Abstract
Purpose
The aim of this study was to evaluate the effects of pre-warmed (approximately 41 °C) intravenous fluids (IV) on perioperative hypothermia and postoperative shivering in female patients undergoing short, ambulatory urological surgery under monitored anesthesia care (MAC).
Methods
Patients between the ages of 35 and 80 years were randomly assigned to either the pre-warmed (n = 27) or the room temperature (n = 26) group. According to group allocation, either pre-warmed IV fluids that had been stored in a warming cabinet for at least 8 h or room temperature IV fluids were administered intraoperatively up to approximately 600–700 ml, including a bolus infusion of 10 ml/kg within 20 min. Perioperative core temperatures at the tympanic membrane, postoperative shivering, subjective thermal comfort, and the use of forced-air warming interventions in the post-anesthesia care unit (PACU) were recorded.
Results
Mean core temperatures were significantly higher in the pre-warmed group than they were in the room temperature group after 10 ml/kg preload fluid was administered, at the end of the operation, and on admission to the PACU (p = 0.004, p = 0.02, and p = 0.008, respectively). The incidence of hypothermia (<36 °C) was significantly lower in the pre-warmed group (n = 4) than in the room temperature group (n = 11, p = 0.035) upon PACU admission. The postoperative shivering incidence was also significantly lower in the pre-warmed group (n = 2) than in the room temperature group (n = 8, p = 0.039).
Conclusions
Infusion of pre-warmed IV fluid improved the postoperative recovery profile by decreasing hypothermia and shivering in female patients undergoing short, ambulatory urological surgery under MAC.
Similar content being viewed by others
References
Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet. 1996;347:289–92.
Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, Beattie C. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997;277:1127–34.
Esnaola NF, Cole DJ. Perioperative normothermia during major surgery: is it important? Adv Surg. 2011;45:249–63.
Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996;334:1209–15.
Arkilic CF, Akca O, Taguchi A, Sessler DI, Kurz A. Temperature monitoring and management during neuraxial anesthesia: an observational study. Anesth Analg. 2000;91:662–6.
Frank SM, Fleisher LA, Olson KF, Gorman RB, Higgins MS, Breslow MJ, Sitzmann JV, Beattie C. Multivariate determinants of early postoperative oxygen consumption in elderly patients. Effects of shivering, body temperature, and gender. Anesthesiology. 1995;83:241–9.
Yokoyama K, Suzuki M, Shimada Y, Matsushima T, Bito H, Sakamoto A. Effect of administration of pre-warmed intravenous fluids on the frequency of hypothermia following spinal anesthesia for Cesarean delivery. J Clin Anesth. 2009;21:242–8.
Woolnough M, Allam J, Hemingway C, Cox M, Yentis SM. Intra-operative fluid warming in elective caesarean section: a blinded randomised controlled trial. Int J Obstet Anesth. 2009;18:346–51.
Andrzejowski JC, Turnbull D, Nandakumar A, Gowthaman S, Eapen G. A randomised single blinded study of the administration of pre-warmed fluid vs active fluid warming on the incidence of peri-operative hypothermia in short surgical procedures. Anaesthesia. 2010;65:942–5.
Smith CE, Gerdes E, Sweda S, Myles C, Punjabi A, Pinchak AC, Hagen JF. Warming intravenous fluids reduces perioperative hypothermia in women undergoing ambulatory gynecological surgery. Anesth Analg. 1998;87:37–41.
Bayman EO, Dexter F, Laur JJ, Wachtel RE. National incidence of use of monitored anesthesia care. Anesth Analg. 2011;113:165–9.
Butterworth IV JF, Mackey DC, Wasnick JD. Fluid management and blood component therapy. In: Belval B, Lebowitz L, editors. Morgan & Mikhail’s clinical anesthesiology. New York: McGraw-Hill; 2013. pp. 1161–81.
Bartels K, Barbeito A, Mackensen GB. The anesthesia team of the future. Curr Opin Anaesthesiol. 2011;24:687–92.
White PF, Eng M. Fast-track anesthetic techniques for ambulatory surgery. Curr Opin Anaesthesiol. 2007;20:545–57.
White PF, Kehlet H, Neal JM, Schricker T, Carr DB, Carli F, Fast-Track Surgery Study Group. The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care. Anesth Analg. 2007;104:1380–96.
Awad IT, Chung F. Factors affecting recovery and discharge following ambulatory surgery. Can J Anaesth. 2006;53:858–72.
Tesniere A, Servin F. Intravenous techniques in ambulatory anesthesia. Anesthesiol Clin N Am. 2003;21:273–88.
Matsukawa T, Kurz A, Sessler DI, Bjorksten AR, Merrifield B, Cheng C. Propofol linearly reduces the vasoconstriction and shivering thresholds. Anesthesiology. 1995;82:1169–80.
Smith CE, Desai R, Glorioso V, Cooper A, Pinchak AC, Hagen KF. Preventing hypothermia: convective and intravenous fluid warming versus convective warming alone. J Clin Anesth. 1998;10:380–5.
Raymond CJ, Kroll A, Smith CE. Warming crystalloid fluid for intravenous infusion: how effective is a fluid warming cabinet? Anesth Analg. 2006;103:1605–6.
Eapen G, Andrzejowski J, Turnbull D. A laboratory evaluation of the heat generating capacity of prewarmed fluid compared with two commercial in-line fluid warming devices. Anaesthesia. 2009;64:806.
Gentilello LM, Cortes V, Moujaes S, Viamonte M, Malinin TL, Ho CH, Gomez GA. Continuous arteriovenous rewarming: experimental results and thermodynamic model simulation of treatment for hypothermia. J Trauma. 1990;30:1436–49.
The Management of Inadvertent Perioperative Hypothermia in Adults. http://www.nice.org.uk/nicemedia/pdf/CG65Gjidance.pdf. 2008 Accessed Apr 2008.
Holte K, Kehlet H. Compensatory fluid administration for preoperative dehydration: does it improve outcome? Acta Anaesthesiol Scand. 2002;46:1089–93.
Doherty M, Buggy DJ. Intraoperative fluids: how much is too much? Br J Anaesth. 2012;109:69–79.
Keita H, Diouf E, Tubach F, Brouwer T, Dahmani S, Mantz J, Desmonts JM. Predictive factors of early postoperative urinary retention in the postanesthesia care unit. Anesth Analg. 2005;101:592–6.
Eberhart LH, Doderlein F, Eisenhardt G, Kranke P, Sessler DI, Torossian A, Wulf H, Morin AM. Independent risk factors for postoperative shivering. Anesth Analg. 2005;101:1849–57.
Crossley AW, McVey FK, Cartwright DP. Perioperative shivering. Lancet. 1991;338:1026.
Horn EP, Schroeder F, Wilhelm S, Sessler DI, Standl T, von dem Busche K, Schulte am Esch J. Postoperative pain facilitates nonthermoregulatory tremor. Anesthesiology. 1999;91:979–84.
Nakasuji M, Nakamura M, Imanaka N, Tanaka M, Nomura M, Suh SH. Intraoperative high-dose remifentanil increases post-anaesthetic shivering. Br J Anaesth. 2010;105:162–7.
Stavem K, Saxholm H, Smith-Erichsen N. Accuracy of infrared ear thermometry in adult patients. Intensive Care Med. 1997;23:100–5.
Modell JG, Katholi CR, Kumaramangalam SM, Hudson EC, Graham D. Unreliability of the infrared tympanic thermometer in clinical practice: a comparative study with oral mercury and oral electronic thermometers. South Med J. 1998;91:649–54.
Moran DS, Mendal L. Core temperature measurement: methods and current insights. Sports Med. 2002;32:879–85.
Sessler DI. A proposal for new temperature monitoring and thermal management guidelines. Anesthesiology. 1998;89:1298–300.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Kim, G., Kim, M.H., Lee, S.M. et al. Effect of pre-warmed intravenous fluids on perioperative hypothermia and shivering after ambulatory surgery under monitored anesthesia care. J Anesth 28, 880–885 (2014). https://doi.org/10.1007/s00540-014-1820-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-014-1820-z