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General Intensive Care

The researchers from the Department of Anesthesia of General Intensive Care and Orthopedics from the University of Vienna of Austria conducted a 2-year randomized control trial on 150 hip arthroplasty patients to evaluate the effects of maintaining normothermia by means of aggressive warming and its effects on subsequent surgical blood loss and the need for allogenic transfusion. The fact that perioperative hypothermia, which is common and easily preventable, causes complications like adverse myocardial outcomes, surgical wound infection and prolonged hospital delivery, prompted the authors to conduct the study.

Consequences of aggressive intraoperative warming were analyzed by forming 2 groups, one of which, called the control group received only conventional intraoperative warming upto 36 deg centigrade and the other group, called the study group was subjected to aggressive intraoperative warming to maintain tympanic temperature of 36. 5 deg centigrade. The results of the study were analyzed on the intention-to-treat basis. Based on the results, the researchers concluded that aggressive intraoperative warming is an important intervention that reduces blood loss in surgeries like hip arthroplasty.

The authors presented the study in a lucid manner including a good background and significance of the issue. The study is worth considering for evidence-based practice because it is a randomized control trial with minimal bias chances and a conducted in an organized manner. In the discussion part, the researchers hypothesized that the cause for increased blood loss in hypothermic conditions was probably due to the established effect of low temperatures on the normal functioning of platelets.

The authors also hypothesized that the effects of vigorous cutaneous warming on blood pressure probably caused decreased blood loss. Though this study convinced that aggressive warming that causes rise in 0. 5 deg. centigrade over conventional warming decreased blood loss, it is yet unclear as to why a similar study by the same authors did not produce similar results with one degree difference. Though the authors attribute this difference to the number of participants studied, there is a need to analyze which is the optimum temperature that causes maximum benefits to surgical patients.

Janczyk, R. J. , Howells, G. A. , Bair, H. A. , Huang, R. , Bendick, P. J. , and Zelenock, G. B. (2004). Hypothermia is an independent predictor of mortality in rupture abdominal aneurysms. Vascular and Endovascular Surgery, 38(1), 37-42. The researchers from the Department of Surgery at the William Beaumont Hospital, Royal Oak evaluated the correlation between hypothermia and the outcomes of ruptured abdominal aortic aneurysm patients who reached the hospital and underwent surgical intervention.

The authors conducted this study with the background rationale that hypothermia increases mortality in trauma patients and there is not much research to understand the effects of hypothermia on the ruptured abdominal aortic aneurysm patients. The study was conducted in the form of review of cases over 10 years between 1990 and 1999 with a hypothesis that hypothermia has a negative impact on the survival of patients with ruptured aortic abdominal aortic aneurysm who are subjected to surgical intervention.

100 cases were reviewed and based on univariate ANOVA analysis and multiple logistic regression, the authors concluded that “hypothermia is a strong independent contributor to mortality in patients with ruptured abdominal aortic aneurysms. ” The study was presented with clear indications and background rationale for the study. The authors discuss that in the wake of research pointing to the deleterious effects of a combination of shock and hypothermia in trauma patients; it is worth knowing the effects of hypothermia in ruptures aortic aneurysm patients.

Surgical interventions in these patients induce hypothermia which can worsen the as such worse prognosis of ruptured abdominal aortic aneurysm cases. Kumar, S. , Wong, P. F. , Melling, A. C. , Leaper, D. J. (2005). Effects of perioperative hypothermia and warming in surgical practice. Int Wound Journal, 2, 193- 204. The authors who are surgeons at the Professional Unit of Surgery at the University Hospital of North Tees in Stockton-on-Tees conducted a literature review and research to evaluate the beneficial effects of warming in perioperative period.

The fact that many adverse consequences of perioperative hypothermia are preventable by usage of certain warming techniques prompted the authors to conduct the research. The authors hypothesised that awareness of the risks associated with hypothermia is the key for prevention of hypothermia. The literature review was elaborate and included all published articles pertaining to the topic from 1996 to 2005. The authors proposed that increased blood flow and raised oxygen tension at tissue level due to warming produced beneficial effects and prevented complications arising out of peroiperative hypothermia.

Infact, the literature review reveled that warming reduced blood loss, wound infection and perioperative pain. The authors were however not convinced with the type of studies reporting on these aspects and emphasized the need for more prospective randomized controlled studies to evaluate the benefits of perioperative warming and prevention of perioperative hypothermia. The authors discuss the knowledge from the literature review in topic-wise creating an easy understanding for the reader. The key points and conclusion are crisp and offer gist information to the research.

Leung, K. K. , Lai, A. , and Wu, A. (2007). A randomised controlled trial of the electric heating pad vs forced-air warming for preventing hypothermia during laparotomy. Anaesthesia, 62, 605- 608. The authors, who are anesthetists at the United Christian Hospital and Queen Elizebath Hospital at the Hong Kong Special Administrative Region of People’s Republic of China conducted a randomized controlled trial to compare the levels of efficacy between 2 hypothermia preventing devices namely, the upper body forced-air warming device and an electric heating pad device.

The study was conducted on patients undergoing laparotomy under general anesthesia. The trial was undertaken with a background rationale that forced -air warming is a more commonly used method of preventing perioperative hypothermia and that some recent study proved that electric heating pad method of warming is an effective as forced-air warming. The results of the study revealed that upper body forced-air warming is a more efficient method of maintaining body temperature in laparotomy patients than when compared to electric heating pad.

Nasopharyngeal temperature was used to monitor the benefits between the 2 methods and the results of the study were presented in a graphic presentation. Alfonsi, P. , Nourredine, K. E. A. , Adam, F. , Chauvi, M. , and Sessler, D. I. (2003). Effect of postoperative skin-surface warming on oxygen consumption and the shivering threshold. Anaesthesia, 58, 1220- 1234. The first 3 authors are anesthesiologists at the Hospital Ambroise Pare in France and the last author is the associate dean for research and and also professor of anesthesiology and pharmacology at the university of Louisville at USA.

The researchers conducted a randomized controlled trial to evaluate the benefits of cutaneous warming in maintaining normal temperature and also in preventing shivering in patients undergoing surgery under epidural anesthesia and general anesthesia. Cutaneous warming was provided by forced-air heating method which was provided for patients in the study group. While those in the control group were offered only blanket covering to prevent and treat shivering. Shivering was measured based on oxygen consumption.

The study revealed that though active warming caused improvement in thermal comfort and reduced shivering, however did not cause a reduction in the duration of shivering. The authors opined that cutaneous warming could only decrease shivering but not obliterate it. Being a randomized controlled trial, this study is useful to ascertain the benefits of active cutaneous warming when considering to reduce the adverse effects of hypothermia in surgical patients. Hasankhani, H. , Mohammadi, E. , Moazzamin, F. , Mokhtari, M. and Naghgizadh, M. M. (2007).

The effects ofintravenous fluids temperature on perioperative hemodynamic situation, port-operative shivering and recovery in orthopedic surgery. Canadian Operating Room Nursing Journal, 20-27. The authors of this study are from various faculties. While the first 2 authors are nurses, the third author is an anesthetist, the fourth is a medical physicist and the fifth is a biostatistician. All of them belong to various universities from Iran. The study was conducted with the purpose to evaluate the effects of intravenous fluids temperature on perioperative hemodynamics and temperature control.

The study was conducted with a background perspective that perioperative hypothermia is stressful physiologically and can lead to cardiac, hemodynamic and delayed wound healing consequences. The study was a randomized control trial and was conducted on 60 orthopedic surgery patients recruited in a serial manner. In one group, intravenous fluids were infused without warming and caused hypothermia whereas in the other group, the fluids were set to maintain normothermia.

Based on the reports, the authors concluded that intraoperative fluid warming caused reduction in perioperative hemodynamic distress, post-operative shivering and improved recovery time. The knowledge of this randomized controlled trial is useful to apply on surgical patients to prevent the deleterious consequences of hypothermia. Williamson, J. E. (2007). The heat is on: Noninvasive patient warming solutions hot on innovation. Operating room. Health Care Purchasing News. www. hpnonline. Com

The article by William elaborates on the warming techniques in the perioperative period with intentions to prevent the adverse effects of perioperative hypothermia. The article provides a brief introduction about the deleterious effects of hypothermia backed by statistics. The author elaborates a proactive approach to maintain normothermia, the crunch of which is noninvasive active warming solutions. The need for using these solutions right from the in the preoperative period itself arises because research has shown that temperature drops quickly in the intraoperative setting.

The author elaborates on various non-invasive solutions which can be used for perioperative warming and also when to use what solution. The article has good pictures of various warming devices and solution brands allowing the reader a quick understanding of the subject. Williamson, J. E. (2003). Thermo-technology warms up to hospital demands. Operating room. Health Care Purchasing News. Retrieved on August 5th from www. hpnonline. com In this article, the author elaborates on the technology that is available to maintain normothermia in patients in the perioperative period.

The main techniques discussed in this article are convectional warming and liquid heat. Pictures have been used to make the reader understand the methods of cooling. The article elaborates benefits of cooling including comfort. While most of the article discusses about the benefits of perioperative normothermia and the methods to establish it, the last portions of the article discuss about the benefits of hypothermia especially in heart attack and stroke patients opening the eyes of the reader. In these sections, the author tips about various cooling trends available in the medical market.

The article is a report and is useful for the reader to enhance knowledge on devices that are useful to warm-up a patient. Akridge, J. (2004). Turning up the heat on temperature and pressure management. Operating room. Health Care Purchasing News. Retrieved on August 5th from www. hpnonline. com The article by Akridge elaborates about various methods and devices to prevent hypothermia in perioperative period. Aakridge begins the article with an introduction wherein the importance of maintaining normothermia in surgical patients is briefed. This is followed by various methods of maintain normal temperature.

The main devices discussed are convective warmers, conductive warmers, fluids and blood warmers, warming cabinets, localised warmers, speciality warmers and positioning devices. Pictures are used to enhance the understanding of the devices. The article also briefs about pressure management devices. There is one table in the article which elaborates about various pressure and temperature management devices and the sources of their availability which is very useful for the reader, especially if he is interested in purchasing any of the devices. Burns, S. M. , Wojnakowski, M. , Piotrowsky, K. , Caraffa, G.

(2009). Unintentional Hypothermia: Implications for Perianesthesia Nurses. Journal of perianesthesia Nursing, 24(3), 167- 176. The authors who are perianesthesia nurses have presented this article with the purpose to provide the reader an overview of intraoperative temperature physiology and strategies to prevent and manage it. The article has been resented with definite objectives to educate perianaesthesia nurses about the physiology of perioperative heat loss, alterations associated with the loss and implications for nurses related to prevention of hypothermia and its deleterious consequences.

The article is elaborate and highlighted with beautiful pictures which allow the reader to gain perfect understanding of the subject. Especially important is the figure which describes the effects of anesthesia on heat balance. The article elaborates various factors associated with perioperative hypothermia and strategies to handle the factors. The conclusion is crisp and gives the reader an overall understanding of the strictly. The article is backed with appropriate references and sources and thus serves to educate the reader current trends in the management of perioperative hypothermia.

Akridge, J. (2005). What a difference a degree makes. Operating room. Health Care Purchasing News. Retrieved on August 5th from www. hpnonline. Com The article by Akridge elaborates about the deleterious effects of perioperative hypothermia and strategies to overcome it. Of special mention in the article is the need to prevent hypothermia to prevent subsequent wound-infections which increase morbidity, mortality and length of hospitalization in surgical patients. Akridge emphasizes on high-tech systems to prevent hypothermia.

He uses pictures to provide the reader an understanding of the subject. Forced air solutions, fluid warming and temperature monitoring are elaborated in detail give a good sketch to practicing anesthetists, nurses and surgeons about techniques to prevent perioperative hypothermia. The article is backed by references and is a valuable guide for those who want to gain current knowledge about strategies to prevent perioperative hypothermia. Steves, D. , Johnson, M. , Langdon, R. (1999).

Comparison of two warming interventions in surgical patients with mild and moderate hypothermia. International journal of nursing practice, 6, 268- 275. The first author is a clinical nurse specialist, the second one is a research professor in the faculty of health and the third one is a research assistant. All the 3 researchers hail from various New South Wales research centers. The authors compare the benefits of two interventions to prevent perioperative hypothermia, namely, forced warm-air device and standard warmed blankets.

The study was a randomized control trial and concluded that forced warm-air devices were much more superior to blanket method of warming in the prevention of perioperative hypothermia. The authors specially recommend force-air warming strategies is select surgical patients with mild or moderate hypothermia. The article provides an elaborate introduction into the hazards of hypothermia which are actually put in a table format providing the reader an easy understanding into the need to prevent perioperative hypothermia. Through out the article, tables give a good picture of the data and results of the study.

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