Preoperative Warming Versus no Preoperative Warming for Maintenance of Normothermia in Women Receiving Intrathecal Morphine for Cesarean Delivery: A Single-Blinded, Randomized Controlled Trial

Munday, Judy; Osborne, Sonya; Yates, Patsy; Sturgess, David; Jones, Lee; Gosden, Edward

doi:10.1213/ane.0000000000002026

Cited by 28 publications

(19 citation statements)

References 35 publications

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“…3 In fact, 48% and 64 % of patients in the combined and single modality groups respectively were hypothermic on admission to PACU, and 68% and 80 % respectively required warming in PACU, confirming the findings of du Toit et al that core temperatures continue to decline in the postoperative period. 2,3 This study only applied forced air warming preoperatively, and did not continue it intraoperatively. While preoperative warming has been proposed as an effective strategy for preventing hypothermia particularly in short surgical procedures under general anesthesia, 19 the study by Munday and colleagues suggests that its efficacy is limited in women undergoing cesarean delivery under spinal anesthesia.…”

supporting

confidence: 74%

“…4 In this issue of Anesthesia & Analgesia , Munday et al assessed the efficacy of another multimodal active warming strategy in women who received spinal anesthesia with intrathecal morphine. 3 In this study, the addition of 20 min of whole body preoperative forced air warming to intraoperative warmed intravenous fluid administration did not significantly reduce the incidence of inadvertent perioperative hypothermia or the rate of decline of intraoperative core temperatures compared to fluid warming alone, but the study did not include a control group not receiving any warming modality. 3 In fact, 48% and 64 % of patients in the combined and single modality groups respectively were hypothermic on admission to PACU, and 68% and 80 % respectively required warming in PACU, confirming the findings of du Toit et al that core temperatures continue to decline in the postoperative period.…”

mentioning

confidence: 66%

“…Two publications in this month’s Anesthesia & Analgesia have highlighted inadvertent perioperative hypothermia as one area where further work is needed. 2,3 Inadvertent perioperative hypothermia, the unintentional cooling of a patient’s core temperature to less than 36°C, has long been a recognized complication of general anesthesia. However it is also common in women receiving spinal anesthesia for cesarean delivery, with the incidence reported as high as 91%.…”

mentioning

confidence: 99%

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Inadvertent Perioperative Hypothermia Induced by Spinal Anesthesia for Cesarean Delivery Might Be More Significant Than We Think: Are We Doing Enough to Warm Our Parturients?

Allen

Habib

2018

Anesthesia &Amp; Analgesia

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supporting

confidence: 74%

mentioning

confidence: 66%

mentioning

confidence: 99%

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Inadvertent Perioperative Hypothermia Induced by Spinal Anesthesia for Cesarean Delivery Might Be More Significant Than We Think: Are We Doing Enough to Warm Our Parturients?

Allen

Habib

2018

Anesthesia &Amp; Analgesia

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“…Thirteen published studies (15% of included studies) had a primary outcome of preventing perioperative hypothermia or temperature monitoring. 35,46,56,74,82,85,86,87,96,98,99,100,104…”

Section: Perioperative Hypothermia Prevention and Temperature Monitoringmentioning

confidence: 99%

<p>Nurse-Led Randomized Controlled Trials in the Perioperative Setting: A Scoping Review</p>

Munday¹,

Higgins²,

Mathew³

et al. 2020

JMDH

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Purpose: Nurses provide care at each phase of the complex, perioperative pathway and are well placed to identify areas of care requiring investigation in randomized controlled trials. Yet, currently, the scope of nurse-led randomized controlled trials conducted within the perioperative setting are unknown. This scoping review aims to identify areas of perioperative care in which nurse-led randomized controlled trials have been conducted, to identify issues impacting upon the quality of these trials and identify gaps for future investigation. Methods: This scoping review was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Searches were conducted in PubMed, Embase, Cumulative Index for Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials, with a date range of 2014-19. Sources of unpublished literature included Open Grey, and ProQuest Dissertation and Theses, Clinical Trials.gov and the Australian and New Zealand Clinical Trials Registry. After title and abstract checking, full-text retrieval and data extraction, studies were appraised using the Joanna Briggs Institute Critical Appraisal Checklists for randomized controlled trials. Data were synthesized according to the main objectives. Key information was tabulated. Results: From the 86 included studies, key areas where nurses have led randomized controlled trials include patient or caregiver anxiety; postoperative pain relief; surgical site infection prevention: patient and caregiver knowledge; perioperative hypothermia prevention; postoperative nausea and vomiting; in addition to other diverse outcomes. Issues impacting upon quality (including poorly reported randomization), and gaps for future investigation (including a focus on vulnerable populations), are evident. Conclusion: Nurse-led randomized controlled trials in the perioperative setting have focused on key areas of perioperative care. Yet, opportunities exist for nurses to lead experimental research in other perioperative priority areas and within different populations that have been neglected, such as in the population of older adults undergoing surgery.

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“…Similarly, in a study by De Bernardiset al, thermal gowns and warmed intravenous fluids decreased the patient temperature drops and the incidence of shivering as compared to the same variables in the control group [26] . In contrast, in Munday et al's study, 20 minutes of preoperative forced-air warming with intravenous fluid warming did not prevent temperature drops in women undergoing cesarean delivery [27] . However, the OR ambient temperature was lower in that study (21.4˚C).…”

Section: Discussionmentioning

confidence: 71%

Effects of Combined Warmed Preoperative Forced-air and Warmed Perioperative Intravenous Fluids on Maternal Temperature During Cesarean Section: a prospective, randomized, controlled clinical trial

Ni¹,

Zhou²,

He³

et al. 2020

Preprint

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Background: Preventing the frequent perioperative hypothermia incidents that occur during elective caesarean deliveries would be beneficial. This trial aimed at evaluating the effect of preoperative forced-air warming alongside perioperative intravenous fluid warming in women undergoing cesarean sections under spinal anesthesia.Methods: We randomly allocated135 women undergoing elective cesarean deliveries to either the intervention group (preoperative forced-air and intravenous fluid warmings, n = 69) or the control group (no active warming, n = 66). The primary outcome measure was the change from the core baseline temperature to that at the end of the procedure. Secondary outcomes included thermal comfort scores, the incidences of shivering and hypothermia (<36℃), the core temperature on arrival at the post-anesthesia care unit, neonatal axillary temperature at birth, and Apgar scores.Results: Two-way repeated measures ANOVA revealed significantly different core temperature changes (from the pre-spinal temperature to that at the end of the procedure) between groups (F = 13.022, P <0.001). The thermal comfort scores were also higher in the intervention group than in the control group (F = 9.847, P = 0.002). The overall incidence of perioperative hypothermia was significantly lower in the intervention group than in the control group (20.6% vs. 51.6%, P <0.0001).Conclusions: Warming preoperative forced-air and perioperative intravenous fluids may prevent maternal hypothermia, reduce maternal shivering, and improve maternal thermal comfort for patients undergoing cesarean sections under spinal anesthesia.Trial registration: The study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800019117) on October26, 2018. Keywords: Cesarean section, Spinal anesthesia, Warming

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Preoperative Warming Versus no Preoperative Warming for Maintenance of Normothermia in Women Receiving Intrathecal Morphine for Cesarean Delivery: A Single-Blinded, Randomized Controlled Trial

Abstract: A short period of preoperative warming is not effective in preventing intraoperative temperature decline for women receiving intrathecal morphine. A combination of preoperative and intraoperative warming modalities may be required for this population.

Cited by 28 publications

References 35 publications

Inadvertent Perioperative Hypothermia Induced by Spinal Anesthesia for Cesarean Delivery Might Be More Significant Than We Think: Are We Doing Enough to Warm Our Parturients?

Inadvertent Perioperative Hypothermia Induced by Spinal Anesthesia for Cesarean Delivery Might Be More Significant Than We Think: Are We Doing Enough to Warm Our Parturients?

<p>Nurse-Led Randomized Controlled Trials in the Perioperative Setting: A Scoping Review</p>

Effects of Combined Warmed Preoperative Forced-air and Warmed Perioperative Intravenous Fluids on Maternal Temperature During Cesarean Section: a prospective, randomized, controlled clinical trial

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