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Journal of Clinical Anesthesia xxx (xxxx) xxxx Contents lists available at ScienceDirect Journal of Clinical
Journal of Clinical Anesthesia xxx (xxxx) xxxx Contents lists available at ScienceDirect Journal of Clinical

Contents lists available at ScienceDirect

Journal of Clinical Anesthesia

journal homepage: www.elsevier.com/locate/jclinane Correspondence Is preoperative forced-air warming effective

Correspondence

Is preoperative forced-air warming effective in the prevention of hypothermia in orthopedic surgical patients? A randomized controlled trial

ARTICLE INFO

Keywords:

Hypothermia Orthopedic surgery Forced air prewarming

A Letter to The Editor,

Perioperative hypothermia, defined as a core temperature below 36 °C, is still common in patients undergoing surgery with either gen- eral or neuraxial anesthesia with a reported incidence of up to 90% [1]. Currently there are several warming devices available to prevent peri- operative hypothermia [2]. The aim of the present study was to com- pare forced-air perioperative warming with our standard of care con- sisting of thermal insulation and warmed cotton blankets. We hypothesized that preoperative warming of orthopedic surgical patients using forced-air warming would cause an increase of the peripheral temperature. This might lead to less redistribution of heath during the first phase of anesthesia and thus to less patients with hypothermia at arrival in the postoperative recovery area. The objective of this study was to assess differences in perioperative hypothermia-incidence, complications and patient satisfaction between patients receiving pre- operative active warming using forced-air and patients receiving warmed disposable blankets (Table 1). The study was approved by the Medical Research Ethics Committees United (MEC-U), Nieuwegein, The Netherlands and the Institutional board of OLVG Hospital, Amsterdam, The Netherlands. All subjects had given written informed consent to participate and publish according to GCP. The inclusion period ranged from February 1st, 2016 until June 22nd, 2016. We included two-hundred-and-twelve patients, American Society of Anesthesiologist Class I to III, undergoing elective total knee- or total hip arthroplasty. The patients were randomized to prewarming for 30 minutes using forced-air with a 3M Bair Paws flex gown model 81003 at the preoperative preparation room (Intervention group), or to receive a disposable warmed blanket (Standard of care group). Core and peripheral temperature were measured preoperative, during sur- gery and at the postoperative recovery area. Complications within 30 days post-surgery were obtained from the patient data management

system. To rate satisfaction, patients received a questionnaire about the treatment to which they were allocated. At the start of surgery, 3 (3%) patients in the prewarm group were hypothermic compared to 11 (11%) in the standard care with a re- duction of 7% 95%CI [−0.15% to 15%]. At the time of the first incision this was 13 (12%) in the prewarm group compared to 31 (29%) in de standard care group with a statistically significant reduction of 17%, 95%CI [5% to 28%]. At the end of surgery in the prewarm group there were 5 (5%) hypothermic patients compared to 13 (12%) in the stan- dard care group with a reduction of 7%, 95%CI [−1% to 16%]. Upon arrival at the postoperative recovery area this was 11 (10%) in the prewarm group compared to 23 (21%) in the standard care group with a statistically significant reduction of 11%, 95%CI [0.4% to 21%]. In the prewarm group, 6 (5.7%, 95%CI [2.3% to 12.5%]) complications within 30 days post-surgery were recorded compared to 18 (16.8% [10.5% to 25.5%]) complications in the standard care group with a statistically significant reduction of 11.1%, 95%CI [1.8% to 20.4%]. There were no differences between the two groups whether the treat- ment was too warm, too cold or just right. Furthermore, there was no difference in patient satisfaction between treatments. Recent studies show that intraoperative and postoperative hy- pothermia are still common in patients who have undergone orthopedic surgery [3–5]. The conclusions of these studies are in accordance with our results and they emphasize the importance of perioperative tem- perature management. A reduction of perioperative hypothermia, and complications caused by it, can be achieved by adding a simple inter- vention such as prewarming to local perioperative warmings protocols. To conclude, prewarming using forced-air seems to be effective in reducing hypothermia and post-surgical complications in patients un- dergoing total hip- and total knee arthroplasty.

Received 23 July 2019; Received in revised form 23 September 2019; Accepted 27 September 2019

0952-8180/ © 2019 Elsevier Inc. All rights reserved.

Correspondence Table 1 Hypothermic patients and complications during different perioperative stages. Journal of Clinical

Correspondence

Table 1 Hypothermic patients and complications during different perioperative stages.

Journal of Clinical Anesthesia xxx (xxxx) xxxx

 

Prewarming (105) N(%)

Standard care (107) N%

∆% (95% CI)

Preoperative preparation area Start Discharge Operating room Start induction Incision End surgery Postoperative recovery area Arrival Discharge Complications Complications < 30 d post surgery

4 (4%)

8 (7%)

4% (−4% to 11%)

0 (0%)

0 (0%)

0

3 (3%)

11(10%)

7% (−0.15 to 15%) 17% (5% to 28%) 7% (−1% to 16%)

13% (12%)

31% (29%)

5 (5%)

13 (12%)

11 (10%)

23 (21%)

11% (0.4% to 21%) 1% (−8% to 10%)

10 (9%)

9% (8%)

6 (5.7%)

18 (20.4%)

11.1% (1.8% to 20.4%)

Data are numbers (N), percentage (%), risk difference (95% CI).

Declaration of competing interest

No financial support was received for the conduct of this study.

References

[3]

Bram Thiel (MSc) a, , Bart C. Mooijer (BSc) a , Anna S. Kolff-Gart (MD) a,b , Bojana Milojkovic Kerklaan (MD PhD) a,c , Rudolf W. Poolman (MD PhD) d , Peter de Haan (MD PhD) a , Muriel A.M. Siepel (MD) a a Department of Anesthesiology, OLVG Hospital, Amsterdam, the Netherlands b Department of Radiology, Spaarne Gasthuis, Hoofddorp, the Netherlands c Medical Center Dupont, ‘s Heeren Loo, Ermelo, the Netherlands d Department of Orthopedic Surgery, OLVG Hospital, Amsterdam, the Netherlands E-mail address: b.thiel@olvg.nl (B. Thiel).

Corresponding author at: Department of Anesthesiology, OLVG Hospital, Oosterpark 9, P.O. Box 1091 AC, Amsterdam, the Netherlands.

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