Effects of combined warmed preoperative forced-air and warmed perioperative intravenous fluids on maternal temperature during cesarean section: a prospective, randomized, controlled clinical trial

Qing-he Zhou,Ting-ting Ni,Bo He,Zhen-feng Zhou

doi:10.1186/s12871-020-00970-7

Qing-he Zhou, Ting-ting Ni + Show 2 more

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https://doi.org/10.1186/s12871-020-00970-7

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Abstract

BackgroundPreventing the frequent perioperative hypothermia incidents that occur during elective caesarean deliveries would be beneficial. This trial aimed at evaluating the effect of preoperative forced-air warming alongside perioperative intravenous fluid warming in women undergoing cesarean sections under spinal anesthesia.MethodsWe randomly allocated 135 women undergoing elective cesarean deliveries to either the intervention group (preoperative forced-air and intravenous fluid warming, n = 69) or the control group (no active warming, n = 66). The primary outcome measure was the core temperature change between groups from baseline to the end of the surgical procedure. Secondary outcomes included thermal comfort scores, the incidences of shivering and hypothermia (< 36 °C), the core temperature on arrival at the post-anesthesia care unit, neonatal axillary temperature at birth, and Apgar scores.ResultsTwo-way repeated measures ANOVA revealed significantly different core temperature changes (from the pre-spinal temperature to that at the end of the procedure) between groups (F = 13.022, P < 0.001). The thermal comfort scores were also higher in the intervention group than in the control group (F = 9.847, P = 0.002). The overall incidence of perioperative hypothermia was significantly lower in the intervention group than in the control group (20.6% vs. 51.6%, P < 0.0001).ConclusionsWarming preoperative forced-air and perioperative intravenous fluids may prevent maternal hypothermia, reduce maternal shivering, and improve maternal thermal comfort for patients undergoing cesarean sections under spinal anesthesia.Trial registrationThe study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800019117) on October26, 2018.

Highlights

Preventing the frequent perioperative hypothermia incidents that occur during elective caesarean deliveries would be beneficial
The room temperatures in the preoperative area, operating room (OR), and postanesthesia care unit (PACU) were similar for the two groups (Table 1)
We found a slight decline in the core temperatures from the baseline during the procedure in the intervention group (Fig. 2)

Summary

Introduction

Preventing the frequent perioperative hypothermia incidents that occur during elective caesarean deliveries would be beneficial This trial aimed at evaluating the effect of preoperative forced-air warming alongside perioperative intravenous fluid warming in women undergoing cesarean sections under spinal anesthesia. The hypothermia can cause numerous complications including postoperative wound infections, increased blood loss and transfusion requirements, myocardial ischemia, high risk of coagulopathy, shivering, increased hospital stay, and patient discomfort [5,6,7,8,9,10,11,12] Neonatal outcomes such as birth temperature and Apgar scores have been linked to maternal temperature [13, 14]. Studies have suggested that single-modality interventions to prevent hypothermia (forced-air or intravenous fluid warmings) result in only marginal or no benefit for patients undergoing cesarean sections [1, 4, 19, 20]

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