Preoperative warming versus no preoperative warming for maintenance of normothermia in women receiving intrathecal morphine for cesarean delivery: a single-blinded, randomized controlled trial

Munday, Judy and Osborne, Sonya and Yates, Patsy and Jones, Lee and Gosden, Edward (2018) Preoperative warming versus no preoperative warming for maintenance of normothermia in women receiving intrathecal morphine for cesarean delivery: a single-blinded, randomized controlled trial. Anesthesia and Analgesia, 126 (1). pp. 183-189. ISSN 0003-2999

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Abstract

Introduction. Rates of hypothermia for women undergoing spinal anesthesia for cesarean delivery are high and prevention is desirable. This trial compared the effectiveness of pre-operative warming versus usual care amongst women receiving intrathecal morphine, which is thought to exacerbate perioperative heat loss.

Methods. A prospective, single-blinded, randomized controlled trial compared 20 minutes of forced air warming(plus intravenous fluid warming) versus no active preoperative warming(plus intravenous fluid warming)in 50 healthy American Society of Anesthesiologists(ASA) graded II women receiving intrathecal morphine as part of spinal anesthesia for elective cesarean delivery. The primary outcome of maternal temperature change was assessed via aural canal and bladder temperature measurements at regular intervals. Secondary outcomes included maternal thermal comfort, shivering, mean arterial pressure, agreement between aural temperature, and neonatal outcomes (axillary temperature at birth, Apgar scores, breastfeeding and skin-to-skin contact). The intention-to-treat population was analyzed with descriptive statistics, general linear model analysis, linear mixed model analysis, Chi-square test of independence, Mann-Whitney, and Bland Altman analysis. Full ethical approval was obtained, and the study was registered on the Australia and New Zealand Clinical Trials Registry (Trial No: 367160, registered athttp://www.ANZCTR.org.au/).

Results. Intention-to-treat analysis(n=50)revealed no significant difference in aural temperature change from baseline to the end of the procedure between groups: F (1, 47) = 1.2, p =0.28. There were no other statistically significant differences between groupsin any of the secondary outcomes.

Conclusions. A short period of pre-operative warming is not effective in preventing intraoperative temperature decline for women receiving intrathecal morphine. A combination of preoperative and intraoperative warming modalities may be required for this population.


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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Accepted version made available in accordance with the copyright policy of the publisher. Clinical Trial number:ANZCTR 367160
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Nursing and Midwifery
Date Deposited: 01 Mar 2019 03:07
Last Modified: 05 Mar 2019 01:07
Uncontrolled Keywords: perioperative hypothermia; intrathecal morphine; cesarean delivery' randomized controlled trial
Fields of Research : 11 Medical and Health Sciences > 1110 Nursing > 111003 Clinical Nursing: Secondary (Acute Care)
Socio-Economic Objective: E Expanding Knowledge > 97 Expanding Knowledge > 970111 Expanding Knowledge in the Medical and Health Sciences
Funding Details:
Identification Number or DOI: doi: 10.1213/ANE.0000000000002026
URI: http://eprints.usq.edu.au/id/eprint/35887

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