Forced-air warming effectively prevents midazolam-induced core hypothermia in volunteers

Sato, Hiroaki; Yamakage, Michiaki; Okuyama, Katsumi; Imai, Yusuke; Iwashita, Hironobu; Ishiyama, Tadahiko; Matsukawa, Takashi

doi:10.1097/eja.0b013e328328f662

Cited by 8 publications

(13 citation statements)

References 24 publications

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“…This seems especially true, if this drop in core temperature, as we have shown in our study, cannot be offset by active prewarming. This result is in contrast to the findings of Sato et al [12] who observed that prewarming did not prevent a transient decrease in core temperature by midazolam, but increased the temperature to the control level thereafter. However, in our study active prewarming was started about 40 min after premedication and not at the time of premedication.…”

Section: Discussioncontrasting

confidence: 99%

“…In another study administration of 0.075 mg.kg − 1 midazolam i.m. was also associated with a drop of core temperature of 0.5 °C [12]. These results are comparable to the results of our study in which core temperature dropped 0.3 °C between administration of flunitrazepam and induction of anaesthesia.…”

Section: Discussionsupporting

confidence: 90%

“…In contrast, Matsukawa found a clear dose dependent effect of midazolam on core temperature with a drop in core temperature of more than 0.5 °C when 0.075 mg.kg − 1 midazolam were administered. In another study the effects of midazolam on core temperature could be minimized by prewarming [12], which was started directly after the administration of midazolam. In Germany many patients get oral premedication with a benzodiazepine on the ward before being transported through the cold hospital corridors to the preoperative holding area or the operating room.…”

Section: Introductionmentioning

confidence: 99%

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Influence of oral premedication and prewarming on core temperature of cardiac surgical patients: a prospective, randomized, controlled trial

et al. 2019

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Background Perioperative hypothermia is still very common and associated with numerous adverse effects. The effects of benzodiazepines, administered as premedication, on thermoregulation have been studied with conflicting results. We investigated the hypotheses that premedication with flunitrazepam would lower the preoperative core temperature and that prewarming could attenuate this effect. Methods After approval by the local research ethics committee 50 adult cardiac surgical patients were included in this prospective, randomized, controlled, single-centre study with two parallel groups in a university hospital setting. Core temperature was measured using a continuous, non-invasive zero-heat flux thermometer from 30 min before administration of the oral premedication until beginning of surgery. An equal number of patients was randomly allocated via a computer-generated list assigning them to either prewarming or control group using the sealed envelope method for blinding. The intervention itself could not be blinded. In the prewarming group patients received active prewarming using an underbody forced-air warming blanket. The data were analysed using Student’s t-test, Mann-Whitney U-test and Fisher’s exact test. Results Of the randomized 25 patients per group 24 patients per group could be analysed. Initial core temperature was 36.7 ± 0.2 °C and dropped significantly after oral premedication to 36.5 ± 0.3 °C when the patients were leaving the ward and to 36.4 ± 0.3 °C before induction of anaesthesia. The patients of the prewarming group had a significantly higher core temperature at the beginning of surgery (35.8 ± 0.4 °C vs. 35.5 ± 0.5 °C, p = 0.027), although core temperature at induction of anaesthesia was comparable. Despite prewarming, core temperature did not reach baseline level prior to premedication (36.7 ± 0.2 °C). Conclusions Oral premedication with benzodiazepines on the ward lowered core temperature significantly at arrival in the operating room. This drop in core temperature cannot be offset by a short period of active prewarming. Trial registration This trial was prospectively registered with the German registry of clinical trials under the trial number DRKS00005790 on 20th February 2014.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Influence of oral premedication and prewarming on core temperature of cardiac surgical patients: a prospective, randomized, controlled trial

et al. 2019

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“…The increase in body temperature in the FAW group should be considered modest. It is similar to those arising from testing of this intervention with sedated patients in controlled experimental conditions 16 and with application of active warming during neuraxial anaesthesia. 17 A recent meta-analysis of eight trials with 1189 participants who received neuraxial anaesthesia found that active warming increased postoperative temperature by 0.36°C in comparison with passive warming (95% CI=0.16 to 0.55) and reduced risk of hypothermia by 29% (RR 0.71, 95% CI=0.61 to 0.83).…”

Section: Discussionmentioning

confidence: 52%

Forced air warming during sedation in the cardiac catheterisation laboratory: a randomised controlled trial

Conway

Ersotelos

Sutherland

et al. 2017

Heart

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ObjectiveForced air warming (FAW) during general anaesthesia is a safe and effective intervention used to reduce hypothermia. The objective of this study was to determine if FAW reduces hypothermia when used for procedures performed with sedation in the cardiac catheterisation laboratory.MethodsA parallel-group randomised controlled trial was conducted. Adults receiving sedation in a cardiac catheterisation laboratory at two sites were randomised to receive FAW or usual care, which involved passive warming with heated cotton blankets. Hypothermia, defined as a temperature less than 36°C measured with a sublingual digital thermometer after procedures, was the primary outcome. Other outcomes were postprocedure temperature, shivering, thermal comfort and major complications.ResultsA total of 140 participants were randomised. Fewer participants who received FAW were hypothermic (39/70, 56% vs 48/69, 70%, difference 14%; adjusted RR 0.75, 95% CI=0.60 to 0.94), and body temperature was 0.3°C higher (95% CI=0.1 to 0.5, p=0.004). FAW increased thermal comfort (63/70, 90% vs51/69, 74% difference 16%, RR 1.21, 95% CI=1.04 to 1.42). The incidence of shivering was similar (3/69, 4% vs 0/71 0%, difference 4%, 95% CI=−1.1 to 9.8). One patient in the control group required reintervention for bleeding. No other major complications occurred.ConclusionFAW reduced hypothermia and improved thermal comfort. The difference in temperature between groups was modest and less than that observed in previous studies where use of FAW decreased risk of surgical complications. Therefore, it should not be considered clinically significant.Trial registration numberACTRN12616000013460.

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“…[27] The reasons for this may include the short length of the operations involved in this study and the different types of patients recruited, surgeries performed, and precise methods of rewarming selected. [28] …”

Section: Discussionmentioning

confidence: 99%

Effect of an electric blanket plus a forced-air warming system for children with postoperative hypothermia

Shi²,

Ren³

et al. 2017

Medicine

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Background:Postoperative hypothermia in children in postanesthesia care unit (PACU) is a well-known serious complication as it increases the risk of blood loss, wound infections, and cardiac arrhythmias. We conducted this prospective randomized controlled trial to evaluate the effect of an electric blanket plus a forced-air warming system on rewarming in children with postoperative hypothermia.Methods:We recruited 346 children (aged < 3 years) who were admitted to a PACU after surgery and diagnosed with hypothermia between March and August 2016. They were randomly divided into 3 groups: group C (n = 108, rewarmed with only a regular blanket), group E (n = 123, rewarmed with a regular blanket plus an electric blanket), and group EF (n = 115, rewarmed with an electric blanket plus a forced-air warming system). From the beginning of rewarming, the rectal temperature was recorded every 5 minutes for the first half hour, then every 10 minutes up to when the patient left the PACU. The primary outcome was the rewarming time of children (from the beginning of rewarming to recovery of normothermia). The rewarming rate, increase in temperature (compared with the beginning of rewarming), hemodynamics, recovery time, and incidences of adverse effects were recorded.Results:There were no significant differences among the 3 groups in terms of the baseline clinical characteristics, use of narcotic drugs, intraoperative temperature, and hemodynamics (P > .05). Compared with the children in groups C and E, both the heart rate and mean arterial pressure of those in group EF were significantly increased after 10 minutes of arriving at the PACU (P < .05). Children in the EF group had the shortest rewarming time (35.61 ± 16.45 minutes, P < .001) and highest rewarming efficiency (0.028 ± 0.001 °C/min, P < .001), while there was no evidence of a difference in increased rectal temperature among the 3 groups. Children in the EF group had lower incidences of arrhythmia, shivering, nausea, and vomiting (P < .05).Conclusion:The combination of an electric blanket and a forced-air warming system was shown to be an effective rewarming method for children with postoperative hypothermia.

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Forced-air warming effectively prevents midazolam-induced core hypothermia in volunteers

Abstract: We conclude that forced-air warming can effectively prevent midazolam-induced redistribution hypothermia.

Cited by 8 publications

References 24 publications

Influence of oral premedication and prewarming on core temperature of cardiac surgical patients: a prospective, randomized, controlled trial

Influence of oral premedication and prewarming on core temperature of cardiac surgical patients: a prospective, randomized, controlled trial

Forced air warming during sedation in the cardiac catheterisation laboratory: a randomised controlled trial

Effect of an electric blanket plus a forced-air warming system for children with postoperative hypothermia

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