Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2017 May:38:93-104.
doi: 10.1016/j.jclinane.2017.01.005. Epub 2017 Jan 31.

Effectiveness of active and passive warming for the prevention of inadvertent hypothermia in patients receiving neuraxial anesthesia: A systematic review and meta-analysis of randomized controlled trials

Clarissa A Shaw  1 , Victoria M Steelman  2 , Jennifer DeBerg  3 , Marin L Schweizer  4
Affiliations
Meta-Analysis

Effectiveness of active and passive warming for the prevention of inadvertent hypothermia in patients receiving neuraxial anesthesia: A systematic review and meta-analysis of randomized controlled trials

Clarissa A Shaw et al. J Clin Anesth. 2017 May.

Abstract

Objective: Perioperative hypothermia is a common complication of anesthesia that can result in negative outcomes. The purpose of this review is to answer the question: Does the type of warming intervention influence the frequency or severity of inadvertent perioperative hypothermia (IPH) in surgical patients receiving neuraxial anesthesia?

Design: Systematic review and meta-analysis.

Setting: Perioperative care areas.

Patients: Adults undergoing surgery with neuraxial anesthesia.

Intervention: Perioperative active warming (AW) or passive warming (PW).

Measurements: PubMed, CINAHL, Embase, and Cochrane Central Register of Controlled Trials were searched. Inclusion criteria were: randomized controlled trials; adults undergoing surgery with neuraxial anesthesia; comparison(s) of AW and PW; and temperature measured at end of surgery/upon arrival in the Postanesthesia Care Unit. Exclusion criteria were: no full-text available; not published in English; studies of: combined neuraxial and general anesthesia, warm intravenous or irrigation fluids without using AW, and rewarming after hypothermia. Two independent reviewers screened abstracts and titles, and selected records following full-text review. The Cochrane Collaboration's tool for assessing risk of bias was used to evaluate study quality. A random-effects model was used to calculate risk ratios for dichotomous data and mean differences for continuous data.

Main results: Of 1587 records, 25 studies (2048 patients) were included in the qualitative synthesis. Eleven studies (1189 patients) comparing AW versus PW were included in the quantitative analysis. Meta-analysis found that intraoperative AW is more effective than PW in reducing the incidence of IPH during neuraxial anesthesia (RR=0.71; 95% CI 0.61-0.83; p<0.0001; I2=32%). The qualitative synthesis revealed that IPH continues despite current AW technologies.

Conclusions: During neuraxial anesthesia, AW reduces IPH more effectively than PW. Even with AW, IPH persists in some patients. Continued innovation in AW technology and additional comparative effectiveness research studying different AW methods are needed.

Keywords: Anesthesia; Body temperature; Heating; Hypothermia; Intraoperative complications; Perioperative care.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Risk of Bias within the included studies (n=25).
Fig. 3
Fig. 3
Risk of Bias across the included studies (n=25).
Fig. 4
Fig. 4
Dichotomous data (hypothermia vs. normothermia) forest plot for AW vs. PW.
Fig. 5
Fig. 5
Continuous data (mean temperature) forest plot for AW vs. PW.
See this image and copyright information in PMC

Comment in

References

    1. Frisch NB, Pepper AM, Rooney E, Silverton C. Intraoperative Hypothermia in Total Hip and Knee Arthroplasty. Orthopedics. 2016:1–8. - PubMed
    1. Madrid E, Urrutia G, Roque i Figuls M, Pardo-Hernandez H, Campos JM, Paniagua P, et al. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. Cochrane Database Syst Rev. 2016;4:CD009016. - PMC - PubMed
    1. 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. The New England journal of medicine. 1996;334:1209–1215. - PubMed
    1. Sun Z, Honar H, Sessler DI, Dalton JE, Yang D, Panjasawatwong K, et al. Intraoperative core temperature patterns, transfusion requirement, and hospital duration in patients warmed with forced air. Anesthesiology. 2015;122:276–285. - PMC - PubMed
    1. Kurz A. Physiology of thermoregulation. Best Pract Res Clin Anaesthesiol. 2008;22:627–644. - PubMed

MeSH terms