Effects of Preanesthetic Forced Air Warming and Administration of Warmed Intravascular Fluid

Study Overview
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Brief Summary
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The majority of women (> 60%) developed hypothermia and shivering during cesarean delivery. Core hypothermia may be associated with a number of adverse outcomes in patients, including shivering, wound infection, coagulopathy, increased blood loss and transfusion requirements, decreased metabolism and prolonged recovery. Shivering can result in interference with monitoring, increased tension on wound edges, and increased oxygen consumption. A previous study has shown several modalities to prevent hypothermia and shivering in patients undergoing cesarean delivery with spinal anesthesia. But, single modality intervention have shown marginal or no efficacy. Neuraxial anesthesia reduces the threshold for vasoconstriction and shivering. It often also produces a lower body sympathectomy that provokes a core to peripheral redistribution of body heat. It is difficult to treat the core to peripheral redistribution of body heat. However redistribution can be prevented by preanesthetic cutaneous warming. Prewarming hardly changes core temperature that remains well regulated, but it markedly increases peripheral tissue heat content. As a result, prewarming reduces the core to peripheral tissue temperature gradient and the propensity for redistribution after the induction of anesthesia. We therefore hypothesized that Combined modality active warming consisting of preoperative 15 min of surface warming using a forced air warmer before spinal anesthesia and coloading of warmed intravenous fluid might reduce perioperative hypothermia and shivering in women undergoing cesarean delivery. Additionally, We tested the hypothesis that maintaining maternal normothermia increases newborn temperature and Apgar scores.

Official Title
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Effects of Preanesthetic Forced Air Warming and Administration of Warmed Intravascular Fluid on Preventing Hypothermia and Shivering During Cesarean Delivery Under Spinal Anesthesia

Conditions
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Pregnancy

Intervention / Treatment
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* Behavioral: Prewarming using forced air warmer, warmed intravenous fluid


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients scheduled for cesarean delivery under spinal anesthesia The American Society of Anesthesiologists physical status class one or two female between 20 and 45 Exclusion Criteria: Patients with heart disease Patients with infectious disease Patients with coagulopathy Patients with a drug allergy In case of switching to general anesthesia Patients BMI under 18.5 or over 31

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active warming<br>preoperative 15 min of surface warming using a forced air warmer before spinal anesthesia and coloading of warmed intravenous fluid | Behavioral: Prewarming using forced air warmer, warmed intravenous fluid<br>* Combined modality active warming consisting of preoperative 15 min of surface warming using a forced air warmer before spinal anesthesia and coloading of warmed intravenous fluid in active warming group<br>|
| Control<br>no preoperative warming and room temperature intravenous fluid | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| incidence of hypothermia and shivering |  | immediately after arrival at the postanesthesia care unit | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| temperature of newborn |  | immediately after delivery of newborn | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cesarean delivery with spinal anesthesia, Hypothermia and shivering, Active warming