C7PRE AND INTRA OPERATIVE WARMING DEVICES

StudyParticipantsInterventions
Bock 1998
Trial held in Germany;
Funding: not stated
Exclusion: patients undergoing surgery of biliary tract, liver, pancreatic, gasterctomy, or those who underwent preoperative radiotherapy or from recurrent rectal cancer; patients with temperature <36.5°C or >37.5°C on arrival in preoperative holding area

Perioperative phase: pre and intra; surgery type: not stated; surgical speciality: abdominal; surgery duration: over 3 h; anaesthesia type:
General; anaesthesia duration more than 1h; premed: midazolam(7.5 mg) 10 min before arrival in holding area; all patients ASA grade: mixed;

Age (range): 46(19–78 years); gender (m/f): 21: 19; BMI: Not stated

comorbidities: not stated; fluids-warmed; gas flow at 3l/min; ambient room temperature: 22°C during preinduction and anaesthesia; included: ASA 1–III undergoing major abdominal surgery for cancer or inflammatory bowel disease; no patients showed signs of bowel obstruction or acute onset of ibd
  1. Warm touch (mallinckrodt medical gmbh) and (circulating water mattress and blankets and fluid warming devices (active patients and active fluids); duration: not stated; 40–42°C; water mattress: 39°C; intervention. Body area covered: arms and chest using forced air; abdomen and legs-blankets; proportion covered ≥ 50%; treated; n=20
  2. Circulating water mattress and blankets and fluid warming devices (active patients and active fluids ); duration: not stated; water mattress: 39°C ontrol body area covered: abdomen and legs/two blankets; arms and chest covered with blankets; proportion covered ≥ 50% treated; n=20
Buggy 1994
Trial held in Ireland;
Funding: not stated
Inclusion: surgery: orthopaedic and plastic surgery on the limbs

Exclusion: patients <14 years or >80 year, with pyrexial illness, those who required mechanical ventilation or who required intraoperativeerative blood transfusions

Perioperative phase: pre and intra; surgery type: elective; surgical speciality: mixed;: mixed; surgery duration: 30 to 60 min; anaesthesia type: general; anaesthesia duration 30 to 60 min; premed: all patients-oral temazepam or diazepam 10 mg; ASA grade: I–II

Age (range): 35 (14–79 years); gender (m/f): 48: 20; BMI: not stated

Comorbidities: not stated; theatre temperature 21–22°C; no patients received IV fluids; humidity-59–61%; air flow maintained constant; closed circle breathing system (Drager, Narkomed) fresh gas glow 1) 5 l/min; active humidification not used.
  1. Space blanket (UN320) placed next to the cotton gown and inside all surgical drapes. (thermal insulation); duration: from before induction to transfer to recovery room; amount; intervention body area covered: at least 60%; proportion covered ≥ 50% treated; n=34
  2. Standard surgical draping (similar to intervention) usual care; control body area covered; proportion covered; n=34
Horn 2002
Trial held in USA;
Funding: not stated
Inclusion: Cesarean delivery. Indication for caesarean including prior caesarean and breech; none were in labour

Exclusion: <18 years, diagnosis of preeclampsia or eclampsia, history or clinical evidence of a clotting disorder. Patients taking any chronic medications (except patients perinatal vitamins)

Perioperative phase: pre and intra; surgery type: elective; surgical speciality: gynaecology;: grade 2; surgery duration: 30 to 60 min; anaesthesia type: regional; anaesthesia duration: not stated; premed: oral ranitidine (150 mg) 2h before surgery; ASA grade: not stated

Age (range): 32 years; gender (m/f): 0: 30; BMI: not stated

comorbidities: not stated; intraoperative ambient temperature maintained near 24°C; fluids warmed to 37°C; patients fasted for at least 6 hours; surgery started 81 min v 89 min after induction for the actively warmed and usual care group, respectively.
  1. Bair Hugger forced-air cover (Augustine Medical) (active warming device); duration: 15 min; 43°C; intervention body area covered: ‘upper body’; proportion covered not stated; n=15
  2. Single cotton blanket usual care; control body area covered; proportion covered: not stated; n=15
Smith 2007
Trial held in USA; Funding: Metro-Health Medical Center, Smiths Medical Asd inc (formerly SIMS)
Inclusion: gynaecological, orthopaedic, urological, general surgery scheduled >30mins

Exclusion: <18/>85 years; abnormal bleeding; malignant Hyperthermia (or fh); pre-operationtemperature >38/<35 c, chemo/major srugery last 3 mo; immuno-suppressed/steroids last 2 wk; coagglutinins/vasospasm; pregnancy

Perioperative phase: pre and intra; surgery type: elective; surgical speciality: mixed surgery
Duration: 30 to 60 min; anaesthesia type: general; anaesthesia duration more than 1h; premed: midazolam; some patients ASA grade: mixed

Age (range): 40 years (SD 13); gender (m/f): 98: 238; BMI: not stated

comorbidities: not stated; 6 patients in each group had diabetes; 67 and 72 were smokers; ambient temperature 21°C; temperature measures; sublingually pre-operation and postoperatively and oesophageal or nasopharyngeal intra-operatively
  1. Snuggle warm convective warming system, sims, Irvine, Ca and warmed IV fluids (active warming device); duration: aim for 30 mins; actually 42 and/−38 min pre- and intra-op; 40°C (SD 1); intervention body area covered: 40%; proportion covered; n=156
  2. Convective air warming and/or warmed IV fluids at discretion of anaesthetist usual care; duration: not stated; control body area covered:; proportion covered: not stated; n=180
Wong 1997
Trial held in UK Funding: not stated
Inclusion: major open abdominal surgery requiring bowel resection, with or without anastomosis; 69% had abdominal surgery for colorectal surgery, 15% inflammatory bowel disease, diverticular disease (7%), gastric carcinoma (3%), benign colonic tumour (2%) and other (5%). Similar proportion of benign and malignant diseases between the 2 groups

Perioperative phase: pre and intra; surgery type: not stated; surgical speciality: abdominal;: unclear; surgery duration: over 3 h; anaesthesia type: general; anaesthesia duration not stated; premed: not stated; ASA grade: mixed

Age (range): 61 years; gender (m/f): 53: 50; BMI: not stated

Comorbidities: not stated;

Exclusion: laparoscopic procedures, use of corticosteroids or other immunosuppressive drugs (including cancer chemotherapy) 4 weeks before surgery, recent history of fever, infection or both
  1. Warming mattress (Inditherm) (pre and intra) and forced air warming (Bair Hugger) and warmed fluids[intra only (active patients and active patients); duration: 2 hr(pre and intra); warming mattress: 40°C; forced air warming: 40°C; Intervention body area covered: patients placed on mattress; length not stated; proportion covered not stated; n=47
  2. Usual care (pre and intra) and forced air warming (Bair Hugger) and warmed fluids [intra only] (active patients and active fluids ); duration: n/r; FAW: 40°C body area covered: patients placed on warming mattress but not turned on; proportion covered not stated; n=56
Wongorasartsuk 1998
Trial held in Australia; Funding: not stated
Exclusion: patients of ASA ≥ IV; <18 or >75 years; inter- current febrile illness, temperature >38°C on arrival in OR, active thyroid disease, allergy to anaesthetic agents to be used or documented history of family history of malignant hyperthermia and emergency surgery

Perioperative phase: pre and intra; surgery type: elective; surgical speciality: orthopaedics;: grade 2;
Surgery duration: 1 to 3 h; anaesthesia type: general; anaesthesia duration not stated; premed: not stated; all patients ASA grade: mixed

Age (range): 50; gender (m/f): 14: 12; BMI: not stated;

comorbidities: not stated; in both groups, after upper body blanket prep, rest of the body covered by 2 layers of cotton blankets prior to surgery; all IV fluids warmed via a warming coil; OR temperature: 18–19°C; at end of surgery, no additional warming
  1. Forced air warming (Bair Hugger) (active warming device); duration: 30 min; not stated; intervention body area covered: upper body and limbs; proportion covered <50% treated; n=14
  2. Two cotton blankets usual care; duration: 30 min; control body area covered: upper body and limbs; proportion covered <50% treated; n=12

From: APPENDIX C, CHARACTERISTICS OF INCLUDED STUDIES

Cover of The Management of Inadvertent Perioperative Hypothermia in Adults
The Management of Inadvertent Perioperative Hypothermia in Adults [Internet].
NICE Clinical Guidelines, No. 65.
National Collaborating Centre for Nursing and Supportive Care (UK).
Copyright © 2008, National Collaborating Centre for Nursing and Supportive Care.

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