Abstract
BackgroundThe purpose of this study is to assess whether the application of preoperative forced air warming set to high temperature (> 43 °C) for brief period can increase temperature on admission to the postanesthesia care unit (PACU) and prevent hypothermia or shivering during holmium laser enucleation of the prostate performed under spinal anesthesia.MethodsFifty patients were enrolled were assigned randomly to receive passive insulation (control group, n = 25) or forced-air skin surface warming for 20 min before spinal anesthesia (pre-warming group, n = 25). The primary outcome was temperature at PACU admission.ResultsThe pre-warming group had a significantly higher temperature on admission to the PACU than the control group (35.9 °C [0.1] vs 35.6 °C [0.1], P = 0.023; 95% confidence interval of mean difference, 0.1 °C–0.5 °C). The trend of decreasing core temperature intraoperatively was not different between groups (P = 0.237), but intraoperative core temperature remained approximately 0.2 °C higher in the pre-warming group (P = 0.005). The incidence of hypothermia on admission to the PACU was significantly lower in the pre-warming group (56% vs 88%, P = 0.025). Shivering occurred in 14 patients in the control group, and 4 patients in the pre-warming group (P = 0.007).ConclusionBrief pre-warming at 45 °C increased perioperative temperature and decreased the incidence of hypothermia and shivering. However, it was not sufficient to modify the decline of intraoperative core temperature or completely prevent hypothermia and shivering. Continuing pre-warming to immediately before induction of spinal anesthesia or combining pre-warming with intraoperative active warming may be necessary to produce clearer thermal benefits in this surgical population.Trial registrationThis trial was registered with Clinicaltrials.gov, NCT03184506, 5th June 2017.
Highlights
The purpose of this study is to assess whether the application of preoperative forced air warming set to high temperature (> 43 °C) for brief period can increase temperature on admission to the postanesthesia care unit (PACU) and prevent hypothermia or shivering during holmium laser enucleation of the prostate performed under spinal anesthesia
The purpose of this study is to assess whether the application of preoperative forced air warming set to high temperature (> 43 °C) for brief period can increase temperature on admission to the postanesthesia care unit (PACU) and prevent hypothermia or shivering during Holmium laser enucleation of prostate (HoLEP) performed under spinal anesthesia
We evaluated the interaction between treatment group and time adjusted for preoperative core temperature because a treatment-by-time interaction reflects differing temperature changes over time based on treatment
Summary
The purpose of this study is to assess whether the application of preoperative forced air warming set to high temperature (> 43 °C) for brief period can increase temperature on admission to the postanesthesia care unit (PACU) and prevent hypothermia or shivering during holmium laser enucleation of the prostate performed under spinal anesthesia. General anesthesia greatly impair central thermoregulation, reducing the thresholds for vasoconstriction and shivering [1, 2]. Neuraxial anesthesia impairs central thermoregulatory control less than does general anesthesia [4]. Unlike general anesthesia, neuraxial anesthesia blocks peripheral sympathetic and motor nerve, which inhibits thermoregulatory vasoconstriction and shivering in blocked area [5]. Perioperative hypothermia during neuraxial anesthesia is common and severe as during general anesthesia [6]. As neuraxial anesthesia impair behavioral thermoregulatory responses (i.e., patient sensation of cold) and routine core temperature monitoring remains rare during regional anesthesia, substantial hypothermia commonly goes undetected [7]
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