JURDING

Efficacy of forced-air warming and warmed intravenous fluid for prevention of hypothermia
and shivering during caesarean delivery under spinal anaesthesia

Disusun Oleh :
Khoerunnisa Cahyani Kurnia
2016730056

Pembimbing :
dr. Fauzi Abdilah Susman, Sp.An, M.Sc

KEPANITERAAN KLINIK ILMU ANESTESI

RUMAH SAKIT UMUM DAERAH
SEKARWANGI
FAKULTAS KEDOKTERAN DAN KESEHATAN
UNIVERSITAS MUHAMMADIYAH JAKARTA
2020
INTRODUCTION
Peri-operative hypothermia or shivering are reported to occur in up to 60 and 85% of
women, respectively, during caesarean delivery under spinal anaesthesia.
Hypothermia and shivering increase the risk of complications such as surgical site
infection, myocardial ischemia and peri-operative coagulopathy.
A recent meta-analysis found that active warming during caesarean delivery can
decrease the incidence of hypothermia and shivering
Multimodal intra-operative active warming, with the use of forced-air warming
along with warmed intravenous (i.v.) fluid infusions, has also proved to be
ineffective for prevention of hypothermia and shivering
MATERIALS AND METHODS
This prospective, single blind, randomised, controlled study was carried out from
July 2017 to April 2018
Fifty pregnant women scheduled for elective caesarean delivery under spinal
anaesthesia were randomly assigned to one of two treatment groups:
 an active warming group that received combined active warming
 or a control (C) group, which received routine care

Exclusion criteria were pre-operative core temperature more than 37.28C; severe
endocrine, cardiovascular or respiratory disease; current treatment with anticoagulant
therapy; twin pregnancy; or body weight less than 50 or more than 100kg
RESULTS
A total of 50 patients (25 patients in each group) were initially enrolled in the study.
Two patients in the active warming group were excluded from the analyses because
of conversion to general anaesthesia
 RESULTS
In the active warming group, after
the pre-anaesthetic whole body
forced-air warming period, core
temperature increased and was
significantly higher than the baseline
core temperature
RESULTS

Umbilical venous blood pH, neonatal temperature at birth and Apgar score were not
significantly different between the groups
DISCUSSION
The study findings suggest that this combined active warming method may be an
effective strategy for the prevention of hypothermia and shivering
Previous studies have investigated the efficacy of several different warming
techniques and different durations of warming
Cobb et al studied the effect of intra-operative warmed i.v. fluid and lower body
forced-air warming to prevent hypothermia and shivering. The mean core temperature
in the warming group on arrival at the PACU was 35.9 (0.5) 8C, which was 0.48C
higher than the mean core temperature in the control group; nevertheless,
hypothermia occurred in 64% of patients in the warming group. This suggests that
warming interventions applied only during the intra-operative period are not sufficient
to prevent peri-operative hypothermia and shivering under spinal anaesthesia.
DISCUSSION
In this study, pre-anaesthetic whole body forced-air warming for 15min increased
core temperature significantly above baseline core temperature in the active warming
group
In previous study, use of short pre warming alone has a little effect on peri-operative
core temperature and does not modify the intra-operative temperature decline
The incidence of shivering in the perioperative period was significantly lower in the
active warming group than in the C group
DISCUSSION
To conclude, routine warming of the patients during caesarean delivery is not widely
practiced, although many patients experience peri-operative hypothermia
In the present study, the combination of pre-anaesthetic whole body forced-air warming
and intra-operative pre warmed i.v. fluid infusion was shown to be effective for
preventing hypothermia and shivering in patients undergoing caesarean delivery under
spinal anaesthesia