The effects of a forced-air warming system plus electric blanket for elderly patients undergoing transurethral resection of the prostate: A randomized controlled trial

Abstract

Background: Perioperative inadvertent hypothermia in elderly urology patients undergoing transurethral resection of the prostate (TURP) is a well-known serious complication, as it increases the risk of myocardial ischemia, blood loss, and surgical wound infection. We conducted this prospective randomized controlled trial to evaluate the combined effect of a forced-air warming system and electric blanket in elderly TURP patients.

Methods: Between January 2015 and October 2017, we recruited 443 elderly male patients undergoing elective TURP with subarachnoid blockade (SAB). These were randomly divided into 3 groups: group E (intraoperative warming using electric blankets set to 38°C; n = 128); group F (intraoperative warming using a forced-air warmer set to 38°C; n = 155) and group FE (intraoperative warming using a forced-air warmer plus electric blankets, both set to 38°C; n = 160). The primary outcome was shivering and their grades. Hemodynamic changes, esophageal temperature, recovery time, incidences of adverse effects, and patient and surgeon satisfaction were also recorded.

Results: Baseline characteristics showed no significant differences when compared across the 3 groups (P >.05). Compared with groups E and F, both HR and mean arterial pressure (MAP) in group FE were significantly decreased from T6 to T10 (P <.05). Compared with groups E and F, esophageal temperature in group FE increased significantly from T5 to T10 (P <.05). Compared with group E, esophageal temperature in group F was significantly increased from T5 to T10 (P <.05). Compared with groups F and FE, post-anesthesia care unit (PACU) recovery time was longer in group E, while compared with group F, PACU recovery time was shorter in group FE (P <.05). Compared to patients in groups E and F, those in group FE had a significantly lower incidence of arrhythmia and shivering (P <.05). The number of patients with shivering grades 0 to 3 was higher in group E than in other groups, while the number of patients with shivering grade 2 was significantly higher in group F than in group FE (P <.05). Patient and surgeon satisfaction scores were higher in group FE than in groups E and F (P <.05).

Conclusions: Use of a forced-air warming system combined with an electric blanket was an effective method with which to retain warmth among elderly TURP patients.

Figure 1

Flow diagram depicting patient enrolment.

Figure 2

Hemodynamic data for the 3 groups of patients at various timepoints: arrival in the operating room (T0), just before the induction of anesthesia (T1), at the beginning of the operation (T2), 10 minutes (T3), 20 minutes (T4), 30 minutes (T5), 60 minutes after the onset of operation (T6), at the end of operation (T7), and 10 minutes (T8), 20 minutes (T9), and 30 minutes (T10) after arriving in the PACU. ∗P <.05 versus Group E.

Figure 3

Esophageal temperature data for the 3 groups of patients at various timepoints: arrival in the operating room (T0), just before anesthesia induction (T1), at the beginning of the operation (T2), 10 minutes (T3), 20 minutes (T4), 30 minutes (T5), 60 minutes after the onset of operation (T6), at the end of operation (T7), and 10 minutes (T8), 20 minutes (T9), and 30 minutes (T10) after arriving in the PACU. ^∗P <.05 versus Group E, ^#P <.05 versus Group F.