Journal List > J Korean Acad Nurs > v.47(4) > 1003251

J Korean Acad Nurs. 2017 Aug;47(4):456-466. Korean.
Published online August 31, 2017.  https://doi.org/10.4040/jkan.2017.47.4.456
© 2017 Korean Society of Nursing Science
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,1 and Haesang Yoon2
1Department of Nursing, Gachon University Gil Medical Center, Incheon, Korea.
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, Email: yoonhs@gachon.ac.kr
Received February 01, 2017; Revised May 22, 2017; Accepted May 22, 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

Figures


Figure 1
Flow diagram of the study participants.
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Tables


Table 2
Baseline Demographic and Clinical Characteristics of Subjects (N=62)
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Table 3
Comparison of Body Temperature, Systolic Blood Pressure, Heart Rate and Shivering between Control and Experimental Groups (N=62)
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Table 4
Comparison of CRP and ESR between Control and Pre-warming Groups (N=62)
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Notes

This manuscript is a revision of the first author's master's thesis from Gachon University.

CONFLICTS OF INTEREST:The authors declared no conflict of interest.

References
1. Sessler DI, Moayeri A, Støen R, Glosten B, Hynson J, Mc-Guire J. Thermoregulatory vasoconstriction decreases cutaneous heat loss. Anesthesiology 1990;73(4):656–660.
2. Matsukawa T, Sessler DI, Christensen R, Ozaki M, Schroeder M. Heat flow and distribution during epidural anesthesia. Anesthesiology 1995;83(5):961–967.
3. Kurz A, Sessler DI, Christensen R, Dechert M. Heat balance and distribution during the core-temperature plateau in anesthetized humans. Anesthesiology 1995;83(3):491–499.
4. Matsukawa T, Sessler DI, Sessler AM, Schroeder M, Ozaki M, Kurz A, et al. Heat flow and distribution during induction of general anesthesia. Anesthesiology 1995;82(3):662–673.
5. National Institute for Health and Clinical Excellence. Clinical Practice Guidelines: The management of inadvertent perioperative hypothermia in adults. London: Royal College of Nursing; 2008. pp. 1-567.
6. Kim EJ, Yoon H. Preoperative factors affecting the intraoperative core body temperature in abdominal surgery under general anesthesia: an observational cohort. Clin Nurse Spec 2014;28(5):268–276. [doi: 10.1097/NUR.0000000000000069]
7. Lee S, Yoon HS. Factors affecting intraoperative body temperature in surgical patients with laparotomy under general anesthesia. J Korean Biol Nurs Sci 2015;17(3):236–244. [doi: 10.7586/jkbns.2015.17.3.236]
8. Kasai T, Hirose M, Matsukawa T, Takamata A, Yaegashi K, Tanaka Y. Preoperative blood pressure and catecholamines related to hypothermia during general anesthesia. Acta Anaesthesiol Scand 2003;47(2):208–212. [doi: 10.1034/j.1399-6576.2003.00048.x]
9. Matsui T, Ishikawa T, Takeuchi H, Okabayashi K, Maekawa T. Mild hypothermia promotes pro-inflammatory cytokine production in monocytes. J Neurosurg Anesthesiol 2006;18(3):189–193. [doi: 10.1097/01.ana.0000188639.39844.f6]
10. Cereda M, Maccioli GA. Intraoperative temperature monitoring. Int Anesthesiol Clin 2004;42(2):41–54.
11. Eberhart LH, Döderlein F, Eisenhardt G, Kranke P, Sessler DI, Torossian A, et al. Independent risk factors for postoperative shivering. Anesth Analg 2005;101(6):1849–1857.
12. Shakya S, Chaturvedi A, Sah BP. Prophylactic low dose ketamine and odansetron for prevention of shivering during spinal anaesthesia. J Anaesthesiol Clin Pharmacol 2010;26(4):465–469.
13. Frank SM, Fleisher LA, Olson KF, Gorman RB, Higgins MS, Breslow MJ, et al. Multivariate determinants of early postoperative oxygen consumption in elderly patients. Effects of shivering, body temperature, and gender. Anesthesiology 1995;83(2):241–249.
14. Kong MJ. In: Risk factors of intraoperative hypothermia in laparoscopic abdominal surgery [Master's thesis]. Incheon: Gachon University; 2013. pp. 1-42.
15. Kasai T, Hirose M, Yaegashi K, Matsukawa T, Takamata A, Tanaka Y. Preoperative risk factors of intraoperative hypothermia in major surgery under general anesthesia. Anesth Analg 2002;95(5):1381–1383.
16. Kitamura A, Hoshino T, Kon T, Ogawa R. Patients with diabetic neuropathy are at risk of a greater intraoperative reduction in core temperature. Anesthesiology 2000;92(5):1311–1318.
17. Kongsayreepong S, Chaibundit C, Chadpaibool J, Komoltri C, Suraseranivongse S, Suwannanonda P, et al. Predictor of core hypothermia and the surgical intensive care unit. Anesth Analg 2003;96(3):826–833. [doi: 10.1213/01.ANE.0000048822.27698.28]
18. A statistical year book for 2015 major surgical case [Internet]. Seoul: National Health Insurance Service; 2016 [cited 2017 May 31].
19. Hynson JM, Sessler DI, Moayeri A, McGuire J, Schroeder M. The effects of preinduction warming on temperature and blood pressure during propofol/nitrous oxide anesthesia. Anesthesiology 1993;79(2):219–228.
discussion 21A-22A.
20. Horn EP, Bein B, Böhm R, Steinfath M, Sahili N, Höcker 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]
21. Andrzejowski J, Hoyle J, Eapen G, Turnbull D. Effect of prewarming on post-induction core temperature and the incidence of inadvertent perioperative hypothermia in patients undergoing general anaesthesia. Br J Anaesth 2008;101(5):627–631. [doi: 10.1093/bja/aen272]
22. Akhtar Z, Hesler BD, Fiffick AN, Mascha EJ, Sessler DI, Kurz A, et al. A randomized trial of prewarming on patient satisfaction and thermal comfort in outpatient surgery. J Clin Anesth 2016;33:376–385. [doi: 10.1016/j.jclinane.2016.04.041]
23. Fettes S, Mulvaine M, Van Doren E. Effect of preoperative forced-air warming on postoperative temperature and postanesthesia care unit length of stay. AORN J 2013;97(3):323–328. [doi: 10.1016/j.aorn.2012.12.011]
24. Wong PF, Kumar S, Bohra A, Whetter D, Leaper DJ. Randomized clinical trial of perioperative systemic warming in major elective abdominal surgery. Br J Surg 2007;94(4):421–426. [doi: 10.1002/bjs.5631]
25. Fossum S, Hays J, Henson MM. A comparison study on the effects of prewarming patients in the outpatient surgery setting. J Perianesth Nurs 2001;16(3):187–194. [doi: 10.1053/jpan.2001.24039]
26. Sessler DI, Schroeder M, Merrifield B, Matsukawa T, Cheng C. Optimal duration and temperature of prewarming. Anesthesiology 1995;82(3):674–681.
27. Crossley AW, Mahajan RP. The intensity of postoperative shivering is unrelated to axillary temperature. Anaesthesia 1994;49(3):205–207. [doi: 10.1111/j.1365-2044.1994.tb03422.x]
28. Kim HY, Lee KC, Lee MJ, Kim MN, Kim JS, Lee WS, et al. Comparison of the efficacy of a forced-air warming system and circulating-water mattress on core temperature and postanesthesia shivering in elderly patients undergoing total knee arthroplasty under spinal anesthesia. Korean J Anesthesiol 2014;66(5):352–357. [doi: 10.4097/kjae.2014.66.5.352]
29. Mekjavić IB, Bligh J. Core threshold temperatures for sweating. Can J Physiol Pharmacol 1989;67(9):1038–1044.
30. C-reactive protein: Clinical applications [Internet]. Delhi: Embee Diagnostics; c2002 [cited 2017 July 07].
Available from: www.embeediagnostics.com.