Thermal Mattress Research Articles

Effectiveness and safety of an inexpensive infant chemical warmer: a pilot study

Introduction. Hypothermia has been widely regarded as a major contributor to neonatal mortality and morbidity. Chemical warming packs used during delivery room resuscitation are associated with decreased rates of hypothermia. The ideal thermal mattress should be inexpensive, electricity-free, reusable, and safe for use in low-resource settings. In this pilot study, we describe the characteristics of a novel, inexpensive chemical warmer developed by the authors. Methods. The novel neonatal chemical warmer consists of two main components. The first component is the chemical warmer bag which is designed for single use, while the other is the container in which the chemical warmer is placed upon activation is reusable. A total of 5 chemical heaters were activated and tested. The goal was to determine whether the temperatures measured on the surface of the warmer were in the optimal range of the chemical heaters available so far. The temperature was measured every 5 minutes at 5 places (corners of the heater and in the middle of the heater), and the maximum measured temperature will be recorded. Temperatures were recorded every 5 minutes as long as the surface temperature measured above 35.9 ºC. Results. By the 5 minutes after activation two and at the 10th minute, all five chemical warmers achieved the desired surface temperature > 36.0 °C (range 38.4 – 40.4 °C.). The length in which the chemical warmer provided the temperatures in the desired range (36.0 – 42.0 °C) varied between 35 to 60 minutes, and we observed that this is highly dependent on starting surface temperatures. Regarding the safety of the surface temperatures produced, no recorded temperatures were above 42.0 °C. The maximum recorded temperature was 40.4 °C in the warmer, with the highest starting temperature in the 10th minute. Conclusion. The novel neonatal chemical warmer performed well when the starting surface temperatures were higher, with the best-performing one being the one with the highest starting temperature of 33.0 °C.

Prevention of NICU Admission Hypothermia in Moderate- and Late-Preterm Infants.

Neonatal hypothermia is a common and preventable cause of neonatal morbidity and mortality. Although hypothermia prevention has been extensively studied in infants <32 weeks' gestation, the authors of few studies have targeted moderate- and late-preterm infants (MLPIs) in the delivery room. This quality improvement initiative was conducted from June 2019 to June 2023 at the Massachusetts General Hospital NICU and Labor and Delivery Unit. All inborn MLPIs 32 + 0/7 to 36 + 6/7 weeks' gestation admitted to the NICU were included. We expanded thermoregulatory measures typically used in protocols for infants <32 weeks' gestation, including increasing delivery room ambient temperature to 74°F and thermal mattress use. The primary outcome was hypothermia (<36.5°C) after NICU admission. The balancing measure was hyperthermia (≥38 °C). During the study period, there were 566 inborn MLPIs with a mean gestational age of 34 + 3/7 weeks and a mean birth weight of 2269 g. Special cause variation in neonatal hypothermia incidence was observed with a decrease from a mean baseline of 27% to 7.8% postintervention. Special cause variation was observed in hyperthermia incidence, with an increase from 1.4% to 6.2% postintervention largely initially associated with noncompliance with the protocol for thermal mattress removal. The expansion of several thermoregulation techniques commonly used in infants <32 weeks' gestation, particularly thermal mattress use, was associated with a decreased incidence of NICU admission hypothermia in MLPIs, with an increase in mild hyperthermia predominantly associated with concomitant polyethylene wrap use.

Neonatal warming devices: What can be recommended for low-resource settings when skin-to-skin care is not feasible?

Hypothermia occurs frequently among clinically unstable neonates who are not suitable to place in skin-to-skin care. This study aims to explore the existing evidence on the effectiveness, usability, and affordability of neonatal warming devices when skin-to-skin care is not feasible in low-resource settings. To explore existing data, we searched for (1) systematic reviews as well as randomised and quasi-randomised controlled trials comparing the effectiveness of radiant warmers, conductive warmers, or incubators among neonates, (2) neonatal thermal care guidelines for the use of warming devices in low-resource settings and (3) technical specification and resource requirement of warming devices which are available in the market and certified medical device by the US Food and Drug Administration or with a CE marking. Seven studies met the inclusion criteria, two were systematic reviews comparing radiant warmers vs. incubators and heated water-filled mattresses vs. incubators, and five were randomised controlled trials comparing conductive thermal mattresses with phase-change materials vs. radiant warmers and low-cost cardboard incubator vs. standard incubator. There was no significant difference in effectiveness between devices except radiant warmers caused a statistically significant increase in insensible water loss. Seven guidelines covering the use of neonatal warming devices show no consensus about the choice of warming methods for clinically unstable neonates. The main warming devices currently available and intended for low-resource settings are radiant warmers, incubators, and conductive warmers with advantages and limitations in terms of characteristics and resource requirements. Some devices require consumables which need to be considered when making a purchase decision. As effectiveness is comparable between devices, specific requirements according to patients' characteristics, technical specification, and context suitability must play a primary role in the selection and purchasing decision of warming devices. In the delivery room, a radiant warmer allows fast access during a short period and will benefit numerous neonates. In the neonatal unit, warming mattresses are low-cost, effective, and low-electricity consumption devices. Finally, incubators are required for very premature infants to control insensible water losses, mainly during the first one to two weeks of life, mostly in referral centres.

Environmentally Friendly Building Materials with Beneficial Potential for Indoor Air Quality

Following the obvious increasingly interest for environmental protection and pollution reduction, worldwide, there is a strong orientation for identification and use in buildings some materials that require low power consumption and to determine a pollution low level in all stages of their production and exploitation. These energy and environmental protection criteria can be met successfully by a combination of unburned masonry bodies made of clay, mixed with various other natural materials, and sheep wool thermal insulation mattresses. These construction elements have a beneficial influence on the air quality of the interior space, ensuring, through the permeability to water vapor, the regulation of the relative humidity of the air and, through ability to store thermal energy in warm periods and release it in the cold ones, a uniform temperature distribution inside and avoiding high temperature fluctuations between seasons. Based on the experimental research results, we can identify solutions for achieving a vernacular housing (resistance walls, partition walls, floors, plasters, water protection, thermal insulation and finishing) in terms of safety, comfort and current aesthetic criteria. Keywords: adobe bricks, clay, hemp fibers, straw, sheep wool

Prevention of hypothermia in newborn submitted to surgical procedures: an integrative review.

to discuss in the scientific literature the strategies used to prevent hypothermia in newborns undergoing surgical procedures. this is an integrative literature review, with structured search in April and May 2020 in 08 databases, using the descriptors: Hypothermia; Surgical Procedures, Operative; Infant, Newborn; Protocols. Four primary studies were selected and analyzed using three instruments to assess the methodological quality of the Joanna Briggs Institute and content analysis. Among the strategies used, the following stand out: room temperature control; establishment of humidification and quality of air conditioning cleanliness; use of a heated incubator or cradle; use of thermal mattress; use of caps and blanket; heated fluids; temperature monitoring and abdominal organ coverage. good hypothermia prevention strategies were identified, despite the small number of publications on this topic; thus, it points out the need for research with strong evidence.

Delivery room thermal care interventions in preterm neonates.

Abiramalatha T, Ramaswamy VV, Bandyopadhyay T, Pullattayil AK, Thanigainathan S, Trevisanuto D, Roehr CC. Delivery Room Interventions for Hypothermia in Preterm Neonates: A Systematic Review and Network Meta-analysis. JAMA Pediatr. 2021 May 24:e210775. 10.1001/jamapediatrics.2021.0775. Epub ahead of print. PMID: 34028513; PMCID: PMC8145154. Preterm neonates are at increased risk for hypothermia after birth which is an independent predictor for neonatal mortality and morbidity.1, 2 Maintaining normal temperature is a key initial step in stabilisation of the newborn at birth.3 Several interventions to prevent hypothermia in the delivery room have been studied either solely or in combinations.4-7 The neonatal life support task force suggested using a combination of different interventions to prevent hypothermia on neonatal admission to the NICU.3 However, this suggestion was based on relatively old evidence with weak recommendations and very low certainty. This network meta-analysis was conducted on 34 randomised and quasi-randomised controlled trials including 3688 preterm, ≤36 weeks gestation and infants aiming to identify thermal care intervention in the delivery room that can best reduce neonatal hypothermia and improve clinical outcomes. The researchers compared eight interventions to routine care and found that most of the interventions were associated with higher core body temperature. They found that plastic bag or wrap alone, thermal mattress, and plastic bag or wrap with heated humidified gas were associated with reduced risk of moderate to severe hypothermia compared with routine care. The SUCRA analysis showed that the combination of plastic bag or wrap with a thermal mattress was the best intervention to improve core body temperature at admission, but direct evidence from pairwise comparisons indicated that this combination increases the risk of hyperthermia. In sensitivity analyses, plastic bag and plastic wrap were equally good at maintaining core body temperature, the effect of interventions in improving temperature was consistent among preterm infants ≤30 weeks gestation, and drying did not make a difference compared to no drying before the application of plastic bag or wrap. Authors found that the use of a plastic bag or wrap with heated humidified gas was associated with reduced risk of major brain injury and a plastic bag or wrap with a plastic cap was associated with lower risk of mortality. Major strengths of this study are the use of network meta-analysis which can inform comparative effectiveness in the presence of multiple interventions, the systematic search strategy, and clinically relevant interventions and outcomes. However, the study is limited by wide differences in the method of temperature measurement between included trials, inability to perform analysis of some secondary outcomes due to data limitation, small sample size of the included trials and low event rates for the primary outcome leading to possible selective reporting and publication bias, and inability to access unpublished data from the included studies.5 Although, the majority of thermal care interventions were associated with better core body temperature and decreased risk of moderate to severe hypothermia at admission or within the first 2 h of life compared with routine care, the certainty of evidence ranged from very low to moderate for the primary and secondary outcomes. Future, adequately powered, randomised controlled trials are needed to determine the best combination of interventions to prevent hypothermia with no risk of hyperthermia and to assess quality improvement bundle of hypothermia preventive measures to assess the individual benefit for each newborn. https://ebneo.org/preterm-thermal-care None.

Delivery Room Interventions for Hypothermia in Preterm Neonates

Prevention of hypothermia in the delivery room is a cost-effective, high-impact intervention to reduce neonatal mortality, especially in preterm neonates. Several interventions for preventing hypothermia in the delivery room exist, of which the most beneficial is currently unknown. To identify the delivery room thermal care intervention that can best reduce neonatal hypothermia and improve clinical outcomes for preterm neonates born at 36 weeks' gestation or less. MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, and CINAHL databases were searched from inception to November 5, 2020. Randomized and quasi-randomized clinical trials of thermal care interventions in the delivery room for preterm neonates were included. Peer-reviewed abstracts and studies published in non-English language were also included. Data from the included trials were extracted in duplicate using a structured proforma. A network meta-analysis with bayesian random-effects model was used for data synthesis. Primary outcomes were core body temperature and incidence of moderate to severe hypothermia on admission or within the first 2 hours of life. Secondary outcomes were incidence of hyperthermia, major brain injury, and mortality before discharge. The 9 thermal interventions evaluated were (1) plastic bag or plastic wrap covering the torso and limbs with the head uncovered or covered with a cloth cap; (2) plastic cap covering the head; (3) skin-to-skin contact; (4) thermal mattress; (5) plastic bag or plastic wrap with a plastic cap; (6) plastic bag or plastic wrap along with use of a thermal mattress; (7) plastic bag or plastic wrap along with heated humidified gas for resuscitation or for initiating respiratory support in the delivery room; (8) plastic bag or plastic wrap along with an incubator for transporting from the delivery room; and (9) routine care, including drying and covering the body with warm blankets, with or without a cloth cap. Of the 6154 titles and abstracts screened, 34 studies that enrolled 3688 neonates were analyzed. Compared with routine care alone, plastic bag or wrap with a thermal mattress (mean difference [MD], 0.98 °C; 95% credible interval [CrI], 0.60-1.36 °C), plastic cap (MD, 0.83 °C; 95% CrI, 0.28-1.38 °C), plastic bag or wrap with heated humidified respiratory gas (MD, 0.76 °C; 95% CrI, 0.38-1.15 °C), plastic bag or wrap with a plastic cap (MD, 0.62 °C; 95% CrI, 0.37-0.88 °C), thermal mattress (MD, 0.62 °C; 95% CrI, 0.33-0.93 °C), and plastic bag or wrap (MD, 0.56 °C; 95% CrI, 0.44-0.69 °C) were associated with greater core body temperature. Certainty of evidence was moderate for 5 interventions and low for plastic bag or wrap with a thermal mattress. When compared with routine care alone, a plastic bag or wrap with heated humidified respiratory gas was associated with less risk of major brain injury (risk ratio, 0.23; 95% CrI, 0.03-0.67; moderate certainty of evidence) and a plastic bag or wrap with a plastic cap was associated with decreased risk of mortality (risk ratio, 0.19; 95% CrI, 0.02-0.66; low certainty of evidence). Results of this study indicate that most thermal care interventions in the delivery room for preterm neonates were associated with improved core body temperature (with moderate certainty of evidence). Specifically, use of a plastic bag or wrap with a plastic cap or with heated humidified gas was associated with lower risk of major brain injury and mortality (with low to moderate certainty of evidence).

Conductive thermal mattress versus routine care to reduce neonatal hypothermia during transport among low-birthweight neonates: An experimental study with historical controls

BackgroundNeonatal hypothermia at delivery, during transport and in the postnatal wards is common, under-recognized and infrequently monitored with prevalence ranging from 32% to 85%. This study compared conductive thermal mattress to routine care for prevention of hypothermia among low-birthweight (LBW) neonates during transport. MethodsFrom July 2015 to November 2016 (historical controls), all eligible LBW neonates (1500–2499 g) were transported from the labour room/operation theatre to the neonatal intensive care unit (NICU)/postnatal wards using routine care (towels, blankets, cap, mittens and socks) and from December 2016 to December 2018 using conductive thermal mattress (EMBRACETM) Axillary temperature was measured before transport and at arrival in the NICU/postnatal wards using a digital thermometer. ResultsA total of 154 and 102 neonates were transported using conductive thermal mattress and routine care, respectively. The mean standard deviation (SD) axillary temperature at arrival in the postnatal wards in conductive thermal mattress and routine care group was 36.6 (0.6) ⁰C and 36.4 (0.5) ⁰C, respectively (p-value 0.005). Relative Risk (RR) of mild and moderate neonatal hypothermia among neonates transported using conductive thermal mattress compared to routine care group was 0.59 (0.33,1.07), number needed to treat (NNT) of 13 and 0.22 (0.04,1.07), NNT 22 respectively. ConclusionsUse of conductive thermal mattress for transport among LBW neonates led to a significant, although clinically small improvement in admission temperatures at the NICU/postnatal ward and non-significant decrease in the incidence of hypothermia.

Skin Burn by Termal Mattress - A Therapeutic Approach

Background: Burns are caused by a direct or indirect action of heat on an organism, compromising the functional integrity of the skin. Hypothermia is a common intercurrence in animals during the transoperative period; thermal mattresses are used to maintain the animal’s body temperature, but inappropriate use can cause the patient’s skin to burn. In humans, burns are quite common; however, in veterinary medicine, they are infrequent. The aim of this study was to describe a case of accidental burn in a canine caused by a thermal mattress, emphasizing wound treatment and analgesia used.Case: A 12-year-old male canine without defined breed weighing 15 kg underwent an emergency exploratory laparotomy due to rupture of a spleen mass and presented with intercurrence hypothermia during the anesthesia procedure, which was controlled using a thermal mattress. Ten days after the surgical procedure, he developed a skin lesion with erythema, suffusion, and necrosis, evolving skin displacement along the entire back with a lot of pain which was possibly caused by the use of a thermal mattress in the transoperative procedure. The intuited analgesic treatment involved the use of numerous and different drugs, including Methadone (0.3 mg/kg, QID, SC), Dipyrone (25 mg/kg, TID, IV), and Ketamine (0.5 mg/kg, TID, SC) (during hospitalization), as well as Tramadol (4 mg/kg, TID, PO) and Dipyrone (25 mg/kg, TID, PO) after medical release as support therapy. For the wound treatment, calcium alginate was initially used daily and subsequently changed for daily application of dermisana oil. The patient followed up weekly for approximately two months for wound monitoring as well as adjustments to the drug therapy. The would almost completely healed, but the patient showed a significant worsening in the general clinical condition correlated with the neoplasm that he had, and the owner and clinical staff of the veterinary hospital opted for euthanasia.Discussion: Hypothermia should be avoided as much as possible during anesthesia, as the body’s temperature is very important in homeostasis, in addition to being able to change the pharmacokinetics and pharmacodynamics of some drugs. The use of a thermal mattress to avoid hypothermia during the intraoperative period is a common and useful tool in veterinary routine, but should be used with caution and constant monitoring of the animal under general anesthesia to avoid skin burns which are not immediately noted. When diagnosed, the treatment should aim for wound healing and provide analgesia. Different pharmacological approaches can be used for this purpose, including topical therapies with different products that provide wound healing and regard to analgesia can be used for association of non-steroidal anti-inflammatory drugs such as meloxicam, opioids like morphine and tramadol, and N-Methyl-D-aspartate (NMDA) blockers like ketamine for analgesia. Burn treatment is difficult but can have a favorable prognosis. In the present report, the conservative wound management using sodium alginate and dermisana oil almost completely cured the wound, and the canine responded positively to the analgesic protocol instituted with the association of different drugs. It is still important to highlight the attendance and commitment of the owner in the proposed treatment, as euthanasia, in this case, was due to the comorbidity presented by the patient.

Neonatal Thermoregulation: A Golden Hour Protocol Update.

Premature infants are poor regulators of body temperature and are subjected to environmental factors that can lead to rapid heat loss, leaving them vulnerable to an increased risk of morbidity and mortality from hypothermia. Thermoregulation protocols have proven to increase survival in preterm infants. To evaluate a Plan-Do-Study-Act (PDSA) cycle on a previously implemented Golden Hour protocol at a military medical care facility for infants born at less than 32 weeks of gestation and weighing less than1500 g. Specific aims included the use of increased delivery/operating room temperatures and proper use of thermoregulatory devices (polyethylene bags and thermal mattress). Outcomes were analyzed and compared using a pre/postdesign. The data was collected using the neonatal intensive care unit admission worksheet. Although statistical analysis was not significant, clinical significance was illustrated by a decrease in hypothermia rates on admission and at 1 hour of life. There was a 100% compliance rate with increasing delivery room/operating room temperatures and thermal mattress use. Polyethylene bag use compliance was 50%. Golden Hour protocols have proven to be an effective tool. Thermoregulation is a significant component of these protocols, and it is imperative that every step is taken to manage the environmental temperature during the birth and admission process. There is a need for continued research on the impacts of thermoregulatory devices and protocols, with resulting practice and device recommendations.

Anesthesia for rabbits submitted to experimental surgeries: Report of a series of eight anesthesias

Anesthesia for laboratory animals is a matter of biomedical concern and one of the most present dilemmas in the current bioethical debate. The use of anesthetic agents in experimental surgery aims at analgesia and restraining the animal, in order to achieve a reasonable degree of muscle relaxation and to produce sufficient analgesia. This practice requires the use of protocols for the administration of safe and efficient doses. Eight New Zealand rabbits were submitted to laparotomies demonstrating the surgical technique discipline of the local medical course. For pre-anesthetic medication, acepromazine 1 mg.kg-1 associated with ketamine 15 mg.kg-1 was used subcutaneously. Anesthesia was maintained with isoflurane and oxygen under a laryngeal mask in a Mapleson D anesthesia system and under spontaneous breathing. Hydration was performed with 10 ml.kg-1 saline every hour. A thermal mattress was used. Precordial stethoscope, pulse oximetry and clinical parameters were used for monitoring. For euthanasia, ketamine 10 mg.kg-1 associated with potassium chloride 19.1% 1 ml.kg-1 was used intravenously. The average weight of the rabbits was 2721.25 ± 275.01 grams and the duration of the anesthetic procedure was 120 ± 87 minutes. Discussion. In long-term anesthesia, such as laparotomies, the use of pre-anesthetic medication and then anesthetic induction by the combination of agents is recommended. However, anesthetic management requires monitoring to prevent insufficient or excessive doses from occurring.

Hydrocolloid Use in the Treatment of Thermal Injury in a Dog

Background: Thermal injury is one of the most common type of skin damage found in clinical care, which results in a chronic wound. The treatment of chronic wounds should be specific, because it has a greater vulnerability of the organism to the external agents input. So, the treatment can be performed with covers to keep the lesion clean and free of contamination and also promote healing. Considering the amount of products available for the treatment, as well as the scarcity of studies in the literature proving the effectiveness of hydrocolloid in dogs, the aim of this case report was to describe a third degree burn wound in the sternal region of a dog treated with this material.Case: A 2-year-old non-castraded German Spitz dog, was attended in a private veterinary clinic located in Ribeirão Preto city, São Paulo state. The animal was submitted to general anesthesia for microneedling session to treat alopecia "X", and after the procedure, it showed a burn focus due to the resting time on the thermal mattress, affecting the entire sternal region. The choice treatment was a surgical debridement followed by second intention healing. The superficial crust of the wound was removed and the debridement of almost all the tissue that was not fit for healing was continued, resulting in a wide wound, with healthy tissue and only a small portion of devitalized musculature. On the same day, the daily dressing phase with crystal sugar was started, in order to promote the debridement of the remaining devitalized tissue and enable the appearance of granulation tissue, together with the asepsis provided by the chlorhexidine ointment (0.7 g/100mL). After five days, the wound presented with ascending granulation, with no signs of contamination and minimal residue of devitalized tissue. Then, the treatment with the hydrocolloid plate was chosen, which was cut and molded to the wound to allow the debridement with crystal sugar to continue in the devitalized muscle region. At this stage of treatment, the wound region where crystal sugar was used was cleaned and given a new dressing to be changed the next day, while the rest of the wound that had the hydrocolloid plate remained unmanaged for an average of five days, in order to improve animal welfare. After six days of dressing, the wound showed significant contraction, however the growth of the granulation tissue was exuberant. Four days after the first dressing change, the contraction of the wound proceeded at an accelerated rate, as well as the proliferation of granulation tissue, and on the 15th day of treatment with the hydrocolloid plaque, the wound was already quite reduced, with the maintenance of the tissue with healthy granulation, without contamination and with signs of good evolution. On the 27th day, the wound was practically healed, leaving a small central portion of the lesion. The scar tissue that involved the burn contributed to its retraction and accelerated the reepithelialization process. Finally, after 42 days, when the treatment finished, it was possible to notice hair growth and poor visibility of scar tissue.Discussion: The application of this type of dressing in the micro-needling burn injury suggested a better healing due the increase of keratinocyte proliferation and cell proliferation, since when used in the inflammation process, it accelerated the cleaning of purulent and necrotic tissues, stimulating the repair of clean wounds leading to good results and greater patient comfort. This study demonstrated that good healing could be achieved in alternative treatment using hydrocolloid dressing. In this method, healing proved to be more effective than conventional treatment, considering wound resolution and wound healing time.

Experimental Study on Thermal Balance in Soft Clay Area During GSHP Operation

Geothermal energy resources, such as a green and clean renewable energy, are utilized all over the world, especially in soft clay areas along coastal cities in China, such as Shanghai. However, the operation of the ground-buried heat exchanger potentially affects the initial temperature field and the thermal balance, which will probably result in some potential engineering or environmental problems. This paper presents results from a series of large-scale laboratory modeling experiments which were conducted to study the thermal balance in saturated soft clay during the operation of the ground source heat pump (GSHP) system. In experiments, thermal phenomena are induced by a heat exchanger which is embedded in the testing soils and investigated by temperature sensor arrays. It summarizes the experimental methodologies and presents the time-dependent temperature distribution within the testing soils both in operation stage and the re-stabilization duration. Characteristics of thermal balance are discussed in two specific parameters of relative time ratio and temperature factor by comparing summer and winter cases. The thermal mattress effect is proposed to provide valuable guidelines for the utilization and operation of the GSHP system in soft clay areas.

Randomized clinical study comparing active heating methods for prevention of intraoperative hypothermia in gastroenterology.

ABSTRACTObjective:to compare the efficacy of three active heating methods in the prevention of intraoperative hypothermia in open gastroenterological surgeries. Method:randomized clinical trial with a sample of 75 patients, whose initial body temperature measured by a tympanic thermometer. Esophageal temperature <36ºC was considered hypothermic. Patients were divided into three groups using: thermal mattress, underbody forced-air warming blanket and heated infusion system. The tympanic and esophageal temperatures were measured at different times of the intraoperative period, but the temperature considered gold standard was the esophageal. To evaluate the homogeneity of the groups, we used chi-square test (categorical variables). In the comparison of temperature measurements over time, the analysis of variance (ANOVA) and the contrast profile test were used for the difference in temperature between the times. The non-parametric Kruskal-Wallis test was used to compare the three groups. The level of significance was 5%. Results:regarding the studied variables, the groups were not homogeneous as to the categorical variable sex. All patients presented hypothermia during the intraoperative period (p> 0.05). Conclusion:there was no significant difference between the heating methods in the prevention of intraoperative hypothermia. REBEC - Brazilian Registry of Clinical Trials (RBR- no. 52shjp).

Effects of yohimbina, atipamezole and naloxone on the anesthetic reversal in Howley monkeys (Alaoutta guariba clamitans)

The present study addressed the effects caused by chemical restraint with methadone (0,1mg/kg), dexmedetomidine (5µg/kg) and ketamine (8 mg/kg) in Howley monkeys (Alouattaguaribaclamitans) and the comparison of the quality and the time of the anesthetic reversal with isolated or associated narcotic α2-adrenergic antagonists. Five adult and healthy Howley monkeys were submitted to food and water restraining intake of 12 hours. The anesthetic protocol was administered via intramuscular in the semimembranosus and semitendinosus muscles. Five minutes after sedation, the animal was put on a table with thermal mattress where the following parameters were measured: cardiac and respiratory frequencies, rectal temperature, systolic blood/arterial pressure and palpebral reflexes. These parameters were measured every 10 minutes. After 40 minutes of anesthesia a solution of NaCl 0.9% were administered to the control treatment, 25µg/kg of atipamezole for the ATI treatment, 0,5 mg/kg of yohimbine to the IOI treatment, atipamezole (25µg/kg) with naloxone (0,2 mg/kg) to the ATINALOX treatment and the IOINALOX treatment was composed of yohimbine (0,5 mg/kg) associated with naloxone (0,2 mg/kg), administered via intravenous in the primates’ ulnar vein. After the reverser administration the animal was placed on a cage in supine and the period of full recovery was understood from the antagonist administration until the patient’s full recovery. The recovery was evaluated using scores that varied from zero (0) to three (3). The association of methadone, dexmedetomidine and ketamine was effective to the chemical restraint of these animals allowing the performance of clinical procedures during up to 40 minutes. Some animals showed drooling after the intravenous administration of atipamezole and yohimbine. The IOINALOX treatment was the most effective regarding to time but the ATINALOX treatment gained the best recovery.

Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants.

Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants.

Mild hypothermia ameliorates muscle wasting in septic rats associated with hypothalamic AMPK-induced autophagy and neuropeptides

Sepsis, always developing muscle wasting, contributes to serious complications and mortality. Mild hypothermia has been reported to have protective effects on the prognosis of septic patients. However, the underlying mechanisms remain unclear. We therefore hypothesized that mild hypothermia could ameliorate muscle wasting during sepsis and whether it was associated with hypothalamus AMPK-induced autophagy and neuropeptides. Adult male Sprague-Dawley rats were intraperitoneally injected with lipopolysaccharide (LPS) (5 mg/kg) or saline. Mild hypothermia was instantly induced at 33 °C for 3h after LPS injected. Meanwhile, the control and sepsis groups were simultaneously placed on the thermal mattress to maintain the a normal temperature in control group whatever the changes induced by anesthesia. Twenty-four hours after injection, skeletal muscle and hypothalamus tissues were obtained. Muscle wasting was measured by the mRNA expression of two muscle atrophic genes, muscle ring finger 1 (MuRF-1) and muscle atrophy F-box (MAFbx), as well as 3-methylhistidine (3-MH) and tyrosine release. Hypothalamic AMPK-induced autophagy markers and neuropeptides expression were also detected. Results showed that LPS administration significantly decreased hypothalamic AMPK-induced autophagy together with muscle wasting. Also, increased hypothalamic neuropeptides, proopiomelanocortin (POMC), cocaine and amphetamine-related transcript (CART) and neuro-peptides Y (NPY) and decreased agouti-related protein (AgRP) were observed. Mild hypothermia significantly increased hypothalamic AMPK-induced autophagy and ameliorated LPS-induced muscle wasting, and attenuated the alteration of neuropeptides, POMC, CART and NPY. In conclusion, mild hypothermia could alleviate muscle wasting by LPS injection, which was associated with reversing the level of hypothalamic AMPK-induced autophagy and the alteration of neuropeptides. These results suggested that mild hypothermia could be a potential treatment concept and a novel mechanism in management of muscle wasting in critically ill patients.

Human Subject Effects on Torsion Pendulum Oscillations: Further Evidence of Mediation by Convection Currents

When a human subject sits beneath a wire mesh, hemispheric torsion pendulum (TP) a rapid-onset series of oscillations at frequencies both higher and lower than the fundamental frequency of the TP have been consistently observed. This study was designed to replicate and extend prior findings that suggest the human subject effect on TP behavior is due to subject-generated, heat-induced convection currents. Effects on pendulum behavior were tested after draping an aluminized "space blanket" over the subject and by replacing the subject with a thermal mattress pad shaped to approximate the human form. Experiments were performed in a basic science university research laboratory. Real-time recordings and Fast Fourier Transform frequency spectra of pendulum oscillatory movement. The space blanket blocked, while the mattress pad mimicked, the human subject induced complex array of pendulum oscillations. Our findings support and strengthen previous results that suggest the effects of human subjects on behavior of a torsion pendulum are mediated by body-heat-induced air convection rather than an unknown type of biofield.

Uso do mel orgânico tópico no tratamento de queimadura de terceiro grau em cão: relato de caso

O uso tópico do mel oferece considerável benefício nos cuidados de feridas como o estímulo de crescimento tecidual, aumento na epitelização e formação mínima de cicatriz. Estes efeitos decorrem da sua acidez, presença de peróxido de hidrogênio, efeito osmótico e conteúdo anti-oxidante. Uma cadela da raça labrador, de quatro anos, apresentou uma ferida que se estendia da região toraco-abdominal lateral esquerda até a região sacra, ocasionada por uma queimadura de terceiro grau devido ao uso de colchão térmico elétrico. Após o debridamento do tecido necrosado e antibioticoterapia por dez dias, foi iniciado o uso de curativo com mel orgânico tópico, aplicado sob a forma pura com auxílio de gaze, duas vezes ao dia. Após a aplicação do mel, a região foi mantida com bandagem compressiva. A lesão apresentou boa evolução da cicatrização, com epitelização e formação de tecido de granulação após 15 dias do início do tratamento, não havendo necessidade da realização da técnica cirúrgica de reconstrução para o fechamento do defeito da pele. O mel é uma opção de baixo custo e de fácil uso pelo proprietário, após o debridamento da lesão e antibioticopterapia instituídos pelo profissional veterinário.

Reconstructive Surgical Repair of a Forth Degree Iatrogenic Burn in a Dog

Background: Burns are uncommon in small animal surgery routine and represents a real therapeutic challenge. Skin can be affect in different degrees of deepness as superfcial, partial thickness, full thickness and full thickness affecting underlying tissues. Each degree has individual features. Progression through degrees can occur in the frst 24 h or if treatment is inadequate. This paper aims to describe therapeutic approach and surgical technique to treat a huge dorsal iatrogenic thermal burn injury. Case: A 4-year-old female German Shepard was referred to veterinary hospital after 11 days of elective ovariosalpingohisterectomy. The patient presented a severe skin injury with crusts, eschars, purulent discharge and myiasis on dorsal cervical, thoracic and lumbar region. Beside severity of the wound, animal present good general status and normal vital signs. Complete blood count and biochemical analysis were within normal ranges. Histopathologic analysis of a wound tissue sample revealed the presence of coagulation necrosis and inflammatory response. The absence of traumatic events, histopathologic result and wound features increased suspicious of an iatrogenic burn injury from a poorly regulated thermal mattress used during surgical intervention. “Rule of Nines” was estimated as 25% of total body surface area. Systemic antibiotics and topical treatment with 0.05% chlorhexidine digluconate and 2.5% silver sulfadiazine ointment followed by wet-wet bandage was performed after initial surgical debridement. Muscle and vertebral bone explosion were evident. Topical treatment with Silver Sulfadiazine and chlorhexidine persisted twice daily until granulation tissue formation. Pain killers and sedation were often necessary during bandage changes. At 65th day proceeded to en bloc excision of scar tissue and surgical reconstruction with skin advancement and recruitment technique. Tie-over dressing was applied to cover the fnal wound. After 14 days animal received hospital discharge, and was assessed bi-weekly for 60 days. Discussion: Besides great extension of the burn injury, patient’s age, absence of systemic involvement and fluid therapy or critical care the prognosis was good. Modifed “rule of nine” are used to estimate wound size in dogs. The wound was classifed as forth degree or full thickness injury due to exposed muscular layer and bone. Early debridement, standard topical and systemic treatment protocol applied granted good recovery of wound bed. Due to be uncommon in small animal routine, main diagnosis and therapeutic recommendations for veterinary patients are based on human data. Systemic antimicrobial drugs are usually not recommended due to low concentration in burned tissues, however, prophylactic use was necessary due to highly infected tissues and possible bacterial absorption from devitalized tissues. Delayed primary closure technique was necessary due to highly infection site and extension, which turns surgical approach hard to perform. After formation of a granulation tissue bed for wound reconstruction, surgical treatment was performed. Surgical reconstruction is indicated in large full thickness defects and for better cosmetic appearance. The correct use and regulation of thermal mattress can avoid burns that can be life threatening. This case report rises the important concept that even low contact temperatures when persistent for long time can cause burn injuries. Keywords: thermal, mattress, injury, dogs, plastic.