Effect of pre-warming on perioperative hypothermia during holmium laser enucleation of the prostate under spinal anesthesia: a prospective randomized controlled trial

Joo-Hyun Jun, Mi Hwa Chung, Eun Mi Kim, In-Jung Jun, Jung Hwa Kim, Joon-Sang Hyeon, Mi Hyeon Lee, Hye Sun Lee, Eun Mi Choi, Joo-Hyun Jun, Mi Hwa Chung, Eun Mi Kim, In-Jung Jun, Jung Hwa Kim, Joon-Sang Hyeon, Mi Hyeon Lee, Hye Sun Lee, Eun Mi Choi

Abstract

Background: The purpose of this study is to assess whether the application of preoperative forced air warming set to high temperature (> 43 °C) for brief period can increase temperature on admission to the postanesthesia care unit (PACU) and prevent hypothermia or shivering during holmium laser enucleation of the prostate performed under spinal anesthesia.

Methods: Fifty patients were enrolled were assigned randomly to receive passive insulation (control group, n = 25) or forced-air skin surface warming for 20 min before spinal anesthesia (pre-warming group, n = 25). The primary outcome was temperature at PACU admission.

Results: The pre-warming group had a significantly higher temperature on admission to the PACU than the control group (35.9 °C [0.1] vs 35.6 °C [0.1], P = 0.023; 95% confidence interval of mean difference, 0.1 °C-0.5 °C). The trend of decreasing core temperature intraoperatively was not different between groups (P = 0.237), but intraoperative core temperature remained approximately 0.2 °C higher in the pre-warming group (P = 0.005). The incidence of hypothermia on admission to the PACU was significantly lower in the pre-warming group (56% vs 88%, P = 0.025). Shivering occurred in 14 patients in the control group, and 4 patients in the pre-warming group (P = 0.007).

Conclusion: Brief pre-warming at 45 °C increased perioperative temperature and decreased the incidence of hypothermia and shivering. However, it was not sufficient to modify the decline of intraoperative core temperature or completely prevent hypothermia and shivering. Continuing pre-warming to immediately before induction of spinal anesthesia or combining pre-warming with intraoperative active warming may be necessary to produce clearer thermal benefits in this surgical population.

Trial registration: This trial was registered with Clinicaltrials.gov, NCT03184506 , 5th June 2017.

Keywords: Hypothermia; Pre-warming; Spinal; Temperature.

Conflict of interest statement

Ethics approval and consent to participate

This study was performed according to the Declaration of Helsinki after the approval of Institutional Review Board of Hallym University Kangnam Sacred Heart Hospital (2017–05-002). Written informed consent was obtained from the enrolled patients before surgery.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram
Fig. 2
Fig. 2
Core temperature upon entering the postanesthesia care unit. Boxes represent the estimated mean values in minutes, and whiskers represent ± standard error of the mean. P = 0.027 between control and pre-warming groups
Fig. 3
Fig. 3
Serial changes in core temperature in the operating room (OR). Values are mean and standard error of the mean. Core temperature changes were not significantly different between the two groups (P = 0.237). * P < 0.05; mean core temperatures differed significantly between control and pre-warming groups from immediately after induction of spinal anesthesia to 60 min after induction

References

    1. Matsukawa T, Kurz A, Sessler DI, Bjorksten AR, Merrifield B, Cheng C. Propofol linearly reduces the vasoconstriction and shivering thresholds. Anesthesiology. 1995;82(5):1169–1180. doi: 10.1097/00000542-199505000-00012.
    1. Xiong J, Kurz A, Sessler DI, Plattner O, Christensen R, Dechert M, Ikeda T. Isoflurane produces marked and nonlinear decreases in the vasoconstriction and shivering thresholds. Anesthesiology. 1996;85(2):240–245. doi: 10.1097/00000542-199608000-00003.
    1. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109(2):318–338. doi: 10.1097/ALN.0b013e31817f6d76.
    1. Leslie K, Sessler DI. Reduction in the shivering threshold is proportional to spinal block height. Anesthesiology. 1996;84(6):1327–1331. doi: 10.1097/00000542-199606000-00008.
    1. Matsukawa T, Sessler DI, Christensen R, Ozaki M, Schroeder M. Heat flow and distribution during epidural anesthesia. Anesthesiology. 1995;83(5):961–967. doi: 10.1097/00000542-199511000-00008.
    1. Frank SM, Beattie C, Christopherson R, Norris EJ, Rock P, Parker S, Kimball AW., Jr Epidural versus general anesthesia, ambient operating room temperature, and patient age as predictors of inadvertent hypothermia. Anesthesiology. 1992;77(2):252–257. doi: 10.1097/00000542-199208000-00005.
    1. Arkilic CF, Akca O, Taguchi A, Sessler DI, Kurz A. Temperature monitoring and management during neuraxial anesthesia: an observational study. Anesth Analg. 2000;91(3):662–666. doi: 10.1213/00000539-200009000-00031.
    1. Seki N, Tatsugami K, Naito S. Holmium laser enucleation of the prostate: comparison of outcomes according to prostate size in 97 Japanese patients. J Endourol. 2007;21(2):192–196. doi: 10.1089/end.2006.0123.
    1. Rabke HB, Jenicek JA, Khouri E., Jr Hypothermia associated with transurethral resection of the prostate. J Urol. 1962;87:447–449. doi: 10.1016/S0022-5347(17)64979-6.
    1. Frank SM, El-Rahmany HK, Cattaneo CG, Barnes RA. Predictors of hypothermia during spinal anesthesia. Anesthesiology. 2000;92(5):1330–1334. doi: 10.1097/00000542-200005000-00022.
    1. Kurz A, Plattner O, Sessler DI, Huemer G, Redl G, Lackner F. The threshold for thermoregulatory vasoconstriction during nitrous oxide/isoflurane anesthesia is lower in elderly than in young patients. Anesthesiology. 1993;79(3):465–469. doi: 10.1097/00000542-199309000-00008.
    1. Okeke LI. Effect of warm intravenous and irrigating fluids on body temperature during transurethral resection of the prostate gland. BMC Urol. 2007;7:15. doi: 10.1186/1471-2490-7-15.
    1. Pit MJ, Tegelaar RJ, Venema PL. Isothermic irrigation during transurethral resection of the prostate: effects on peri-operative hypothermia, blood loss, resection time and patient satisfaction. Br J Urol. 1996;78(1):99–103. doi: 10.1046/j.1464-410X.1996.04819.x.
    1. Hynson JM, Sessler DI, Glosten B, McGuire J. Thermal balance and tremor patterns during epidural anesthesia. Anesthesiology. 1991;74(4):680–690. doi: 10.1097/00000542-199104000-00011.
    1. Matsukawa T, Sessler DI, Sessler AM, Schroeder M, Ozaki M, Kurz A, Cheng C. Heat flow and distribution during induction of general anesthesia. Anesthesiology. 1995;82(3):662–673. doi: 10.1097/00000542-199503000-00008.
    1. 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. doi: 10.1111/j.1365-2044.2012.07073.x.
    1. Forbes SS, Eskicioglu C, Nathens AB, Fenech DS, Laflamme C, McLean RF, McLeod RS, Best practice in general surgery committee UoT Evidence-based guidelines for prevention of perioperative hypothermia. J Am Coll Surg. 2009;209(4):492–503.e491. doi: 10.1016/j.jamcollsurg.2009.07.002.
    1. Schulz KF, Altman DG, Moher D, Group C CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med. 2010;152(11):726–732. doi: 10.7326/0003-4819-152-11-201006010-00232.
    1. Paice JA, Cohen FL. Validity of a verbally administered numeric rating scale to measure cancer pain intensity. Cancer Nurs. 1997;20(2):88–93. doi: 10.1097/00002820-199704000-00002.
    1. Winkler M, Akca O, Birkenberg B, Hetz H, Scheck T, Arkilic CF, Kabon B, Marker E, Grubl A, Czepan R, et al. Aggressive warming reduces blood loss during hip arthroplasty. Anesth Analg. 2000;91(4):978–984. doi: 10.1097/00000539-200010000-00039.
    1. Jo YY, Chang YJ, Kim YB, Lee S, Kwak HJ. Effect of preoperative forced-air warming on hypothermia in elderly patients undergoing transurethral resection of the prostate. Urol J. 2015;12(5):2366–2370.
    1. Sessler DI. Perioperative heat balance. Anesthesiology. 2000;92(2):578–596. doi: 10.1097/00000542-200002000-00042.
    1. Saito T, Sessler DI, Fujita K, Ooi Y, Jeffrey R. Thermoregulatory effects of spinal and epidural anesthesia during cesarean delivery. Reg Anesth Pain Med. 1998;23(4):418–423.
    1. Glosten B, Sessler DI, Faure EA, Karl L, Thisted RA. Central temperature changes are poorly perceived during epidural anesthesia. Anesthesiology. 1992;77(1):10–16. doi: 10.1097/00000542-199207000-00003.
    1. Frank SM, Beattie C, Christopherson R, Norris EJ, Perler BA, Williams GM, Gottlieb SO. Unintentional hypothermia is associated with postoperative myocardial ischemia. The perioperative ischemia randomized anesthesia trial study group. Anesthesiology. 1993;78(3):468–476. doi: 10.1097/00000542-199303000-00010.
    1. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of wound infection and temperature group. N Engl J Med. 1996;334(19):1209–1215. doi: 10.1056/NEJM199605093341901.
    1. Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet. 1996;347(8997):289–292. doi: 10.1016/S0140-6736(96)90466-3.
    1. Rajagopalan S, Mascha E, Na J, Sessler DI. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology. 2008;108(1):71–77. doi: 10.1097/01.anes.0000296719.73450.52.
    1. Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, Beattie C. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997;277(14):1127–1134. doi: 10.1001/jama.1997.03540380041029.
    1. Horn EP, Schroeder F, Gottschalk A, Sessler DI, Hiltmeyer N, Standl T, Schulte am Esch J. Active warming during cesarean delivery. Anesth Analg. 2002;94(2):409–414.
    1. Brandes IF, Jipp M, Popov AF, Seipelt R, Quintel M, Brauer A. Intensified thermal management for patients undergoing transcatheter aortic valve implantation (TAVI) J Cardiothorac Surg. 2011;6:117. doi: 10.1186/1749-8090-6-117.
    1. De Witte JL, Demeyer C, Vandemaele E. Resistive-heating or forced-air warming for the prevention of redistribution hypothermia. Anesth Analg. 2010;110(3):829–833. doi: 10.1213/ANE.0b013e3181cb3ebf.
    1. Monga M, Comeaux B, Roberts JA. Effect of irrigating fluid on perioperative temperature regulation during transurethral prostatectomy. Eur Urol. 1996;29(1):26–28. doi: 10.1159/000473713.
    1. Sessler DI. Perioperative thermoregulation and heat balance. Lancet. 2016;387(10038):2655–2664. doi: 10.1016/S0140-6736(15)00981-2.
    1. Stavem K, Saxholm H, Smith-Erichsen N. Accuracy of infrared ear thermometry in adult patients. Intensive Care Med. 1997;23(1):100–105. doi: 10.1007/s001340050297.
    1. Modell JG, Katholi CR, Kumaramangalam SM, Hudson EC, Graham D. Unreliability of the infrared tympanic thermometer in clinical practice: a comparative study with oral mercury and oral electronic thermometers. South Med J. 1998;91(7):649–654. doi: 10.1097/00007611-199807000-00008.
    1. Bapat S, Umranikar S, Satav V, Bapat A, Joshi A, Ranade G. Comparison of fluid absorption during transurethral resection of prostate and holmium-Yag laser enucleation of benign adenoma of prostate using breath ethanol concentration. Indian J Urol. 2007;23(2):126–129. doi: 10.4103/0970-1591.32061.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere