reduce wound infection rates, 82 blood transfusion requirements, and complication rates. 83 However, there would appear to be no literature examining the impact of this strategy on the SIR following colorectal surgery. Therefore, there is no evidence that maintenance of intraoperative normothermia can reduce the surgical stress response as part of an ERAS protocol.…”

Section: Maintenance Of Intraoperative Normothermiamentioning

confidence: 99%

Enhanced Recovery after Surgery

Lsmu¹,

klinika²,

nuskausminimas³

et al. 2018

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Enhanced Recovery or Fast Track Recovery after Surgery protocols (ERAS) have significantly changed perioperative care following colorectal surgery and are promoted as reducing the stress response to surgery.The present systematic review aimed to examine the impact on the magnitude of the systemic inflammatory response (SIR) for each ERAS component following colorectal surgery using objective markers such as C-reactive protein (CRP) and interleukin-6 (IL-6).A literature search was performed of the US National Library of Medicine (MEDLINE), EMBASE, PubMed, and the Cochrane Database of Systematic Reviews using appropriate keywords and subject headings to February 2015.Included studies had to assess the impact of the selected ERAS component on the SIR using either CRP or IL-6. Nineteen studies, including 1898 patients, were included. Fourteen studies (1246 patients) examined the impact of laparoscopic surgery on the postoperative markers of SIR. Ten of these studies (1040 patients) reported that laparoscopic surgery reduced postoperative CRP. One study (53 patients) reported reduced postoperative CRP using opioidminimising analgesia. One study (142 patients) reported no change in postoperative CRP following preoperative carbohydrate loading. Two studies (108 patients) reported conflicting results with respect to the impact of goal-directed fluid therapy on postoperative IL-6. No studies examined the effect of other ERAS components, including mechanical bowel preparation, antibiotic prophylaxis, thromboprophylaxis, and avoidance of nasogastric tubes and peritoneal drains on markers of the postoperative SIR following colorectal surgery.The present systematic review shows that, with the exception of laparoscopic surgery, objective evidence of the effect of individual components of ERAS protocols in reducing the stress response following colorectal surgery is limited.(Medicine 94(36):e1286)Abbreviations: CRP = C-reactive protein, EA = epidural analgesia, ERAS = Enhanced Recovery After Surgery, IL-6 = interleukin-6, LA = local anaesthetic, LMWH = low molecular weight heparin, MBP = mechanical bowel preparation, NSAID = non-steroidal anti-inflammatory drug, SIR = systemic inflammatory response, TAP = transversus abdominis plane, TNF = tumor necrosis factor.

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Randomized clinical trial of perioperative systemic warming in major elective abdominal surgery

Abstract: Extending systemic warming to the perioperative period had additional beneficial effects, with minimal additional cost and patient discomfort.

Cited by 194 publications

References 28 publications

The role of perioperative warming in surgery: a systematic review

The role of perioperative warming in surgery: a systematic review

Peri‐operative warming devices: performance and clinical application

Enhanced Recovery after Surgery

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