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

You Mi Cheon; Haesang Yoon

doi:10.4040/jkan.2017.47.4.456

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Cheon and Yoon: 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

Original Article

J Korean Acad Nurs 2017;47(4):456-466.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.4.456

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

You Mi Cheon¹, Haesang Yoon^2,

¹Department of Nursing, Gachon University Gil Medical Center, Incheon

²College of Nursing, Gachon University, Incheon, Korea

Address reprint requests to : Yoon, Haesang College of Nursing, Gachon University, 191 Hambakmoero, Incheon 21936, Korea Tel: +82-32-820-4212 Fax: +82-32-820-4201 E-mail: yoonhs@gachon.ac.kr

Received 1 February 2017 Revised 22 May 2017 Accepted 22 May 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

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 (χ²=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: Hypothermia, Body temperature regulation, Hemodynamics, Shivering, Inflammation

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Figure 1.

Flow diagram of the study participants.

Table 1.

Measurement of Outcome by Time Sequence

Time	At preanesthetic review	Arrival at preanesthetic room	Just before spinal anesthesia	Induction of spinal anesthesia	1, 2 and 3 hours after induction of spinal anesthesia	30 minutes after arrival at PACU	Postoperative
		Base line	Time 1		Time 2 Time 3 Time 4	Time 5 Time 6	1 day 2 day
Spinal				Administration of
anesthesia				0.5% bupivacaine
				2 mg/kg into
				subdural cavity
Nursing		CG: No intervention		CG and EG: Starting		CG and EG:
intervention				intraoperative		Postoperative
		EG: prewarming		warming using		warming
		using forced-		circulating water		using forced-
		air warming		mattress set to		air warming
		mattress set		37°C		mattress set
		to 40~42°C				to 40~42°C
		during 30 min
Outcomes	Weight	CBT	CBT		CBT	Shivering	CRP
	Height	SBP	SBP		SBP		ESR
	WBC	Heart Rate	Heart Rate		Heart Rate
	CRP		SaO₂		Ambient
	ESR				temperature

PACU=Postanesthetic care unit; CG=Control group; EG=Experimental (pre-warming) group; CRP=C-reactive protein; ESR=Erythrocyte sedimentation rate; CBT=Core body temperature; SBP=Systolic blood pressure.

Table 2.

Baseline Demographic and Clinical Characteristics of Subjects (N=62)

Variables		Experimental group (n=31)	Control group (n=31)	t or χ²	p
			M±SD or n (%)
Age (yr)		73.33±6.43	73.41±6.82	0.03	.926
Gender	Female	20 (64.5)	22 (71.0)	0.30	.587
	Male	11 (35.5)	9 (29.0)
Weight (kg)		56.34±9.67	60.82±9.92	1.81	.077
Level of spinal anesthesia	T4	15 (48.4)	21 (67.7)	3.22	.200
	T5	11 (32.3)	9 (25.0)	3.22	.200
	T8	6 (19.4)	3 (6.3)	3.22	.200
Duration of operation (min)		179.33±24.04	185.71±25.14	1.03	.310
Duration of anesthesia (min)		212.89±27.88	212.79±29.24	-0.02	.984
Ambient temperature (°C)		18.43±0.24	18.34±0.33	-0.95	.347
Albumin (g/dL)		3.25±0.61	3.48±0.64	1.49	.143
SaO₂ (%)*		94.62±9.01	95.21±4.91	0.33	.742
Blood loss (mL)		319.44±195.23	406.89±194.44	1.74	.087
WBC (number/mm³)		7,790±1,880	7,990±3,230	0.30	.767
CRP (mg/dL)		2.12±2.31	3.36±2.68	1.94	.069
ESR (mm/h)		18.93±16.73	24.14±22.06	1.06	.297

CRP=C-reactive protein; ESR=Erythrocyte sedimentation rate.

^*=SaO2 just before spinal anesthesia/Time 1.

Table 3.

Comparison of Body Temperature, Systolic Blood Pressure, Heart Rate and Shivering between Control and Experimental Groups (N=62)

Variable	Time	Experimental group (n=31)	Control group (n=31)	Source	F or χ²	p	Mean difference (95% CI)	t	p^‡
			M±SD or n(%)
Body temperature (°C)	Arrival at pre-anesthetic room	36.71±0.33	36.82±0.39				0.08	0.92	.364
							(-0.09~0.27)
	Before induction for spinal anesthesia	36.70±0.39	36.52±0.34				-0.17	-2.23	.029
							(-0.02~-0.35)
	1 hr after spinal anesthesia	36.13±0.48	35.93±0.41	Time	99.21	<.001	-0.22	-2.22	.031
				Group	4.20	.045	(-0.01~-0.45)
	2 hr after spinal anesthesia	35.84±0.48	35.53±0.42	T*G	3.85	.008	-0.31	-3.10	.003
							(-0.07~-0.54)
	3 hr after spinal anesthesia	35.62±0.53	35.31±0.44				-0.30	-3.14	.003
							(-0.05~-0.54)
Systolic blood	Arrival at pre-anesthetic room	143.00±20.45	153.10±29.63
pressure	Before induction for spinal anesthesia	145.65±25.59	152.10±26.72	9.88 Time	<.001
(mmHg)	1 hr after spinal anesthesia	126.68±18.63	132.77±19.07	2.75 Group	.102
	2 hr after spinal anesthesia	128.10±18.64	135.03±19.23	0.27 T*G	.899
	3 hr after spinal anesthesia	128.68±17.89	136.39±20.20
Heart rate	Arrival at pre-anesthetic room	74.32±13.26	75.19±12.12
(bpm)	Before induction for spinal anesthesia	71.58±15.27	75.26±12.95	5.43 Time	.001
	1 hr after spinal anesthesia	68.97±14.03	69.87±14.13	0.16 Group	.691
	2 hr after spinal anesthesia	68.81±12.99	69.35±14.98	0.94 T*G	.480
	3 hr after spinal anesthesia	69.03±11.92	69.19±13.33
Shivering	For 30 after arrival at PACU
	Yes	5 (16.1)	14 (45.2)	6.15	.013
	No	26 (83.9)	17 (54.8)

PACU=Post anesthetic care unit; T*G=Time*Group; bpm=Beats per minute. ‡=Multiple comparison with Bonferroni’s correction (p=.010) between control and experimental group.

Table 4.

Comparison of CRP and ESR between Control and Pre-warming Groups (N=62)

Variable	Time	Experimental group (n=31)	Control group (n=31)	Source	F	p	Mean difference (95% CI)	t or U	p^‡
			M±SD
CRP	Pre-operative	1.93±2.41	3.06±2.41	Time	28.12	<.001	1.13 (-0.09~2.36)	1.85	.069
Post-op 1d	ay	5.33±3.11	8.70±6.08	Group	5.42	.023	3.37 (0.92~5.83)	2.75	.008
Post-op 2d	ay	2.87±3.51	3.99±6.47	T*G	1.85	.166	1.12 (-1.52~3.77)	-0.36^u	.720
ESR	Pre-operative	18.92±16.72	24.16±22.10	Time	11.43	<.001	5.24 (-4.71~15.18)	1.05	.297
Post-op 1d	ay	25.71±20.40	35.09±28.50	Group	1.82	.094	9.38 (-3.20~21.04)	1.49	.141
	Post-op 2day	25.90±15.52	36.50±24.11	T*G	0.69	.508	10.60 (0.31~20.87)	2.06	.044

CRP=C-Reactive protein; U=Mann-Whitney U test; ESR=Erythrocyte sedimentation rate; T*G=Time*Group; Pre-op=Pre-operative; Post-op=Post-operative; CI=Confidence interval.

^‡=Multiple comparison with Bonferroni's correction (p=.017) between control and experimental group.

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