Active Warming Research Articles

Effect of active warming during general anaesthesia on post-operative body temperature, shivering, thermal comfort, pain, nausea and vomiting in adult patients: a randomized clinical trials protocol

<p><strong>Background: </strong>This study aims to investigate the effects of individual and combined use of intraoperative forced-air warming and warmed intravenous and irrigation fluids on post-operative body temperature, shivering, thermal comfort, pain, nausea and vomiting in adult patients receiving general anaesthesia.</p><p><strong>Methods: </strong>This is a randomised controlled clinical trial. A 2x2 factorial design will used in the experiment. Eligible patients will be randomly assigned to one of four groups. We attempt to report this randomized controlled trial to comply with the spirit. The study population will consist of 120 adult patients receiving general anaesthesia at university hospitals in Turkey. After the induction of anaesthesia, the first group (n=30) will be warmed with only forced-air warming device, the second group (n=30) will receive only warmed intravenous and irrigation fluids, forced-air warming as well as warmed intravenous (IV) and irrigation fluids will be applied to the third group (n=30), the fourth group (n=30) will consist of the control group without any intervention. Blood and blood products to be applied intraoperatively to all groups will be heated to 37°C.</p><p><strong>Conclusions:</strong> The primary outcome measures are post-operative body temperature, shivering, thermal comfort, pain, nausea and vomiting. The primary results will be subjected to a one-way analysis of variance for covariant such as amount of bleeding and volume of intraoperative fluids.</p><p><strong>Trial registration: </strong>The trial has been registered in clinical trials: https://clinicaltrials.gov/. Registration number: NCT04907617).</p>

Resistant fabric warming is a viable alternative to forced-air warming to prevent inadvertent perioperative hypothermia during hemiarthroplasty in the elderly

Surgical site infection (SSI) is associated with inadvertent perioperative hypothermia (IPH). This can be prevented by active patient warming. However, results from comparisons of warming techniques are conflicting. They are based mostly on elective surgery, are from small numbers of patients, and are dominated by the market leader, forced-air warming (FAW). Furthermore, the definition of hypothermia is debatable and systematic reviews of warming systems conclude that a stricter control of temperature is required to study the benefits of warming. To analyse core temperatures in detail in a large subset of elderly patients who took part in a randomized trial of patient warming following hemiarthroplasty who had received constant zero-flux thermometry to record their temperature. Regression models with a fixed effect for warming group and covariates related to temperature were compared for 257 participants randomized to FAW or resistant fabric warming (RFW) from a prior clinical trial. Those in the RFW group were-0.08°C cooler and had a cumulative hypothermia score-1.87 lower than those in the FAW group. There was no difference in the proportion of hypothermic patients at either <36.5°C or <36.0°C. This is the first study to provide accurate temperature measurements in patients undergoing a procedure predominantly under regional rather than general anaesthetic. It shows that RFW is a viable alternative to FAW for preventing IPH during hemiarthroplasty. Further studies are needed to measure the benefits of patient warming in terms of clinically important outcomes.

Responses of oribatid mites to warming in boreal peatlands depend on fen type

Climate warming is expected to disproportionately affect high latitude and alpine systems such as boreal peatlands. Previous studies observing changes in both plant and microbial communities suggest boreal peatlands may shift from carbon sinks to sources under warming. But few studies have investigated oribatid mites (Acari: Oribatida) under climate change scenarios in peatland systems, despite oribatid mites being well represented in terms of diversity in boreal peatlands. We performed a large-scale experimental field manipulation of warming in two contrasting peatland sites in Northern Ontario, Canada, and sampled oribatid mites over four years following three years of passive warming and one full growing season of active warming. We found that warming had contrasting effects on the oribatid mite community at both peatland sites, and depended on the peatland type. Specifically, we observed an increase in species richness at the drier, Sphagnum-dominated site and a reduction in species richness at the wetter, Carex-dominated site. That said, we suggest that these outcomes arise from the same mechanism, namely warming-induced reductions in soil moisture that impacted semi-aquatic species and facilitated the establishment of new species, likely from surrounding forests. We also observed increases in small-bodied species suggesting direct metabolic effects from warming. As such, we show that peatland oribatid mite community composition is driven to an extent by interactions between temperature and moisture but dependant on peatland type. As oribatid mite communities are responsive to multiple environmental changes, and play important mid-trophic level roles in soil food webs, changes in oribatid mite community composition may have consequences for carbon flux in peatland systems.

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.

Introduction: Unintended postoperative hypothermia frequently occurs upon arrival in the post anesthesia care unit (PACU). As part of our quality assurance program in anesthesia, we regularly monitor the incidence of this complication through our anesthesia information management system (AIMS). In this case-controlled retrospective study, our goal was to detect the incidence of unintended severe hypothermia in our breast surgery cancer patients, and subsequently to analyze the consequence of this complication in terms postoperative cutaneous infection, as well as its impact on further complementary treatment, such as radiotherapy and chemotherapy. Methods: This study was a retrospective analysis conducted through our AIMS system from 2015 through 2019, with extraction criteria based on year, type of surgery (breast), and temperature upon arrival in PACU. A tympanic temperature of less than 36 °C was considered to indicate hypothermia. Severe hypothermia was considered for patients having a temperature lower than 35.2 °C (hypothermic) (n = 80), who were paired using a propensity score analysis with a control group (normothermic) (n = 80) of other breast cancer surgery patients. Extracted data included time of surgery, sex, age, ASA status, and type and duration of the intervention. Results: The mean incidence of hypothermia was 21% from 2015 through 2019. The body mass index (BMI) was significantly lower in the hypothermia group before matching, 23.5 ± 4.1 vs. 26.4 ± 6.1 kg/m2 in normothermic patients (p < 0.05). The hypothermia group also had significantly fewer monitoring and active warming devices. No difference was noted for wound complications. Time to complementary chemotherapy and or radiotherapy did not differ between groups (52 ± 21 days in group hypothermia vs 49 ± 22 days in the control group). Conclusion: Severe intraoperative hypothermia remains an important quality assurance issue in our breast surgery cancer patients, but we could not detect any long-term effect of hypothermia.

Perioperative temperature management: a survey of 6 Asia\u2013Pacific countries

BackgroundAnesthesia leads to impairments in central and peripheral thermoregulatory responses. Inadvertent perioperative hypothermia is hence a common perioperative complication, and is associated with coagulopathy, increased surgical site infection, delayed drug metabolism, prolonged recovery, and shivering. However, surveys across the world have shown poor compliance to perioperative temperature management guidelines. Therefore, we evaluated the prevalent practices and attitudes to perioperative temperature management in the Asia–Pacific region, and determined the individual and institutional factors that lead to noncompliance.MethodsA 40-question anonymous online questionnaire was distributed to anesthesiologists and anesthesia trainees in six countries in the Asia–Pacific (Singapore, Malaysia, Philippines, Thailand, India and South Korea). Participants were polled about their current practices in patient warming and temperature measurement across the preoperative, intraoperative and postoperative periods. Questions were also asked regarding various individual and environmental barriers to compliance.ResultsIn total, 1154 valid survey responses were obtained and analyzed. 279 (24.2%) of respondents prewarm, 508 (44.0%) perform intraoperative active warming, and 486 (42.1%) perform postoperative active warming in the majority of patients. Additionally, 531 (46.0%) measure temperature preoperatively, 767 (67.5%) measure temperature intraoperatively during general anesthesia, and 953 (82.6%) measure temperature postoperatively in the majority of patients. The availability of active warming devices in the operating room (p < 0.001, OR 10.040), absence of financial restriction (p < 0.001, OR 2.817), presence of hospital training courses (p = 0.011, OR 1.428), and presence of a hospital SOP (p < 0.001, OR 1.926) were significantly associated with compliance to intraoperative active warming.ConclusionsCompliance to international perioperative temperature management guidelines in Asia–Pacific remains poor, especially in small hospitals. Barriers to compliance were limited temperature management equipment, lack of locally-relevant standard operating procedures and training. This may inform international guideline committees on the needs of developing countries, or spur local anesthesiology societies to publish their own national guidelines.

Benefits of Passive Warming on Surgical Patients Undergoing Regional Anesthetic Procedures

Introduction Perioperative normothermia is vital to reduction of surgical morbidity and mortality and improved surgical patient outcomes. Preoperative patient warming with active or passive warming measures is a key factor to maintaining normothermia throughout the perioperative process. Identification of the problem Potential for development of perioperative hypothermia is associated with use of regional anesthetic procedures (RAPs). Use of active warming during RAP placement is not feasible because of sterility requirements and patient positioning during RAP placement. QI question/Purpose of the study To determine if application of preoperative passive warming methods would maintain body temperature in patients receiving RAPs and contribute to reduced length of stay in PACU at a Level 1 trauma center in Middle Tennessee. Methods After being deemed IRB Exempt, this QI project utilized a convenience sample of 120 patients receiving RAP in conjunction with an elective orthopedic, abdominal, or thoracic surgical procedure. Passive warming trial: 53 patients received warming via thermal insulated surgical cap ($1.54/ea) & activated chemical warmer ($0.54/ea) placed on the inner, upper aspect of one arm. Retrospective review: 67 patients received warming using forced warm air gown ($9.75/ea). All preoperative warming measures remained in place approximately 90 minutes. Tympanic temperature was assessed upon admission, at transfer to OR, after induction of general anesthesia, and upon arrival to PACU. Outcomes/Results No difference in mean temperatures was found between groups post-induction or upon admission to PACU. Additionally, 51.9% of passive group (n = 28) experienced an increase in temperature compared to 48.2% (n = 26) of retrospective group. A statistically significant, positive correlation was found between admission temperature and transfer to OR temperature with age (p = 0.18). Passive group averaged 13.5-minute shorter PACU LOS. Discussions Passive warming affords the RAP population opportunity to receive benefits of pre-operative warming. Older participants responded better to passive warming measures: as age increased, temperature also increased. Passive warming measures were found to be less expensive than forced-air systems (savings of > $7 per patient). Conclusions Passive warming methods maintained patient temperatures throughout the perioperative process. Additionally, passive warming demonstrated a statistically significant increase in temperature from admission to transfer to OR in older participants and a clinically significant decrease in PACU LOS. Implications for Perianesthesia Nurses and Future Research Passive warming is a suitable, cost-effective alternative when forced-air warming is not feasible. Additional inquiry into the use of passive warming is warranted. Perioperative normothermia is vital to reduction of surgical morbidity and mortality and improved surgical patient outcomes. Preoperative patient warming with active or passive warming measures is a key factor to maintaining normothermia throughout the perioperative process. Potential for development of perioperative hypothermia is associated with use of regional anesthetic procedures (RAPs). Use of active warming during RAP placement is not feasible because of sterility requirements and patient positioning during RAP placement. To determine if application of preoperative passive warming methods would maintain body temperature in patients receiving RAPs and contribute to reduced length of stay in PACU at a Level 1 trauma center in Middle Tennessee. After being deemed IRB Exempt, this QI project utilized a convenience sample of 120 patients receiving RAP in conjunction with an elective orthopedic, abdominal, or thoracic surgical procedure. Passive warming trial: 53 patients received warming via thermal insulated surgical cap ($1.54/ea) & activated chemical warmer ($0.54/ea) placed on the inner, upper aspect of one arm. Retrospective review: 67 patients received warming using forced warm air gown ($9.75/ea). All preoperative warming measures remained in place approximately 90 minutes. Tympanic temperature was assessed upon admission, at transfer to OR, after induction of general anesthesia, and upon arrival to PACU. No difference in mean temperatures was found between groups post-induction or upon admission to PACU. Additionally, 51.9% of passive group (n = 28) experienced an increase in temperature compared to 48.2% (n = 26) of retrospective group. A statistically significant, positive correlation was found between admission temperature and transfer to OR temperature with age (p = 0.18). Passive group averaged 13.5-minute shorter PACU LOS. Passive warming affords the RAP population opportunity to receive benefits of pre-operative warming. Older participants responded better to passive warming measures: as age increased, temperature also increased. Passive warming measures were found to be less expensive than forced-air systems (savings of > $7 per patient). Passive warming methods maintained patient temperatures throughout the perioperative process. Additionally, passive warming demonstrated a statistically significant increase in temperature from admission to transfer to OR in older participants and a clinically significant decrease in PACU LOS.

Non-Invasive Core Temperature Monitoring System: Providing Consistent, Reliable Temperature Measurement in the Perianesthesia Patient

<h3>Background Information</h3> Maintaining normothermia (core body temperature 96.8°F to 100.4°F) is imperative in the perianesthesia patient. Anesthesia and environmental factors affect the patient's ability to regulate body temperature. An average adult's core body temperature may drop approximately 2.7°F (1.5°C) with general anesthesia. Undetected hypothermia in the perianesthesia setting can increase the incidence of surgical site infection, cardiac arrythmias, blood loss, altered medication metabolism, pain perception, and increase length of recovery time and length of hospital stay. One hospital in South Central Pennsylvania identified inconsistent temperature measurement practices throughout each phase of surgical care. Various forms of temperature measurements were used on the same patient (oral, rectal, temporal-artery, esophageal, pulmonary artery temperatures). Each of these techniques has varying reliability, which created variability and inconsistency in hypothermia treatment. <h3>Objectives of Project</h3> Develop a consistent technique for temperature measurement throughout the perioperative setting. Non-invasive core temperature monitoring is evidenced as a valid and reliable tool for perianesthesia patients. <h3>Process of Implementation</h3> Implemented a non-invasive core temperature monitoring system and educated all nursing and anesthesia staff members in the perianesthesia and perioperative settings. <h3>Statement of Successful Practice</h3> Non-invasive core temperature monitoring was utilized throughout all phases of surgical patient care. Initial data shows undetected hypothermia as a significant problem previously undetected with less reliable, inconsistently used measures. Heightened awareness among staff has increased active warming measures in the Post Anesthesia Care Unit prior to discharge. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Early identification and intervention for hypothermia is imperative for improved outcomes with the surgical patient. The literature lacks recommendations for a standard length of time for temperature monitoring after normothermia returns and active warming has ceased. This project has stimulated an interest in a multidisciplinary original research project regarding thermoregulation after anesthesia and the reoccurrence of hypothermia after active warming measures have ceased.

Perioperative Hypothermia in Children.

Background: First described by paediatric anaesthesiologists, perioperative hypothermia is one of the earliest reported side effects of general anaesthesia. Deviations from normothermia are associated with numerous complications and adverse outcomes, with infants and small children at the highest risk. Nowadays, maintenance of normothermia is an important quality metric in paediatric anaesthesia. Methods: This review is based on our collection of publications regarding perioperative hypothermia and was supplemented with pertinent publications from a MEDLINE literature search. Results: We provide an overview on perioperative hypothermia in the paediatric patient, including definition, history, incidence, development, monitoring, risk factors, and adverse events, and provide management recommendations for its prevention. We also summarize the side effects and complications of perioperative temperature management. Conclusions: Perioperative hypothermia is still common in paediatric patients and may be attributed to their vulnerable physiology, but also may result from insufficient perioperative warming. An effective perioperative warming strategy incorporates the maintenance of normothermia during transportation, active warming before induction of anaesthesia, active warming during anaesthesia and surgery, and accurate measurement of core temperature. Perioperative temperature management must also prevent hyperthermia in children.

Using Waterless Alcohol-based Antiseptic for Skin Preparation and Active Thermal Support in Laboratory Rats.

Rodents are frequently used for models that require surgical procedures. At our institution, laboratory rats are increasingly preferred for investigations of neurologic disorders, cardiovascular interventions, and assessment and treatment of addictive and depressive behaviors. For these types of studies, surgical preparations of the head and neck areas are necessary for catheterization and instrumentation. Based upon our former work in laboratory mice, we sought to improve rat surgery outcomes and confirm the efficacy of a waterless alcohol-based (WAB) antiseptic for skin disinfection prior to incision. In addition, we wanted to investigate whether active warming efforts improved perioperative body temperatures for rats to aid in return to consciousness. Prior to cranial surgical incision and placement in stereotactic equipment, rats were assessed after skin preparation with WAB and after thermal interventions, including prewarming cages for 30 min before anesthesia and delivery of warmed fluid (NaCl) supplementation. Core temperatures were recorded and aerobic culture swabs collected from surgical sites at multiple time points. As previously shown in mice, bacterial counts in rats were effectively diminished by WAB agents. Assessment of intraoperative body temperature trajectories did not identify appreciable differences between control rats and rats that were exposed to prewarming or warmed fluid supplementation or both. However, heavier male rats recovered more rapidly from isoflurane anesthesia than did lighter male and female rats. Although these thermal support measures did not significantly improve anesthetic recovery times in rats, animals warmed for 30 min trended toward a faster return to righting reflex after exposure to isoflurane. These findings confirm that WAB antiseptic is an acceptable option for skin preparation in rats and suggest that continued evaluation of thermal interventions remains of interest for improved outcomes in rat surgery.

Enhanced PeriOperative Care and Health protection programme for the prevention of surgical site infections after elective abdominal surgery (EPO2CH): statistical analysis plan of a randomised controlled multicentre superiority trial

BackgroundSurgical site infections (SSI) are frequent complications after elective abdominal surgery. We designed the Enhanced PeriOperative Care and Health Protection programme (EPO2CH) care bundle, comprising of intraoperative high fractional inspired oxygen; intraoperative goal-directed fluid therapy; active preoperative, intraoperative and postoperative warming; glucose control and treatment of hyperglycaemia (> 10 mmol L− 1) in diabetics as well as non-diabetics; and wound irrigation before closure using an aqueous antiseptic. We hypothesise that EPO2CH added to standard care reduces the incidence of SSI compared to standard care alone for elective abdominal surgery.MethodsThis trial is designed as an open label, pragmatic randomised controlled parallel-group multicentre superiority trial. The primary endpoint is the incidence of SSI, defined by the Centers for Disease Control and prevention, within 30 days after surgery. The incidence of SSI is assessed using the Dutch national complication register and medical chart review. Secondary endpoints include the SSI incidence within 90 days, incidence of anastomotic leakage at 30 and 90 days, the incidence of incisional hernia within 1 year, mortality within 1 year and 5 years, quality of life, health and disability, and cost-effectiveness. Primarily, an intention-to-treat analysis will be performed to estimate the relative risk using a log binomial model. If not feasible, a logistic regression will be used to estimate the odds ratio. A per-protocol analysis will also be performed. Furthermore, the attributive effect of the distinct interventions will be explored.DiscussionThe results of the EPO2CH trial will determine if the EPO2CH bundle is effective to prevent SSI incidence for patients undergoing elective abdominal surgery. Details of the statistical analysis are described in this Statistical Analysis Plan (SAP).Trial registrationRegistration number: Dutch Trial Register Trial NL5572. Registered on March 3, 2016.SAP version: V1.0, January 8, 2020. This SAP has been written based on study protocol V10.

Efficacy of active forced air warming during induction of anesthesia to prevent inadvertent perioperative hypothermia in intraoperative warming patients: Comparison with passive warming, a randomized controlled trial.

Background:This study aimed to evaluate the efficacy of peri-induction forced air warming to prevent inadvertent perioperative hypothermia, defined as a reduction in body temperature to <36.0°C during the perioperative period, in intraoperatively warmed patients receiving major surgery lasting >120 minutes.Methods:In total, 130 patients scheduled for elective surgery under general anesthesia lasting >120 minutes were divided into 2 groups: peri-induction warming (n = 65) and control (n = 65). Patients in the peri-induction warming group were warmed during the anesthetic induction period using a forced-air warmer set at 47°C, whereas patients in the control group were covered passively with a cotton blanket. All patients were warmed with a forced-air warmer during surgery. Body temperature was measured using a tympanic membrane thermometer in the pre- and postoperative periods and using a nasopharyngeal temperature probe during surgery. Patients were evaluated for shivering scale score, thermal comfort scale score, and satisfaction score in the post-anesthesia care unit.Results:The incidence rates of intraoperative and postoperative hypothermia were lower in the peri-induction warming group than in the control group (19.0% vs 57.1%, P < .001; 3.3% vs 16.9%, P = .013, respectively). Body temperature was higher in the peri-induction warming group (P < .001). However, intraoperative blood loss, as well as postoperative thermal comfort scale score, shivering scale score, and patient satisfaction score, were similar between groups. Post-anesthesia care unit duration was also similar between groups.Conclusions:Peri-induction active forced air warming is an effective, simple, and convenient method to prevent inadvertent perioperative hypothermia in intraoperatively warmed patients undergoing major surgery lasting >120 minutes.

The use of forced air warmer for the prevention of inadvertent perioperative hypothermia under general anaesthesia - A prospective observational study

Temperature is an important parameter which determines patient outcomes perioperatively. Iatrogenic hypothermia during surgery under general anaesthesia leads to significant side effects which can be corrected with the use of active body surface warming devices like the forced air warmer. A prospective observational study was conducted with a sample size of 362 which included patients of either sex aged 18-65years posted for any elective surgery under general anaesthesia lasting &amp;#62;60 and ≤180minutes. Baseline oral temperature was recorded preoperatively. Patients were warmed with forced air warmer intraoperatively at 44°C with half hourly monitoring of nasopharyngeal temperature until extubation. Intravenous fluids were given at room temperature. Further, oral temperature was monitored at 15 and 60 minutes in post anaesthesia care unit and patients were warmed if hypothermic or shivering. The final mean intraoperative temperature (nasopharyngeal) was 36.01⁰C (n=362) with a range from 34.7⁰C to 37.1⁰C. 139 of 362(n) (38.4%) patients were hypothermic (&amp;#60;36⁰C) at the end of surgery. 61.6% of patients were normothermic. In 9 patients (2.5%, n=362) the forced air warmer was turned off due to over heating (temperature &amp;#62;37⁰C). 33 patients (n=362, 9.1%) had shivering postoperatively. Comparing the nasopharyngeal temperature (mean) at half hourly intervals post induction revealed statistically significant results (p&amp;#60;0.001). The establishment of near constant temperature (36±0.03°C) following the initial fall in core body temperature can be attributed to the forced air warmer. However, it is imperative to continuously monitor core body temperature to detect temperature changes(hypo/hyperthermia) in order to use the device safely as chances of overheating is always present.

Study of risk factors for intraoperative hypothermia during pediatric burn surgery

BackgroundIntraoperative hypothermia (core temperature <36.0°C) is common during the perioperative period and can result in adverse consequences, especially in children. We aimed to determine the incidence of intraoperative hypothermia and...

Assessment of intraoperative temperature management at the University Teaching Hospital of Kigali: A quality improvement project

Background: Due to the inhibition of thermoregulation by anesthetics, hypothermia occurs in 50% of patients undergoing general and neuraxial anesthesia without active warming. High-quality research has shown the negative effects of intraoperative hypothermia including increased rates of surgical site infections, increased hospital length of stay, increased cardiac morbidity and increased rate of transfusion. The University Teaching Hospital of Kigali commonly known as CHUK is the largest public referral hospital in Rwanda. The International Standards for Safe Anesthesia were not being met regarding intraoperative temperature management at CHUK. However, due to high ambient temperature in the operating room, it was unknown if this was a significant problem and worth investment, in a health system, with limited resources. Methods: After institutional review board approval, a two-stage descriptive cross-sectional quality improvement project was performed. The first stage was to assess current management of intra-operative temperature, determine if there was a significant rate of hypothermia and establish risk factors for developing intra-operative hypothermia in this clinical setting. The second stage was to determine if locally available warming techniques, an underbody warming blanket, significantly reduced the incidence of intra-operative hypothermia. Results: The primary result of the study was a 58% incidence of hypothermia with current standard practice. This was reduced to 6% with the use of an underbody water blanket. Temperature was measure intraoperatively in only 6% of cases and never documented. Adult patients and patients undergoing neuraxial anesthesia were more likely to experience hypothermia. Conclusions: Intraoperative hypothermia is common at CHUK despite high ambient operating room temperature. Monitoring and documentation of temperature is not occurring on a regular basis. The use of underbody water body, though not the gold standard for intraoperative warming, was effective in this study and a realistic solution in an environment with limited resources.

An effective treatment option for pain caused by urolithiasis: A randomised‐controlled trial of local active warming with heat‐patch

There is growing interest in physical medicine treatment options for renal colic. In this study, we aimed to determine whether or not heat-patch treatment with no drug was effective in relieving renal colic. For this purpose, patients who were diagnosed with renal colic in the emergency department were randomised to have either heat-patch or sham treatment. The Visual Analogue Scale (VAS) scores of renal colic, body temperature (Btemp), and sub-patch skin temperature (Stemp) values were measured at 0, 15, 30, 45, and 60minutes. In addition, the salvage treatment needs of the groups were compared. The average age of the study group was 30.5±8.3years and that of the sham group was 31.0±8.2years (P=.75). According to the baseline VAS score of the patients, 15, 30, 45, and 60minutes VAS scores significantly decreased in the heat-patch group (P<.001). The Btemp values did not differ significantly between the heat-patch and sham groups. In addition, no statistically significant difference was found between the two groups in terms of Stemp values at 0 and 15minutes (P=.39 and P=.10, respectively). However, there was a significant difference in the heat-patch group in terms of Stemp values at 30, 45, and 60minutes compared with the sham group (P<.001). The salvage treatment rates for the heat-patch and sham groups were 11.5% and 31.4%, respectively (P=.01). As non-pharmaceutical treatment, the heat-patch has been shown to be a possible candidate for pain relief in patients with urolithiasis. Further research should concentrate on multicentre and large scale randomised studies.

The effects of active warming on perioperative inadvertent hypothermia in patients undergoing vitreoretinal surgery under local anesthesia.

Purpose:Perioperative inadvertent hypothermia (PIH) is the decrease in core temperature below 36°C. We aimed to assess whether PIH develops in patients operated under local anesthesia (ULA) for vitreoretinal surgery in the operating room and investigate active warming efficacy.Methods:Seventy-two patients were divided into two groups: Group 1 contained unwarmed patients (n = 36), and Group 2, warmed patients (n = 36). The core temperatures, heart rate (HR), and mean arterial pressure (MAP) of the patients were measured at the beginning of surgery, after 20 min, 40 min, 1 h, at the end of the operation, and during the postoperative period.Results:PIH incidence was 44.6% in Group 1, whereas no hypothermia was observed in Group 2. Patient temperatures at 20 min (P = 0.001), 40 min (P < 0.001), 1 h (P < 0.001), the end of the operation (P < 0.001), and the postoperative period (P < 0.001) were significantly higher in Group 2 than in Group 1. Patient HRs at the end of the operation and during the postoperative period were significantly lower in Group 2 (P = 0.005) than in Group 1 (P < 0.001). The intraoperative 40th (P = 0.044) and 60th (P < 0.001) minutes, end of operation (P < 0.001), and postoperative MAP (P < 0.001) values of Group 1 were significantly higher than those of Group 2.Conclusion:PIH may develop in patients operated ULA, especially with a low ambient temperature. Actively warming may help prevent the harmful effects of PIH.

Temperatura corporal y temperatura de calentamiento en el cuidado de pacientes grandes quemados

Objetivos: El objetivo es describir los métodos de calentamiento y su aplicación para el mantenimiento de la temperatura corporal en el paciente gran quemado.Metodología: Revisión bibliográfica realizada entre septiembre de 2019 y febrero de 2020 acerca de la termorregulación y calentamiento del paciente quemado en las bases de datos CINAHL, CUIDEN, PUBMED, MEDES y WOS en español e inglés, de los últimos 10 años, de los cuales fueron analizados 24 documentos.Resultados: La respuesta hipermetabólica y la reprogramación hipotalámica provocan un aumento de la temperatura basal en los pacientes quemados, entre 37 y 38,5ºC sin origen infeccioso. Para disminuir el gasto energético en reposo y la repuesta hipermetabólica se puede aplicar una temperatura ambiental elevada, como calentamiento externo pasivo, entre 28 y 32ºC. Discusión: Existen otros métodos de calentamiento externo activo que pueden conseguir el mismo objetivo como las mantas de aire convectivo, placas térmicas o sistemas de superficie.Conclusión: Debe revisarse la recomendación de calentamiento mediante temperatura ambiental elevada, que crea ambientes hostiles para los trabajadores y los pacientes, a través del estudio de la inclusión de métodos de calentamiento externo activo. Objectives: To describe the heating methods and their application to maintain body temperature in majors burn patients.Methodology: Bibliographic review carried out between September 2019 and February 2020 about the thermoregulation and heating of the burn patient in the CINHAL, CUIDEN, PUBMED, MEDES and WOS databases in Spanish and English, documents from the last 10 years, from which 26 were analyzed.Results: Hypermetabolic response and hypothalamic reprogramming cause an increase in basal temperature in burn patients between 37 and 38.5ºC without infectious origin. To decrease the energy expenditure at rest and the hypermetabolic response, it is possible to act through a high ambient temperature between 28 and 32ºC as passive external heating. Discussion: Other external heating methods can achieve this goal such as convective air blankets, heating plates, or surface systems.Conclusions: The recommendation of warming by means of high ambient temperature, which creates hostile environments for workers and patients, should be reviewed through the study of the inclusion of active external warming methods.

The efficacy of active warming in preventing unplanned hypothermia during perioperative period in pediatric surgery patients in a tertiary care center

Aim: To investigate the effects of using the active warming method on children with hypothermia in the perioperative period and examining the effects of hypothermia on awakening time, pain, shivering and hospital stay. Methods: This study included patients 18 years of age and younger who underwent surgery in the pediatric surgery department of a tertiary hospital. The active warming group consisted of 28 patients and the control group consisted of 29 patients. The first group of patients was actively warmed during the surgery and the second group was treated as the control group and did not actively receive any warming therapy. Preoperative body temperatures of the cases were measured. In addition, body temperatures were recorded every 15 minutes in the intraoperative and postoperative periods. Results: There was no statistically significant difference in preoperative body temperature between the control group and the active warming group. When body temperature were examined in the intraoperative period, there was no significant difference between the groups at the first 15 minutes of operation; however, the mean of the body temperature in active warming group was significantly higher than the control group at the 30th, 45th , and 60th minutes of operation. It was determined that patients in the control group had a longer stay in the hospital and the amount of time for waking at the end of the anesthesia was shorter in the active heating group than in the control group. Conclusions: The results of our study suggest that active heating with a carbon fiber resistant system is an effective method to prevent unplanned hypothermia in operated children.

Active warming after caesarean section to prevent neonatal hypothermia: a systematic review

There is a lack of evidence on the effects of perioperative warming on maternal and neonatal outcomes in women undergoing elective caesarean section who are performing at-birth skin-to-skin contact. This study aimed to provide a systematic review of the current evidence base on the effects of perioperative warming versus no warming. Inclusion criteria included randomised controlled trials involving pregnant women ≥18 years old undergoing an elective caesarean section at term under regional anaesthesia and who initiated at-birth neonatal skin-to-skin contact. Studies investigated active warming versus no active warming interventions. Three studies were included, with a total of 286 participants. Active warming of women resulted in significantly less occurrence of neonatal hypothermia, with no difference in maternal hypothermia. Perioperative active warming of mothers and newborns who had skin-to-skin contact may be beneficial. The quality of the included studies was low, so the review findings should be interpreted with caution. High quality studies with larger sample sizes need to be undertaken.

Seasonal Variability of Temperature Fronts in the Black Sea from Satellite Data

The structure and seasonal variability of temperature frontal zones and fronts in the Black Sea are studied on the basis of a modern high-resolution satellite data set. The distributions of the total temperature gradient allow us to distinguish the following frontal zones: the western frontal zone; the Turkish coastal frontal zone; the Anatolian upwelling frontal zone; the southeastern coastal frontal zone; northeastern, Crimea, and Kerch-Feodosia frontal zones; and the frontal zone of the deep part of the Black Sea. Large-scale fronts are identified within most frontal zones based on an analysis of distributions of meridional and zonal temperature gradients. It is shown that the combined effect of large-scale processes (seasonal warming and cooling of waters and their advection by the Rim Current) and regional factors (river discharge, coastline configuration, shelf width, development of upwelling, and formation of coastal eddies) produces significant spatiotemporal variability of the temperature field and, hence, frontal zones and fronts. It is ascertained that most fronts exist for several months. In the northern part of the sea, the fronts intensify mainly in winter due to an increase in the contrasts between warm Rim Current waters and colder coastal waters. The frontal zones near the southern coast of the sea intensify mainly in late spring–summer during the spring flood, the development of Anatolian upwelling, and active warming of waters in the eastern part of the sea.