scholarly journals Effects of 10-min of pre-warming on inadvertent perioperative hypothermia in intraoperative warming patients: a randomized controlled trial

2020 ◽  
Vol 15 (3) ◽  
pp. 356-364
Author(s):  
Jae Hwa Yoo ◽  
Si Young Ok ◽  
Sang Ho Kim ◽  
Ji Won Chung ◽  
Sun Young Park ◽  
...  
Keyword(s):  
Body Temperature ◽  
Thermal Comfort ◽  
Elective Surgery ◽  
Controlled Trial ◽  
Randomized Study ◽  
Perioperative Period ◽  
Control Group ◽  
Perioperative Hypothermia ◽  
Randomized Controlled ◽  
Forced Air

Background: This study aimed to evaluate the efficacy of 10-min pre-warming in preventing inadvertent perioperative hypothermia, which is defined as a reduction in body temperature to less than 36.0℃ during the perioperative period in intraoperative warming patients. Methods: In this prospective randomized study, 60 patients scheduled for elective surgery under general anesthesia lasting less than 120 min were divided into two groups: the 10-min pre-warming group (n = 30) and the control group (n = 30). Patients in the 10-min pre-warming group were pre-warmed for 10 min in the pre-anesthetic area using a forced-air warmer set at 47ºC. Intraoperatively, we warmed all patients with a forced-air warmer. Body temperature was measured using a tympanic membrane thermometer pre- or postoperatively and a nasopharyngeal temperature probe intraoperatively. Patients were evaluated on the shivering and thermal comfort scale in the pre-anesthetic area and post-anesthesia care unit. Results: The incidences of intraoperative hypothermia and postoperative hypothermia were similar in both groups (10.7% vs. 28.6%, P = 0.177; 10.7% vs. 10.7%, P = 1.000 respectively). Body temperature was higher in the 10-min pre-warming group (P = 0.003). Thermal comfort during the pre-warming period was higher in the 10-min pre-warming group (P < 0.001). However, postoperative thermal comfort and shivering grades of both groups were similar.Conclusions: Ten minutes of pre-warming has no additional effect on the prevention of inadvertent perioperative hypothermia in intraoperative warming patients.

scholarly journals Does pregabalin effectively and safely relieve postoperative pain in patients undergoing pulmonary resections?

2019 ◽  
Vol 29 (4) ◽  
pp. 555-560 ◽  
Author(s):  
Shuangjiang Li ◽  
Wenbiao Zhang ◽  
Shan Cheng ◽  
Yongjiang Li
Keyword(s):  
Randomized Controlled Trial ◽  
Postoperative Pain ◽  
Randomized Controlled Trials ◽  
Controlled Trial ◽  
Perioperative Period ◽  
Control Group ◽  
Controlled Trials ◽  
Clinical Question ◽  
Randomized Controlled ◽  
Study Type

Summary A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether pregabalin could effectively and safely reduce postoperative pain in patients undergoing pulmonary resections. Altogether 23 papers were found using the reported search, of which 6 randomized controlled trials represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Five of 6 randomized controlled trials demonstrated that the application of oral pregabalin during the perioperative period could effectively reduce postoperative pain after pulmonary resections without compromising patients’ safety. One randomized controlled trial reported no difference in the postoperative pain levels between the pregabalin group and the control group. The rates of adverse effects were generally found to be decreased in patients who received pregabalin compared to the patients who received routine analgesia, although 2 studies reported significantly higher incidences of mild drowsiness and dizziness among the pregabalin-treated patients. Currently available evidence supports that the perioperative administration of pregabalin can effectively and safely relieve postoperative pain for patients undergoing pulmonary resections.

scholarly journals Effect of individualized PEEP titration guided by intratidal compliance profile analysis on regional ventilation assessed by electrical impedance tomography – a randomized controlled trial

2019 ◽  
Author(s):  
Jonas Weber ◽  
Jan Gutjahr ◽  
Johannes Schmidt ◽  
Sara Lozano-Zahonero ◽  
Silke Borgmann ◽  
...  
Keyword(s):  
Respiratory System ◽  
Elective Surgery ◽  
Profile Analysis ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Regional Ventilation ◽  
Impedance Tomography ◽  
Randomized Controlled ◽  
Hemodynamic Variables

Abstract Background Application of positive end-expiratory pressure (PEEP) improves lung aeration and reduces mechanical stress during mechanical ventilation. Although numerous approaches for PEEP titration have been proposed, there is no accepted strategy to titrate optimal PEEP. By analyzing the intratidal compliance profiles, PEEP may be titrated patient-individually. Methods After obtaining informed consent, we measured respiratory system mechanics, regional ventilation in 60 consecutive patients undergoing elective surgery, randomly allocated to the control group (PEEP = 5 cmH 2 O) or the intervention group receiving individually titrated PEEP, guided by intratidal compliance profile analysis. Primary endpoint was the frequencies of nonlinear intratidal compliance (C RS ) profiles of the respiratory system (horizontal, increasing, decreasing and mixed). We further investigated respiratory and hemodynamic variables and regional ventilation. Results Frequencies of C RS profiles were comparable between the groups. Besides PEEP [control: 5.0 (0.0), intervention: 5.8 (1.1) cmH 2 O, p<0.001] respiratory and hemodynamic variables were comparable between the two groups. The compliance profile analysis showed no significant differences between the two groups. The loss of ventral and dorsal regional ventilation was higher in the control [ventral: 41.0 (16.3) %, dorsal: 25.9 (13.8) %] than in the intervention group [ventral: 29.3 (17.6) %, dorsal: 16.4 (12.7) %, p (ventral) = 0.039, p (dorsal) = 0.028]. Conclusions Individualized PEEP titration according to bedside compliance profile analysis improves regional ventilation in terms of global aeration gain without affecting respiratory and hemodynamic variables negatively and might be a promising approach to patient-individual ventilation settings. However, differences in dorsal to ventral ventilation distribution were not found. Unfavorable compliance profiles indicating tidal derecruitment were found less often than in earlier studies.

scholarly journals Protocol-driven prevention of perioperative hypothermia in the pediatric neurosurgical population

2020 ◽  
Vol 25 (5) ◽  
pp. 548-554
Author(s):  
Ian Mutchnick ◽  
Meena Thatikunta ◽  
Julianne Braun ◽  
Martha Bohn ◽  
Barbara Polivka ◽  
...  
Keyword(s):  
Surgical Site Infections ◽  
Pediatric Neurosurgery ◽  
Perioperative Period ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Postanesthesia Care Unit ◽  
Control Group ◽  
Time Interval ◽  
Perioperative Hypothermia ◽  
Forced Air

OBJECTIVEPerioperative hypothermia (PH) is a preventable, pathological, and iatrogenic state that has been shown to result in increased surgical blood loss, increased surgical site infections, increased hospital length of stay, and patient discomfort. Maintenance of normothermia is recommended by multiple surgical quality organizations; however, no group yet provides an ergonomic, evidence-based protocol to reduce PH for pediatric neurosurgery patients. The authors’ aim was to evaluate the efficacy of a PH prevention protocol in the pediatric neurosurgery population.METHODSA prospective, nonrandomized study of 120 pediatric neurosurgery patients was performed. Thirty-eight patients received targeted warming interventions throughout their perioperative phases of care (warming group—WG). The remaining 82 patients received no extra warming care during their perioperative period (control group—CG). Patients were well matched for age, sex, and preparation time intraoperatively. Hypothermia was defined as < 36°C. The primary outcome of the study was maintenance of normothermia preoperatively, intraoperatively, and postoperatively.RESULTSWG patients were significantly warmer on arrival to the operating room (OR) and were 60% less likely to develop PH (p < 0.001). Preoperative forced air warmer use both reduced the risk of PH at time 0 intraoperatively and significantly reduced the risk of any PH intraoperatively (p < 0.001). All patients, regardless of group, experienced a drop in core temperature until a nadir occurred at 30 minutes intraoperatively for the WG and 45 minutes for the CG. At every time interval, from preoperatively to 120 minutes intraoperatively, CG patients were between 2 and 3 times more likely to experience PH (p < 0.001). All patients were warm on arrival to the postanesthesia care unit regardless of patient group.CONCLUSIONSPreoperative forced air warmer use significantly increases the average intraoperative time 0 temperature, helping to prevent a fall into PH at the intraoperative nadir. Intraoperatively, a strictly and consistently applied warming protocol made intraoperative hypothermia significantly less likely as well as less severe when it did occur. Implementation of a warming protocol necessitated only limited resources and an OR culture change, and was well tolerated by OR staff.

Forced-Air Warming for Rewarming and Comfort Following Laparoscopy: A Randomized Controlled Trail

2017 ◽  
Vol 27 (5) ◽  
pp. 540-559 ◽  
Author(s):  
Hsiao-Chi Nieh ◽  
Shu-Fen Su
Keyword(s):  
Controlled Trial ◽  
Estimating Equation ◽  
Comfort Level ◽  
Tympanic Temperature ◽  
Postanesthesia Care Unit ◽  
Control Group ◽  
Randomized Controlled ◽  
Comfort Levels ◽  
Forced Air Warming ◽  
Forced Air

We investigated the efficacy of a forced-air warming (FAW) system on postoperative rewarming and comfort in patients undergoing laparoscopic surgery. In this randomized controlled trial, a total of 127 participants were randomly divided into the FAW group ( n = 64) and control group ( n = 63). The esophageal temperature was measured every 30 min during surgery, and the tympanic temperature and comfort levels were measured preoperatively and in the postanesthesia care unit (PACU). Data analysis used the generalized estimating equation. We found that there was a lower incidence of postoperative hypothermia in the FAW group compared with the control group, as well as a higher body temperature between 30 and 180 min in the PACU, a shorter time for rewarming, and a higher comfort level. Taken together, these results suggest that FAW is an effective rewarming technique for laparoscopic patients during surgery and in the PACU that improves comfort levels.

scholarly journals Effect of fast-track surgery in gynecological laparoscopy: a randomized controlled trial

2020 ◽  
Vol 7 (3) ◽  
pp. 235-238
Author(s):  
Xue-Ping Zhu ◽  
Sha-Sha Zhao ◽  
Jie-Dan Qin
Keyword(s):  
Fast Track ◽  
Controlled Trial ◽  
Postoperative Nausea And Vomiting ◽  
Perioperative Period ◽  
Bowel Function ◽  
Control Group ◽  
Fast Track Surgery ◽  
Randomized Controlled ◽  
Gynecological Laparoscopy ◽  
Function Recovery

AbstractObjectiveTo evaluate the value of fast-track surgery (FTS) in gynecological laparoscopy during the perioperative period.MethodsThe clinical data of 234 patients who underwent gynecological laparoscopy from January to December in 2018 were collected. Of note, 117 patients received a routine nursing method (control group), and 117 patients received the FTS nursing method (observation group).ResultsCompared with the control group, FTS group had a quicker postoperative bowel function recovery, earlier to get out of bed, and a lower anxiety level (P < 0.05); The incidence of postoperative nausea and vomiting of two groups had no statistical difference.ConclusionsThe application of FTS in gynecological laparoscopy is safe, effective, and worth promoting.

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

Heart ◽  
2017 ◽  
Vol 104 (8) ◽  
pp. 685-690 ◽  
Author(s):  
Aaron Conway ◽  
Suzanna Ersotelos ◽  
Joanna Sutherland ◽  
Jed Duff
Keyword(s):  
Randomised Controlled Trial ◽  
Thermal Comfort ◽  
Controlled Trial ◽  
Cardiac Catheterisation ◽  
Control Group ◽  
Major Complications ◽  
Forced Air Warming ◽  
Forced Air ◽  
Randomised Controlled ◽  
Catheterisation Laboratory

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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