Abstract
BackgroundPerioperative hypothermia is still very common and associated with numerous adverse effects. The effects of benzodiazepines, administered as premedication, on thermoregulation have been studied with conflicting results. We investigated the hypotheses that premedication with flunitrazepam would lower the preoperative core temperature and that prewarming could attenuate this effect.MethodsAfter approval by the local research ethics committee 50 adult cardiac surgical patients were included in this prospective, randomized, controlled, single-centre study with two parallel groups in a university hospital setting. Core temperature was measured using a continuous, non-invasive zero-heat flux thermometer from 30 min before administration of the oral premedication until beginning of surgery. An equal number of patients was randomly allocated via a computer-generated list assigning them to either prewarming or control group using the sealed envelope method for blinding. The intervention itself could not be blinded. In the prewarming group patients received active prewarming using an underbody forced-air warming blanket. The data were analysed using Student’s t-test, Mann-Whitney U-test and Fisher’s exact test.ResultsOf the randomized 25 patients per group 24 patients per group could be analysed. Initial core temperature was 36.7 ± 0.2 °C and dropped significantly after oral premedication to 36.5 ± 0.3 °C when the patients were leaving the ward and to 36.4 ± 0.3 °C before induction of anaesthesia. The patients of the prewarming group had a significantly higher core temperature at the beginning of surgery (35.8 ± 0.4 °C vs. 35.5 ± 0.5 °C, p = 0.027), although core temperature at induction of anaesthesia was comparable. Despite prewarming, core temperature did not reach baseline level prior to premedication (36.7 ± 0.2 °C).ConclusionsOral premedication with benzodiazepines on the ward lowered core temperature significantly at arrival in the operating room. This drop in core temperature cannot be offset by a short period of active prewarming.Trial registrationThis trial was prospectively registered with the German registry of clinical trials under the trial number DRKS00005790 on 20th February 2014.
Highlights
Perioperative hypothermia is still very common and associated with numerous adverse effects
The two patient groups were similar with respect to age, weight, sex, body mass index (BMI), American Society of Anesthesiology (ASA)-Classification, and type of the planned surgery (Table 1)
Does premedication with flunitrazepam lower the core temperature significantly? Second, does prewarming have an effect on core temperature at the beginning of surgery? In this randomized controlled trial we demonstrated that premedication with flunitrazepam lowered the core temperature significantly
Summary
Perioperative hypothermia is still very common and associated with numerous adverse effects. The effects of benzodiazepines, administered as premedication, on thermoregulation have been studied with conflicting results. We investigated the hypotheses that premedication with flunitrazepam would lower the preoperative core temperature and that prewarming could attenuate this effect. Perioperative hypothermia, defined as core temperature < 36 °C, is still very common [1, 2]. The effects of benzodiazepines on perioperative thermoregulation have been studied with conflicting results. In an early study Kurz et al [11] found that even very high doses of midazolam had only moderate effects on core temperature and the vasoconstriction threshold of healthy volunteers. In another study the effects of midazolam on core temperature could be minimized by prewarming [12], which was started directly after the administration of midazolam. In Germany many patients get oral premedication with a benzodiazepine on the ward before being transported through the cold hospital corridors to the preoperative holding area or the operating room
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