Core temperature monitoring during cesarean delivery under spinal anesthesia: a quality improvement descriptive study

2020 ◽  
Author(s):  
Laura Burey ◽  
Briana Lui ◽  
Robert S White ◽  
Virginia E Tangel ◽  
Klaus Kjaer
Keyword(s):  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Core Temperature ◽  
Information Management System ◽  
Temperature Monitoring ◽  
Interquartile Range ◽  
Maximum Temperature ◽  
Bladder Temperature ◽  
Median Maximum ◽  
Continuous Temperature

Aim: To analyze intraoperative temperature change over time following spinal anesthesia for cesarean delivery using temperature enabled Foley catheters. Materials & methods: 512 records of women who underwent scheduled cesarean deliveries were retrospectively identified from January 1, 2018 through September 9, 2018 using our anesthesia information management system. Results: Median minimum temperature at min 1 following foley insertion was 35.24°C (interquartile range: 1.43), with an average of 12 minutes until temperature equilibration at median maximum temperature of 36.54°C (interquartile range 0.39). Temperature dropped to a nadir of 35.9°C at the 45 min mark, reflecting an average 0.64°C decline in temperature. Conclusion: Bladder temperature is a useful surrogate for core temperature and offers a practical solution to continuous temperature monitoring in awake patients.

scholarly journals Association between Preoperative Toe Perfusion Index and Maternal Core Temperature Decrease during Cesarean Delivery Under Spinal Anesthesia: A Prospective Cohort Study

2021 ◽  
Author(s):  
Shohei Kaneko ◽  
Kentaro Hara ◽  
Shuntaro Sato ◽  
Takaya Nakashima ◽  
Yurika Kawazoe ◽  
...  
Keyword(s):  
Cohort Study ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Core Temperature ◽  
Prospective Cohort Study ◽  
Pulse Oximeter ◽  
Prospective Cohort ◽  
Perfusion Index ◽  
Temperature Decrease ◽  
Pulse Oximeter Probe

Abstract Background: The main mechanism of temperature decrease during spinal anesthesia for cesarean delivery is core-to-peripheral redistribution of body heat, attributable to vasodilation. Perfusion index (PI) obtained with a pulse oximeter helps to assess peripheral perfusion dynamics by detecting changes in peripheral vascular tone. This study aimed to examine whether preoperative toe PI could predict spinal anesthesia-induced core temperature decrease during cesarean delivery.Methods: Parturients undergoing scheduled cesarean delivery under combined spinal-epidural anesthesia from September 2019 to March 2020 were enrolled in this single-center prospective cohort study. All parturients received 0.5% hyperbaric bupivacaine (10 mg) with fentanyl (15 µg) intrathecally. A pulse oximeter probe was placed on the left second toe for continuous PI measurement. The 3M™ Bair Hugger™ Temperature Monitoring System placed over the right temporal region was used to record core temperature over time. We evaluated the association between the maximum core temperature decrease, which is the primary outcome, and the preoperative toe PI at operating room (OR) admission using a segmented regression model (SRM) and a generalized additive model (GAM). The maximum core temperature decrease was defined as the difference between core temperature at OR admission and minimum intraoperative core temperature.Results: Forty-eight patients were evaluated. In the SRM, the slope for the association between the maximum core temperature decrease and the preoperative toe PI changed from 0.031 to 0.124 after PI = 2.4%. Likewise, with the GAM, there was a small core temperature decrease when preoperative toe PI was greater than 2.0% to 3.0%.Conclusions: A lower preoperative toe PI was associated with maternal core temperature decrease during cesarean delivery under spinal anesthesia. Preoperative toe PI is a simple, non-invasive, and effective tool for the early prediction of perioperative core temperature decrease during cesarean delivery.Trial registration: UMIN Clinical Trials Registry (registry number: UMIN000037965).URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042953

Core Temperature Monitoring in Obstetric Spinal Anesthesia Using an Ingestible Telemetric Sensor

2018 ◽  
Vol 126 (1) ◽  
pp. 190-195 ◽  
Author(s):  
Leon du Toit ◽  
Dominique van Dyk ◽  
Ross Hofmeyr ◽  
Carl J. Lombard ◽  
Robert A. Dyer
Keyword(s):  
Spinal Anesthesia ◽  
Core Temperature ◽  
Temperature Monitoring

scholarly journals Noninvasive Temperature Monitoring in Postanesthesia Care Units

2009 ◽  
Vol 111 (1) ◽  
pp. 90-96 ◽  
Author(s):  
Geoffrey E. Langham ◽  
Ankit Maheshwari ◽  
Kevin Contrera ◽  
Jing You ◽  
Edward Mascha ◽  
...  
Keyword(s):  
Core Temperature ◽  
Liquid Crystal Display ◽  
Temporal Artery ◽  
Hospital Performance ◽  
Performance Measure ◽  
Temperature Monitoring ◽  
Postanesthesia Care Unit ◽  
Monitoring Methods ◽  
Temperature Deviation ◽  
Bladder Temperature

Background Initial postoperative core temperature is a physician and hospital performance measure. However, the extent to which core temperature changes during emergence from anesthesia and transport from the operating room to the postanesthesia care unit (PACU) remains unknown. Similarly, the accuracy of many noninvasive temperature-monitoring methods used in the PACU has yet to be quantified. This study, therefore, quantified the change in core temperature occurring during emergence and transport and evaluated the accuracy and precision of eight noninvasive thermometers in the PACU. Methods In 50 patients having laparoscopic surgery, the authors measured temperatures upon PACU arrival and 30 and 60 min thereafter. Monitoring methods included oral, axillary, temporal artery, forehead skin-surface, forehead liquid-crystal display, infrared aural canal, deep forehead, and deep chest. Bladder temperature was used as the reference and was also measured at the end of surgery. The primary outcome was agreement between individual temperatures from each method and bladder temperature in the PACU. A priori, the authors chose 0.5 degrees C as a clinically important temperature deviation. Results Bladder temperature increased 0.2 +/- 0.3 degrees C (95% confidence interval 0.1 to 0.3 degrees C), P < 0.001, during transport. None of the tested noninvasive thermometers was consistently within 0.5 degrees C of bladder temperature. However, oral, deep forehead, and temporal artery temperatures were significantly better than other methods and agreed reasonably well with bladder temperature. Conclusions Invasive temperature monitoring available intraoperatively is more accurate than any generally available postoperative methods. Physician performance measures should therefore not be based exclusively on postoperative temperatures. Among the generally available postoperative monitoring methods, electronic oral thermometry appears to be the best.

Core Temperature Monitoring in Obstetric Spinal Anesthesia Using an Ingestible Telemetric Sensor

2018 ◽  
Vol 38 (2) ◽  
pp. 107-108
Author(s):  
L. du Toit ◽  
D. van Dyk ◽  
R. Hofmeyr ◽  
C.J. Lombard ◽  
R.A. Dyer
Keyword(s):  
Spinal Anesthesia ◽  
Core Temperature ◽  
Temperature Monitoring

Prediction of Post spinal anesthesia hypotension in patients undergoing cesarean section using Perfusion index

2020 ◽  
Vol 5 (3) ◽  
pp. 1241-1245
Author(s):  
Kumud Pyakurel ◽  
Lalit Kumar Rajbanshi ◽  
Ramesh Bhattarai ◽  
Sonia Dahal
Keyword(s):  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Supine Position ◽  
Roc Curve ◽  
Anesthetic Management ◽  
College Teaching ◽  
Perfusion Index ◽  
Sensory Level ◽  
Roc Curve Analysis ◽  
Group I

Introduction: Spinal anesthesia induced hypotension frequently complicates Cesarean delivery. This is usually due to sudden sympatholysis causing decreased venous return which can be aggravated by physiological changes of pregnancy leading to change in baseline peripheral vascular tone. Strategies to prevent hypotensive episodes should be the primary aim of anesthetic management. A simple noninvasive measurement of perfusion index derived from pulse oximeter predicting hypotension during the routine intraoperative course could provide a new dynamism to the management and improving the safe execution of anesthesia. Objectives: The primary objective of this study was to compare incidence of hypotension following SAB for LSCS in patients with baseline PI ≤ 3.5 to those with PI > 3.5. The secondary objectives were to compare PI, HR, SBP, MAP at various time intervals and also to study the side effects between the two groups. Methodology: This prospective observational study was conducted at Nobel Medical College Teaching Hospital from to July 2019 to October 2019. 73 Term parturients presenting for elective cesarean delivery were included for the study. Upon arrival in the operation room, standard monitors were attached and baseline HR, SBP, DBP, MAP, PI and SPO2 were recorded in supine position. The patients with baseline PI ≤ 3.5 were enrolled into Group I and those with a PI > 3.5 were enrolled into Group II. Spinal Anesthesia with 10mg of 0.5% heavy Bupivacaine and 20mcg Fentanyl ( total 2.4ml) was given at L3-L4 interspace in sitting position using midline approach. Patient was then returned to supine position with left lateral tilt of 15 degrees to facilitate left uterine displacement. Upper sensory level was checked at 5 minutes using alcohol swab. Once T-6 level was reached, surgery was started. Maternal SBP, DBP, MAP, HR and PI were recorded at 1 minute intervals between spinal injection and delivery and then 3 minutes until end of surgery. Clinically relevant hypotension was defined as the decrease in MAP by 20% or more from baseline value. Results: The incidence of hypotension in Group I was 18.8% (6/30) compared to 81.3% (26/38). This was clinically and statistically highly significant (P = 0.000, odds ratio 0.11). On Spearman’s rank correlation we found highly significant correlation between baseline PI >3.5 and number of episodes of hypotension (rs 0.482, P = 0.000). The sensitivity and specificity of baseline PI with cut-off 3.5 for predicting hypotension were 81.3% and 66.7% respectively. The ROC curve analysis showed 3.53 as appropriate cut‑off for our findings. The area under the ROC curve (AUC) was 0.734 [Figure 6](Lower bound 0.608 and upper bound 0.861, P=0.001).  Conclusion : This study demonstrates that baseline PI of > 3.5 correlates with incidence of hypotension after spinal anesthesia for cesarean delivery in healthy parturients compared to a baseline PI of < 3.5.

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