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The Effects of 30-Minutes of Pre-Warming on Core Body Temperature, Systolic Blood Pressure, Heart Rate, Postoperative Shivering, and Inflammation Response in Elderly Patients with Total Hip Replacement under Spinal Anesthesia: A Randomized Double-blind Controlled Trial

30분의 수술전 가온이 고관절 전치환술 노인 환자의 수술중 심부체온, 수축기압, 심박동수, 수술후 전율 및 염증반응에 미치는 효과

  • Received : 2017.02.01
  • Accepted : 2017.05.22
  • Published : 2017.08.31

Abstract

Purpose: This study was designed to determine the effects of pre-warming on core body temperature (CBT) and hemodynamics from the induction of spinal anesthesia until 30 min postoperatively in surgical patients who undergo total hip replacement under spinal anesthesia. Our goal was to assess postoperative shivering and inflammatory response. Methods: Sixty-two surgical patients were recruited by informed notice. Data for this study were collected at a 1,300-bed university hospital in Incheon, South Korea from January 15 through November 15, 2013. Data on CBT, systemic blood pressure (SBP), and heart rate were measured from arrival in the pre-anesthesia room to 3 hours after the induction of spinal anesthesia. Shivering was measured for 30 minutes post-operatively. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured pre-operatively, and 1 and 2 days postoperatively. The 62 patients were randomly allocated to an experimental group (EG), which underwent pre-warming for 30 minutes, or a control group (CG), which did not undergo pre-warming. Results: Analysis of CBT from induction of spinal anesthesia to 3 hours after induction revealed significant interaction between group and time (F=3.85, p=.008). In addition, the incidence of shivering in the EG was lower than that in the CG ($x^2=6.15$, p=.013). However, analyses of SBP, heart rate, CRP, and ESR did not reveal significant interaction between time and group. Conclusion: Pre-warming for 30 minutes is effective in increasing CBT 2 and 3 hours after induction of spinal anesthesia. In addition, pre-warming is effective in decreasing post-operative shivering.

Keywords

References

  1. Sessler DI, Moayeri A, Stoen R, Glosten B, Hynson J, Mc-Guire J. Thermoregulatory vasoconstriction decreases cutaneous heat loss. Anesthesiology. 1990;73(4):656-660. https://doi.org/10.1097/00000542-199010000-00011
  2. Matsukawa T, Sessler DI, Christensen R, Ozaki M, Schroeder M. Heat flow and distribution during epidural anesthesia. Anesthesiology. 1995;83(5):961-967. https://doi.org/10.1097/00000542-199511000-00008
  3. Kurz A, Sessler DI, Christensen R, Dechert M. Heat balance and distribution during the core-temperature plateau in anesthetized humans. Anesthesiology. 1995;83(3):491-499. https://doi.org/10.1097/00000542-199509000-00007
  4. Matsukawa T, Sessler DI, Sessler AM, Schroeder M, Ozaki M, Kurz A, et al. Heat flow and distribution during induction of general anesthesia. Anesthesiology. 1995;82(3):662-673. https://doi.org/10.1097/00000542-199503000-00008
  5. National Institute for Health and Clinical Excellence. Clinical Practice Guidelines: The management of inadvertent perioperative hypothermia in adults. London: Royal College of Nursing; 2008. p. 1-567.
  6. Kim EJ, Yoon H. Preoperative factors affecting the intraoperative core body temperature in abdominal surgery under general anesthesia: an observational cohort. Clinical Nurse Specialist. 2014;28(5):268-276. http://dx.doi.org/10.1097/NUR.0000000000000069
  7. Lee SH, Yoon HS. Factors affecting intraoperative body temperature in surgical patients with laparotomy under general anesthesia. Journal of Korean Biological Nursing Science. 2015;17(3):236-244. http://dx.doi.org/10.7586/jkbns.2015.17.3.236
  8. Kasai T, Hirose M, Matsukawa T, Takamata A, Yaegashi K, Tanaka Y. Preoperative blood pressure and catecholamines related to hypothermia during general anesthesia. Acta Anaesthesiologica Scandinavica. 2003;47(2):208-212. http://dx.doi.org/10.1034/j.1399-6576.2003.00048.x
  9. Matsui T, Ishikawa T, Takeuchi H, Okabayashi K, Maekawa T. Mild hypothermia promotes pro-inflammatory cytokine production in monocytes. Journal of Neurosurgical Anesthesiology. 2006;18(3):189-193. http://dx.doi.org/10.1097/01.ana.0000188639.39844.f6
  10. Cereda M, Maccioli GA. Intraoperative temperature monitoring. International Anesthesiology Clinics. 2004;42(2):41-54. https://doi.org/10.1097/00004311-200404220-00005
  11. Eberhart LH, Doderlein F, Eisenhardt G, Kranke P, Sessler DI, Torossian A, et al. Independent risk factors for postoperative shivering. Anesthesia and Analgesia. 2005;101(6):1849-1857. https://doi.org/10.1213/01.ANE.0000184128.41795.FE
  12. Shakya S, Chaturvedi A, Sah BP. Prophylactic low dose ketamine and odansetron for prevention of shivering during spinal anaesthesia. Journal of Anaesthesiology, Clinical Pharmacology. 2010;26(4):465-469.
  13. Frank SM, Fleisher LA, Olson KF, Gorman RB, Higgins MS, Breslow MJ, et al. Multivariate determinants of early postoperative oxygen consumption in elderly patients. Effects of shivering, body temperature, and gender. Anesthesiology. 1995;83(2):241-249. https://doi.org/10.1097/00000542-199508000-00002
  14. Kong MJ. Risk factors of intraoperative hypothermia in laparoscopic abdominal surgery [Master's thesis]. Incheon: Gachon University; 2013. p. 1-42.
  15. Kasai T, Hirose M, Yaegashi K, Matsukawa T, Takamata A, Tanaka Y. Preoperative risk factors of intraoperative hypothermia in major surgery under general anesthesia. Anesthesia and Analgesia. 2002;95(5):1381-1383. https://doi.org/10.1097/00000539-200211000-00051
  16. Kitamura A, Hoshino T, Kon T, Ogawa R. Patients with diabetic neuropathy are at risk of a greater intraoperative reduction in core temperature. Anesthesiology. 2000;92(5):1311-1318. https://doi.org/10.1097/00000542-200005000-00019
  17. Kongsayreepong S, Chaibundit C, Chadpaibool J, Komoltri C, Suraseranivongse S, Suwannanonda P, et al. Predictor of core hypothermia and the surgical intensive care unit. Anesthesia and Analgesia. 2003;96(3):826-833. http://dx.doi.org/10.1213/01.ANE.0000048822.27698.28
  18. A statistical year book for 2015 major surgical case [Internet]. Seoul: National Health Insurance Service; 2016 [cited 2017 May 31]. Available from: http://www.nhis.or.kr/bbs7/boards/B0039/22280.
  19. Hynson JM, Sessler DI, Moayeri A, McGuire J, Schroeder M. The effects of preinduction warming on temperature and blood pressure during propofol/nitrous oxide anesthesia. Anesthesiology. 1993;79(2):219-228, discussion 21A-22A. https://doi.org/10.1097/00000542-199308000-00005
  20. Horn EP, Bein B, Bohm R, Steinfath M, Sahili N, Hocker J. The effect of short time periods of pre-operative warming in the prevention of peri-operative hypothermia. Anaesthesia. 2012;67(6):612-617. http://dx.doi.org/10.1111/j.1365-2044.2012.07073.x
  21. Andrzejowski J, Hoyle J, Eapen G, Turnbull D. Effect of prewarming on post-induction core temperature and the incidence of inadvertent perioperative hypothermia in patients undergoing general anaesthesia. British Journal of Anaesthesia. 2008;101(5):627-631. http://dx.doi.org/10.1093/bja/aen272
  22. Akhtar Z, Hesler BD, Fiffick AN, Mascha EJ, Sessler DI, Kurz A, et al. A randomized trial of prewarming on patient satisfaction and thermal comfort in outpatient surgery. Journal of Clinical Anesthesia. 20 16;33:376-385. http://dx.doi.org/10.1016/j.jclinane.2016.04.041
  23. Fettes S, Mulvaine M, Van Doren E. Effect of preoperative forced-air warming on postoperative temperature and postanesthesia care unit length of stay. AORN Journal. 2013;97(3):323-328. http://dx.doi.org/10.1016/j.aorn.2012.12.011
  24. Wong PF, Kumar S, Bohra A, Whetter D, Leaper DJ. Randomized clinical trial of perioperative systemic warming in major elective abdominal surgery. British Journal of Surgery. 2007;94(4):421-426. http://dx.doi.org/10.1002/bjs.5631
  25. Fossum S, Hays J, Henson MM. A comparison study on the effects of prewarming patients in the outpatient surgery setting. Journal of Perianesthesia Nursing. 2001;16(3):187-194. http://dx.doi.org/10.1053/jpan.2001.24039
  26. Sessler DI, Schroeder M, Merrifield B, Matsukawa T, Cheng C. Optimal duration and temperature of prewarming. Anesthesiology. 1995;82(3):674-681. https://doi.org/10.1097/00000542-199503000-00009
  27. Crossley AW, Mahajan RP. The intensity of postoperative shivering is unrelated to axillary temperature. Anaesthesia. 1994;49(3):205-207. http://dx.doi.org/10.1111/j.1365-2044.1994.tb03422.x
  28. Kim HY, Lee KC, Lee MJ, Kim MN, Kim JS, Lee WS, et al. Comparison of the efficacy of a forced-air warming system and circulating-water mattress on core temperature and post-anesthesia shivering in elderly patients undergoing total knee arthroplasty under spinal anesthesia. Korean Journal of Anesthesiology. 2014;66(5):352-357. http://dx.doi.org/10.4097/kjae.2014.66.5.352
  29. Mekjavic IB, Bligh J. Core threshold temperatures for sweating. Canadian Journal of Physiology and Pharmacology. 1989;67(9):1038-1044. https://doi.org/10.1139/y89-164
  30. C-reactive protein: Clinical applications [Internet]. Delhi: Embee Diagnostics; c2002 [cited 2017 July 07]. Available from: www.embeediagnostics.com.

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