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Preoperative warming combined with intraoperative skin-surface warming does not avoid hypothermia caused by spinal anesthesia in patients with midazolam premedication
Vanni, Simone Maria D'Angelo;Castiglia, Yara Marcondes Machado;Ganem, Eliana Marisa;Rodrigues Júnior, Geraldo Rolim;Amorim, Rosa Beatriz;Ferrari, Fábio;Braz, Leandro Gobbo;Braz, José Reinaldo Cerqueira;
Sao Paulo Medical Journal , 2007, DOI: 10.1590/S1516-31802007000300004
Abstract: context and objective: inadvertent perioperative hypothermia is common during spinal anesthesia and after midazolam administration. the aim of this study was to evaluate the effects of intraoperative skin-surface warming with and without 45 minutes of preoperative warming in preventing intraoperative and postoperative hypothermia caused by spinal anesthesia in patients with midazolam premedication. design and setting: prospective and randomized study at hospital das clínicas, universidade estadual paulista, botucatu. methods: thirty patients presenting american society of anesthesiologists (asa) physical status i and ii who were scheduled for elective lower abdominal surgery were utilized. the patients received midazolam premedication (7.5 mg by intramuscular injection) and standard spinal anesthesia. ten patients (gcontrol) received preoperative and intraoperative passive thermal insulation. ten patients (gpre+intra) underwent preoperative and intraoperative active warming. ten patients (gintra) were only warmed intraoperatively. results: after 45 min of preoperative warming, the patients in gpre+intra had significantly higher core temperatures than did the patients in the unwarmed groups (gcontrol and gintra) before the anesthesia (p < 0.05) but not at the beginning of surgery (p > 0.05). the patients who were warmed intraoperatively had significantly higher core temperatures than did the patients in gcontrol at the end of surgery (p < 0.05). all the patients were hypothermic at admission to the recovery room (tcore < 36° c). conclusions: forty-five minutes of preoperative warming combined with intraoperative skin-surface warming does not avoid but minimizes hypothermia caused by spinal anesthesia in patients with midazolam premedication.
Water warming garment versus forced air warming system in prevention of intraoperative hypothermia during liver transplantation: a randomized controlled trial [ISRCTN32154832]
Piotr K Janicki, Cristina Stoica, William C Chapman, J Kelly Wright, Garry Walker, Ram Pai, Ann Walia, Mias Pretorius, C Wright Pinson
BMC Anesthesiology , 2002, DOI: 10.1186/1471-2253-2-7
Abstract: In this prospective, randomized and open-labelled study, 24 adult patients were enrolled in one of two intraoperative temperature management groups during OLT. The water-garment group (N = 12) received warming with a body temperature (esophageal) set point of 36.8°C. The forced air-warmer group (N = 12) received routine warming therapy using upper- and lower-body forced-air warming system. Body core temperature (primary outcome) was recorded intraoperatively and during the two hours after surgery in both groups.The mean core temperatures during incision, one hour after incision and during the skin closing were significantly higher (p < 0.05, t test with Bonferroni corrections for the individual tests) in the water warmer group compared to the control group (36.7 ± 0.1, 36.7 ± 0.2, 36.8 ± 0.1 vs 36.1 ± 0.4, 36.1 ± 0.4, 36.07 ± 0.4°C, respectively). Moreover, significantly higher core temperatures were observed in the water warmer group than in the control group during the placement of cold liver allograft (36.75 ± 0.17 vs 36.09 ± 0.38°C, respectively) and during the allograft reperfusion period (36.3 ± 0.26 vs 35.52 ± 0.42°C, respectively). In addition, the core temperatures immediately after admission to the SICU (36.75 ± 0.13 vs 36.22 ± 0.3°C, respectively) and at one hr (36.95 ± 0.13 vs 36.46 ± 0.2°C, respectively) were significantly higher in the water warmer group, compared to the control group, whereas the core temperature did not differ significantly afte two hours in ICU in both groups.The investigated water warming system results in better maintenance of intraoperative normothermia than routine air forced warming applied to upper- and lower body.Perioperative hypothermia has been associated with morbidity in the general surgical patient population [1-6]. It is therefore appropriate to keep surgical patients normothermic (i.e., at least 36°C). Despite current advances in intraoperative warming, hypothermia during the extensive abdominal surgeries, including o
High Preoperative Anxiety Level and the Risk of Intraoperative Hypothermia  [PDF]
Noriyoshi Tanaka, Yuko Ohno, Megumi Hori, Mai Utada, Kenji Ito, Toshiyasu Suzuki
International Journal of Clinical Medicine (IJCM) , 2012, DOI: 10.4236/ijcm.2012.36085
Abstract: Aim: The relationship between preoperative anxiety level and intraoperative hypothermia (<36℃) was investigated. Background: Core temperature often decreases during surgery, with an initial rapid decrease followed by a slower decrease for about 2 hours. Preoperative anxiety may influence perioperative physiological responses. The relationship between preoperative anxiety level and perioperative decrease in core temperature has not been studied closely. Design: A prospective observational study. Methods: This study enrolled 120 adult patients who underwent elective major abdominal surgery under combined epidural and general anesthesia. Tympanic membrane temperature was used to measure core temperature preoperatively and during the operation. The relationship between anxiety level according to the State-Trait Anxiety Inventory (STAI) and core temperature was examined using descriptive and multivariate risk analysis. Results: High anxiety level was found in 61 patients (51%), of which 26 (43%) developed hypothermia during the first hour and 40 (66%) developed hypothermia during the first 2 hours of anesthesia. After adjustment for covariates, patients with a high anxiety level were found to have a 2.17-fold higher risk of hypothermia during the first hour and a 1.77-fold higher risk of hypothermia during the first 2 hours than patients with a low/moderate anxiety level. Conclusions: The risk of hypothermia in the early phase of general anesthesia can be predicted by measurement of the preoperative anxiety level using the STAI. Relevance to Clinical Practice: Patients with a high anxiety level had a significantly higher risk of intraoperative hypothermia. Preoperative preventive nursing care programs should include anxiety management and thermal care.
Hypothermia control in elderly surgical patients in the intraoperative period: evaluation of two nursing interventions
Tramontini, Cibele Cristina;Graziano, Kazuko Uchikawa;
Revista Latino-Americana de Enfermagem , 2007, DOI: 10.1590/S0104-11692007000400016
Abstract: objectives: to evaluate the efficacy of two different nursing interventions regarding control of body heat loss, using blankets during the intraoperative period of elderly patients. methods: this was an experimental, comparative, applied, longitudinal prospective study with a quantitative approach. eighty-one elderly patients undergoing elective surgery with a surgical time frame of at least one hour were selected by systematic probability sampling into two experimental and one control group. informed consent was obtained from participants. data was collected by biophysiological measurement, using a tympanic thermometer. results: after the homogeneity of variables - gender, surgical duration, age, bmr, anesthesia, room humidity and temperature, drugs and liquid infusion- had been demonstrated, the interventions were confronted. incidence of hypothermia (59.3%) and body heat loss (e1=-0.6oc , e2=-0.6 oc and c=-0.7oc) were not significantly different between the groups (p=0.85 and p=0.7 respectively). conclusions: results show the need for associated extra body warming methods to maintain normothermia.
Factors associated to the development of hypothermia in the intraoperative period
Poveda, Vanessa de Brito;Galv?o, Cristina Maria;Santos, Claudia Benedita dos;
Revista Latino-Americana de Enfermagem , 2009, DOI: 10.1590/S0104-11692009000200014
Abstract: this study aimed to assess factors associated to body temperature changes intraoperatively in patients undergoing elective surgery. a prospective study including 70 patients was carried out in a charity hospital. a data collection instrument was developed and its face and content validity was established. the variables measured were operating room temperature and humidity and patient body temperature at different times. in the multivariate linear regression, the variables type of anesthesia, duration of anesthesia, body mass index, and operating room temperature were directly associated to mean body temperature. nurses are responsible for planning and implementing effective interventions that can contribute to minimize costs and most importantly reduce hypothermia complications.
Preventing hypothermia in elective arthroscopic shoulder surgery patients: a protocol for a randomised controlled trial
Jed Duff, Renatta Di Staso, Kerry-Anne Cobbe, Nicole Draper, Simon Tan, Emma Halliday, Sandy Middleton, Lawrence Lam, Kim Walker
BMC Surgery , 2012, DOI: 10.1186/1471-2482-12-14
Abstract: The trial will employ a randomised 2 x 2 factorial design. Eligible patients will be stratified by anaesthetist and block randomised into one of four groups: Group one will receive preoperative warming with a forced air warming device; group two will receive warmed intraoperative irrigation solutions; group three will receive both preoperative warming and warmed intraoperative irrigation solutions; and group four will receive neither intervention. Participants in all four groups will receive active intraoperative warming with a forced air warming device. The primary outcome measures are postoperative temperature, thermal comfort, and total recovery time. Primary outcomes will undergo a two-way analysis of variance controlling for covariants such as operating room ambient temperature and volume of intraoperative irrigation solution.This trial is designed to confirm the effectiveness of these interventions at maintaining perioperative normothermia and to evaluate if this translates into improved patient outcomes.ACTRN12610000591055Inadvertent perioperative hypothermia, defined as a core temperature below 36°C [1], is a common, yet widely under-acknowledged adverse clinical consequence of surgery [1-3]. Patients undergoing arthroscopic shoulder surgery are particularly at risk, with the average patient experiencing a core temperature heat loss of between 1°C and 3°C [4-6]. Three principle factors are said to contribute to this problem: Reduced metabolic heat production due to the anaesthetic; heat loss due to the cold perioperative environment and the use of large quantities of surgical irrigation solution; and impaired thermoregulation which results in a core to periphery thermal redistribution [7].Although hypothermia is a common perioperative problem, it is not a benign one: The consequences are both physiological and psychological in nature and are far more serious than patients just ‘feeling uncomfortably cold’. Research has demonstrated a clear link between inadv
Accidental hypothermia
Ivo Casagranda,Giovanni Lombardi,Dalio Cecconi,Stefano Turchetti
Emergency Care Journal , 2006, DOI: 10.4081/ecj.2006.1.9
Abstract: Hypothermia is defined as an unintentional decrease of core body temperature below 35 °C. In this article we discuss pathophysiology, clinical aspects and treatment of hypothermic patients. The most important treatment of hypothermia is the identification of the most appropriate method of rewarming. We report a case of cardiac arrest secondary to severe accidental hypothermia, that occured in a young man, do to prolonged exposure to low temperature in river water, successfully treated with extracorporeal blood warming.
Intermittent warming of 'Tahiti' lime to prevent chilling injury during cold storage
Kluge, Ricardo Alfredo;Jomori, Maria Luiza Lye;Jacomino, Angelo Pedro;Vitti, Maria Carolina Dario;Vitti, Daniela Cristina Clemente;
Scientia Agricola , 2003, DOI: 10.1590/S0103-90162003000400018
Abstract: storage of 'tahiti' limes (citrus latifolia) at low temperature allows the marketing period to be extended. however, the loss of the green skin color and the occurrence of chilling injury (ci) prevent this extension. the purpose of this work was to verify the efficiency of intermittent warming (iw) in 'tahiti' lime quality maintenance during cold storage. fruit were submitted to iw (20oc for 48 hours every 7 or 14 days or 38oc for 24 hours every 14 days) during cold storage at 5oc. fruit were also stored at 5 and 10oc continuously. the evaluations were carried out after 30 and 60 days of storage (+ 3 days of simulated marketing at 20oc). ci occurrence on fruit was not verified after 30 days of storage. however, after 60 days of storage 60% of the fruit kept continuously at 5oc presented ci, while fruit intermittently warmed had 10 to 12.5% ci. fruit stored at 10oc did not present ci, but they showed high degreening after 30 days of storage. fruit warmed at 38oc for 24 hours every 14 days developed rot, loss of green skin color and vitamin c, high respiratory rates, as well as high levels of ethanol and acetaldehyde in the juice. fruit can be stored at 5oc during 30 days, without risk of ci, while iw can be used to reduce ci after 60 days of storage.
Intermittent warming of 'Tahiti' lime to prevent chilling injury during cold storage  [cached]
Kluge Ricardo Alfredo,Jomori Maria Luiza Lye,Jacomino Angelo Pedro,Vitti Maria Carolina Dario
Scientia Agricola , 2003,
Abstract: Storage of 'Tahiti' limes (Citrus latifolia) at low temperature allows the marketing period to be extended. However, the loss of the green skin color and the occurrence of chilling injury (CI) prevent this extension. The purpose of this work was to verify the efficiency of intermittent warming (IW) in 'Tahiti' lime quality maintenance during cold storage. Fruit were submitted to IW (20oC for 48 hours every 7 or 14 days or 38oC for 24 hours every 14 days) during cold storage at 5oC. Fruit were also stored at 5 and 10oC continuously. The evaluations were carried out after 30 and 60 days of storage (+ 3 days of simulated marketing at 20oC). CI occurrence on fruit was not verified after 30 days of storage. However, after 60 days of storage 60% of the fruit kept continuously at 5oC presented CI, while fruit intermittently warmed had 10 to 12.5% CI. Fruit stored at 10oC did not present CI, but they showed high degreening after 30 days of storage. Fruit warmed at 38oC for 24 hours every 14 days developed rot, loss of green skin color and vitamin C, high respiratory rates, as well as high levels of ethanol and acetaldehyde in the juice. Fruit can be stored at 5oC during 30 days, without risk of CI, while IW can be used to reduce CI after 60 days of storage.
Prevention and Management of Neonatal Hypothermia in Rural Zambia  [PDF]
Karsten Lunze, Kojo Yeboah-Antwi, David R. Marsh, Sarah Ngolofwana Kafwanda, Austen Musso, Katherine Semrau, Karen Z. Waltensperger, Davidson H. Hamer
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0092006
Abstract: Background Neonatal hypothermia is increasingly recognized as a risk factor for newborn survival. The World Health Organization recommends maintaining a warm chain and skin-to-skin care for thermoprotection of newborn children. Since little is known about practices related to newborn hypothermia in rural Africa, this study's goal was to characterize relevant practices, attitudes, and beliefs in rural Zambia. Methods and Findings We conducted 14 focus group discussions with mothers and grandmothers and 31 in-depth interviews with community leaders and health officers in Lufwanyama District, a rural area in the Copperbelt Province, Zambia, enrolling a total of 171 participants. We analyzed data using domain analysis. In rural Lufwanyama, community members were aware of the danger of neonatal hypothermia. Caregivers' and health workers' knowledge of thermoprotective practices included birthplace warming, drying and wrapping of the newborn, delayed bathing, and immediate and exclusive breastfeeding. However, this warm chain was not consistently maintained in the first hours postpartum, when newborns are at greatest risk. Skin-to-skin care was not practiced in the study area. Having to assume household and agricultural labor responsibilities in the immediate postnatal period was a challenge for mothers to provide continuous thermal care to their newborns. Conclusions Understanding and addressing community-based practices on hypothermia prevention and management might help improve newborn survival in resource-limited settings. Possible interventions include the implementation of skin-to-skin care in rural areas and the use of appropriate, low-cost newborn warmers to prevent hypothermia and support families in their provision of newborn thermal protection. Training family members to support mothers in the provision of thermoprotection for their newborns could facilitate these practices.
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