Skip to main content
Top
Published in: Journal of Anesthesia 6/2014

01-12-2014 | Original Article

Effect of pre-warmed intravenous fluids on perioperative hypothermia and shivering after ambulatory surgery under monitored anesthesia care

Authors: Gahyun Kim, Myung Hee Kim, Sangmin M. Lee, Soo Joo Choi, Young Hee Shin, Hee Joon Jeong

Published in: Journal of Anesthesia | Issue 6/2014

Login to get access

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.
Literature
1.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
2.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
3.
go back to reference Esnaola NF, Cole DJ. Perioperative normothermia during major surgery: is it important? Adv Surg. 2011;45:249–63.PubMedCrossRef Esnaola NF, Cole DJ. Perioperative normothermia during major surgery: is it important? Adv Surg. 2011;45:249–63.PubMedCrossRef
4.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
5.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
6.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
7.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
8.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
9.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
10.
go back to reference 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.PubMed 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.PubMed
11.
go back to reference Bayman EO, Dexter F, Laur JJ, Wachtel RE. National incidence of use of monitored anesthesia care. Anesth Analg. 2011;113:165–9.PubMedCrossRef Bayman EO, Dexter F, Laur JJ, Wachtel RE. National incidence of use of monitored anesthesia care. Anesth Analg. 2011;113:165–9.PubMedCrossRef
12.
go back to reference 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. 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.
13.
go back to reference Bartels K, Barbeito A, Mackensen GB. The anesthesia team of the future. Curr Opin Anaesthesiol. 2011;24:687–92.PubMedCrossRef Bartels K, Barbeito A, Mackensen GB. The anesthesia team of the future. Curr Opin Anaesthesiol. 2011;24:687–92.PubMedCrossRef
14.
go back to reference White PF, Eng M. Fast-track anesthetic techniques for ambulatory surgery. Curr Opin Anaesthesiol. 2007;20:545–57.PubMedCrossRef White PF, Eng M. Fast-track anesthetic techniques for ambulatory surgery. Curr Opin Anaesthesiol. 2007;20:545–57.PubMedCrossRef
15.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
16.
go back to reference Awad IT, Chung F. Factors affecting recovery and discharge following ambulatory surgery. Can J Anaesth. 2006;53:858–72.PubMedCrossRef Awad IT, Chung F. Factors affecting recovery and discharge following ambulatory surgery. Can J Anaesth. 2006;53:858–72.PubMedCrossRef
17.
go back to reference Tesniere A, Servin F. Intravenous techniques in ambulatory anesthesia. Anesthesiol Clin N Am. 2003;21:273–88.CrossRef Tesniere A, Servin F. Intravenous techniques in ambulatory anesthesia. Anesthesiol Clin N Am. 2003;21:273–88.CrossRef
18.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
19.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
20.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
21.
go back to reference 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.CrossRef 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.CrossRef
22.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
24.
go back to reference Holte K, Kehlet H. Compensatory fluid administration for preoperative dehydration: does it improve outcome? Acta Anaesthesiol Scand. 2002;46:1089–93.PubMedCrossRef Holte K, Kehlet H. Compensatory fluid administration for preoperative dehydration: does it improve outcome? Acta Anaesthesiol Scand. 2002;46:1089–93.PubMedCrossRef
25.
26.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
27.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
29.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
30.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
31.
go back to reference Stavem K, Saxholm H, Smith-Erichsen N. Accuracy of infrared ear thermometry in adult patients. Intensive Care Med. 1997;23:100–5.PubMedCrossRef Stavem K, Saxholm H, Smith-Erichsen N. Accuracy of infrared ear thermometry in adult patients. Intensive Care Med. 1997;23:100–5.PubMedCrossRef
32.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
33.
go back to reference Moran DS, Mendal L. Core temperature measurement: methods and current insights. Sports Med. 2002;32:879–85.PubMedCrossRef Moran DS, Mendal L. Core temperature measurement: methods and current insights. Sports Med. 2002;32:879–85.PubMedCrossRef
34.
go back to reference Sessler DI. A proposal for new temperature monitoring and thermal management guidelines. Anesthesiology. 1998;89:1298–300.PubMedCrossRef Sessler DI. A proposal for new temperature monitoring and thermal management guidelines. Anesthesiology. 1998;89:1298–300.PubMedCrossRef
Metadata
Title
Effect of pre-warmed intravenous fluids on perioperative hypothermia and shivering after ambulatory surgery under monitored anesthesia care
Authors
Gahyun Kim
Myung Hee Kim
Sangmin M. Lee
Soo Joo Choi
Young Hee Shin
Hee Joon Jeong
Publication date
01-12-2014
Publisher
Springer Japan
Published in
Journal of Anesthesia / Issue 6/2014
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI
https://doi.org/10.1007/s00540-014-1820-z

Other articles of this Issue 6/2014

Journal of Anesthesia 6/2014 Go to the issue