Comparison of Two Different Uses of Underbody Forced-air Warming Blankets for the Prevention of Hypothermia in Patients Undergoing Arthroscopic Shoulder Surgery: a Prospective Randomized Study

Background: Forced-air warming (FAW) is an effective method of preventing inadvertent perioperative hypothermia (IPH). However, its warming effects can be influenced by the style and position of the FAW blanket. This study aimed to compare the effects of underbody FAW blankets being placed under or over patients in preventing IPH.Methods: Patients (n=100) undergoing elective arthroscopic shoulder surgery in the lateral decubitus position were randomized into either under body (UB) group or the over body (OB) group (50 per group). The core body temperature (CBT) of the patients was recorded from baseline to the end of anesthesia. The incidences of postoperative hypothermia and shivering were also collected.Results: A steady decline in the CBT was observed in both groups up to 60 minutes after the start of FAW. After 60 minutes of warming, the OB group showed a gradual increase in the CBT. However, the CBT still decreased in UB group until 75 minutes, with a low of 35.7℃ ± 0.4℃. Then the CBT increased mildly and reached 35.8℃ ± 0.4℃ at 90 minutes. After 45 minutes of warming, the CBT was significantly different (P < 0.05). The incidence of postoperative hypothermia in the UB group was significantly higher than that in the OB group (P = 0.023).Conclusions: The CBT was significantly better when the underbody FAW blanket was placed over patients compared with under the patients. However, there was not a clinically significant difference in CBT. The incidence of postoperative hypothermia was much lower in the OB group. Therefore, placing underbody FAW blankets over patients is recommended for the prevention of IPH in patients undergoing arthroscopic shoulder surgery.Trial registration: This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 13/1/2021 with the registration number ChiCTR2100042071. It was conducted from 14/1/2021 to 30/10/2021 as a single, blinded trial in Sichuan Provincial Orthopedic Hospital.

Efficacy and Safety of Forced-Air Warming System versus Passive Warming Measures in Major Surgeries: A Systematic Review

Purpose: To compare the clinical impact of forced-air warming system (Bair HuggerTM, BH) and passive warming measures in major surgery patients. Methods: Databases including Pubmed, Cochrane Library, Clinical Trials.Gov and CNKI were searched to collect studies published before January 2019 that were concerned the clinical effects of Bair Hugger. Two reviewers independently screened the literatures, extracted the data. The revised Jadad scale was used to evaluate the methodological quality of the literatures. Meta-analysis was performed by using Review Manager 5.3.0. Findings: A total of 27 studies were included. The result of meta-analysis showed that BH had a significant advantage in rate of hypothermia (RD = -0.42, 95%CI (-0.68, -0.16)) , shivering (RD = -0.28, 95%CI (-0.43, -0.13)), anesthesia recovery time (MD = -8.27, 95% CI (-13.49, -3.05)), hospital stay (MD = -1.27, 95% CI (-2.05) , -0.48)), while incision infection RD = -0.15, 95%CI (-0.40,0.11)) , intraoperative blood loss (MD = -16.88, 95%CI(-34.73,0.96)), intraoperative blood transfusion (MD = -41.49, 95% CI( -108.36, 25.38)) , pain RD = -0.02, 95%CI(-0.08, 0.03)) and other complications (RD = -0.13, 95%CI(-0.39,0.12)) had an advantage but not significant. Subgroup analyses showed that operation mode and operation duration was the sensitive factors. Conclusion: Compared to passive warming, Bair Hugger has significant advantages in hypothermia protection and further reduces the risk of incision chills and prolonged hospital stay. Combined with the current status of body temperature protection in China, it is necessary to enhance the awareness of body temperature protection, standardize medical behavior, and increase the popularity of active warming systems.

Effectiveness of Combined Strategies for the Prevention of Hypothermia Measured by Noninvasive Zero-Heat Flux Thermometer During Cesarean Section

Background: Perioperative hypothermia (body temperature &lt;36°C) is a common complication of anesthesia increasing the risk for maternal cardiovascular events and coagulative disorders, and can also influence neonatal health. The aim of our work was to evaluate the impact of combined warming strategies on maternal core temperature, measured with the SpotOn. We hypothesized that combined modalities of active warming prevent hypothermia in pregnant women undergoing cesarean delivery with spinal anesthesia.Methods: Seventy-eight pregnant women were randomly allocated into three study groups receiving warmed IV fluids and forced-air warming (AW), warmed IV fluids (WF), or no warming (NW). Noninvasive core temperature device (SpotOn) measured maternal core temperature intraoperatively and for 30 min after surgery. Maternal mean arterial pressure, incidence of shivering, thermal comfort and newborn's APGAR, axillary temperature, weight, and blood gas analysis were also recorded.Results: Incidence of hypothermia was of 0% in AW, 4% in WF, and 47% in NW. Core temperature in AW was constantly higher than WF and NW groups. Incidence of shivering in perioperative time was significantly lower in AW and WF groups compared with the NW group (p &lt; 0.04). Thermal comfort was higher in both AW and WF groups compared with NW group (p = 0.02 and p = 0.008, respectively). There were no significant differences among groups for the other evaluated parameters.Conclusion: Combined modalities of active warming are effective in preventing perioperative hypothermia. The routine uses of combined AW are suggested in the setting of cesarean delivery.

Warm and humidified insufflation gas during gynecologic laparoscopic surgery reduces postoperative pain in predisposed patients—a randomized, controlled multi-arm trial

Background Postoperative pain remains a common problem in gynecologic laparoscopy, especially in head zone-related regions, triggered by intra-abdominal pressure during capnoperitoneum. Humidified and prewarmed insufflation gas may ameliorate pain and be beneficial. Methods This prospective randomized controlled parallel group multi-arm single-center study investigated the effects of temperature and humidity of insufflation gas on postoperative pain during gynecologic laparoscopy with a duration ≥ 60 min. Female participants (18—70 years) were blinded and randomly assigned—computer generated—to either insufflation with dry cold CO2 with forced air warming blanket (“AIR”), humidified warm gas without forced air warming blanket (“HUMI”), or humidified warm gas with forced air warming blanket (“HUMI +”). We hypothesized that using humidified warm gas resulted in lower pain scores and less analgesic consumption. The primary endpoint postoperative pain was assessed for different pain localizations every 12 h during 7 days after surgery. Secondary endpoints were demand for painkillers and epidural anesthetics, length of stay in recovery room, and hospital stay. (Registration: ClinicalTrials.gov NCT02781194—completed). Results 150 participants were randomized. Compared to group “AIR” (n = 48), there was significantly less pain in group “HUMI +” (n = 48) in the recovery room (− 1.068; 95% CI − 2.08 to − 0.061), as well as significantly less ibuprofen use at day two (− 0.5871 g ± 0.258; p-value = 0.0471). Other variables did not change significantly. Stratification for presence of endometriosis or non-previous abdominal surgery in patient history revealed significantly less pain in both groups “HUMI” (n = 50) and “HUMI +” versus group “AIR.” Related side effects were not noted. Conclusion In the overall population, the use of warm, humidified insufflation gas did not yield clinically relevant effects; however, in predisposed patients with endometriosis and who could otherwise expect high pain levels, warm and humidified gas may be beneficial.

Bundled-Care Program for the Prevention of Surgical-Site Infections Following Lower Extremity Total Joint Arthroplasty

Surgical-site infections (SSIs) are among the most difficult-to-manage complications after lower extremity total joint arthroplasty (TJA). While the rates of most implant-related complications have decreased over time due to improvements in prosthetic materials and surgical techniques, the incidence of periprosthetic joint infections (PJIs) continues to increase. They place a tremendous economic burden on healthcare systems that is projected to reach $1.8 billion by the year 2030. A number of perioperative infection mitigation strategies exist that are often implemented concurrently to minimize the risk of these complications. A multicenter randomized controlled trial is underway to evaluate the efficacy of a bundled care program for the prevention of PJIs in lower extremity TJA. This bundle includes five infection-reduction strategies that are used pre-, peri-, and postoperatively, including: (1) povidone-iodine skin preparation and nasal decolonization; (2) iodine-alcohol surgical prepping solution; (3) iodophor-impregnated incise drapes; (4) forced-air warming blankets; and (5) negative pressure wound therapy for select patients. The aim of this review is to describe these products and their appropriate usage, review the available literature evaluating their use, and compare them with other commercially available products. Based on the available literature, each of these strategies appear to be important components for SSI-prevention protocols. We believe that implementing all five of these mitigation strategies concurrently will lead to a synergistic effect for infection control following lower extremity TJA.