Short-Periods of Pre-Warming in Laparoscopic Surgery. A Non-Randomized Clinical Trial Evaluating Current Clinical Practice

Abstract

Background: Pre-warming prevents perioperative hypothermia. We evaluated the current clinical practice of pre-warming and its effects on temperature drop and postoperative complications; Methods: This prospective, observational pilot study examines clinical practice in a tertiary hospital on 99 patients undergoing laparoscopic urological surgery. Pre-warming was performed in the pre-anesthesia room. Patients were classified into three groups: P 0 (non-prewarmed), P 5–15 (pre-warming 5–15 min) and P > 15 (pre-warming 15–30 min). Tympanic temperature was recorded in the pre-anesthesia room, prior to anesthesia induction, and in the PACU. Esophageal temperature was recorded intraoperatively. The occurrence of shivering, pain intensity, length of stay in PACU, and postoperative complications during hospital stay were also recorded; Results: After pre-warming, between-group difference in body temperature was higher in P > 15 than in P 0 (0.4 °C, 95% CI 0.14–0.69, p = 0.004). Between P 5–15 and P 0 difference was 0.2 °C (95% CI 0.04–0.55, p = 0.093). Temperature at the end of surgery was higher in pre-warmed groups [mean between-group difference 0.5 °C (95% CI 0.13–0.81, p = 0.007) for P 5–15; 0.9 °C (95% CI 0.55–1.19, p < 0.001) for P > 15]. Pain and shivering was less common in pre-warmed groups. Postoperative transfusions and surgical site infections were lower in P > 15; Conclusion: Short-term pre-warming prior to laparoscopic urological surgery decreased temperature perioperative drop and postoperative complications.

Incidence of Severe Hypothermia and Its Impact on Postoperative Surgical Complications and Time Delay to Adjunct Treatments in Breast Surgery Cancer Patients: A Case-Controlled Study

“…Prewarming is an important measure for maintaining normothermia [23,24]; it is now part of the guidelines for preventing inadvertent perioperative hypothermia in several countries [25,26]. In addition, prewarming should be performed at least 15 min to be efficient [2,[4][5][6]. We believe that prewarming was probably not performed adequately in our cohort of hypothermic patients; this might be explained by the fact that for a decade, the majority of our patients have entered the operating theaters by walking; therefore, patients cannot be prewarmed in the waiting area and they cannot be prepared, because their hospital bed is not with them.…”

“…In addition to intraoperative warming, prewarming is also reported to significantly contribute to the maintenance of normothermia, decreasing the incidence of surgical site infection [4]. However, to be effective, prewarming should be performed adequately by respecting a minimum dedicated time of 15 minutes [5,6].…”

Anaesthetic Approach to Enhanced Recovery after Surgery for Kidney Transplantation: A Narrative Review

“…In surgical patients, hypothermia is associated with perioperative complications including surgical site infection, coagulopathy, increased transfusion requirements, pain, impaired drug metabolism, adverse cardiac events, and longer LoS [ 130 , 131 ]. There are no specific data on temperature management in KTx recipients, and therefore general rules for the management of surgical patients should be applied.…”

“…IV fluids should be warmed to 37 °C [ 132 ]. Short-term pre-warming before urological procedures decreased the occurrence of hypothermia, which correlated with a lower transfusion rate and a lower prevalence of surgical site infection [ 131 ].…”

Comparison of Perioperative Active or Routine Temperature Management on Postoperative Quality of Recovery in PACU in Patients Undergoing Thoracoscopic Lobectomy: A Randomized Controlled Study

“…29 Prevention of perioperative hypothermia reduces postoperative complications. 30 Intraoperative temperature management has been shown to reduce myocardial injury and the incidence of arrhythmias. 31 However, the incidence of ventricular arrhythmias in the PACU did not differ between the two groups.…”