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Journal Appraisal Lakibul.ppt
1. Journal Appraisal on:
Efficacy Of Forced-air Warming
And Warmed Intravenous Fluid For
Prevention Of Hypothermia And
Shivering During Caesarean
Delivery Under Spinal Anaesthesia
By: Jehan I. Lakibul MD
2. Background
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 perioperative
coagulopathy.
In addition, maternal hypothermia may cause hypothermia in the newborn
3. Background
Peri-operative hypothermia is caused by the combined effect of
anaesthesia-induced impairment of the thermoregulatory
mechanism, environmental conditions in the operating theatre and
surgical factors.
The most important cause is heat redistribution from the core to the
periphery due to vasodilation after the induction of general or
neuraxial anaesthesia
4. Objectiv
e
● Assessed the efficacy of combined preanaesthetic forced-air warming in
combination with warmed intravenous fluid infusion for preventing
hypothermia and shivering during caesarean delivery under spinal
anaesthesia.
5. A total of 50 pregnant women, American Society
of Anaesthesiologists physical status 2, aged
20 to 45 years, scheduled for caesarean
delivery under spinal anaesthesia
6. Setting
Design
A randomized control study
A tertiary care teaching hospital from
July 2017 to April 2018.
Methods Intervention
Randomized
n=50
Experimental group:
combined pre-anaesthetic whole body
forced-air warming for 15 min
+
prewarmed intravenous fluids
Control group:
no intervention
9. Result
● The incidence of peri-operative hypothermia was significantly
lower in the active warming group than in the C group (0 vs.
48%, P<0.001).
● The incidence of shivering in the peri-operative period was
significantly lower in the active warming group than in the C
group (22 vs. 52%, P¼0.031).
● The proportion of patients with a shivering score of 2 was not
significantly different between the groups (4 vs. 12%, P¼0.338).
10. Result
● No patient had severe shivering score (¼ 3) in either group.
● The proportion of patients receiving meperidine was not
significantly different between the groups (4 vs. 12%, P¼0.338).
● The maximum change in maternal temperature was also
significantly lower in the active warming group than in the C
group (P¼0.002).
11. Result
• Maternal thermal comfort scores were higher in the active
warming than in the C group (P¼0.003).
• However, the incidence of nausea/vomiting did not differ
significantly between the two groups.
• 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.
Starting from immediately after the
16. 4. Were patients analyzed in the groups
to which they were randomized?
17. 1. WERE PATIENTS, HEALTH WORKERS
AND STUDY PERSONNEL “BLIND” TO
TREATMENT?
SECONDARY GUIDES
18. 2. Were the groups similar at the start of
the trial?
SECONDARY GUIDES
19. 3. Aside from the experimental
intervention, were the groups treated
equally?
SECONDARY GUIDES
20. 4. Can the results be applied to my
patient care?
SECONDARY GUIDES
21. 5. Were all clinically important outcomes
considered?
SECONDARY GUIDES
22. The combination of pre-anaesthetic forced air warming and warmed
intravenous fluid infusions appears to be effective for preventing
hypothermia and shivering during caesarean delivery under spinal
anesthesia
Study
Conclusions
Editor's Notes
Statistically difference bet groups
The group were similar at the beginning of the study, as we can see here in the baseline characteristic and ancillary treatments of each group, both groups are almost similar to each other. There were no major statistical differences between the two groups.
If both groups are similar, at least at the end of the study we can conclude which ever the result maybe, it can be attributed to the intervention
Statistically difference bet groups
The group were similar at the beginning of the study, as we can see here in the baseline characteristic and ancillary treatments of each group, both groups are almost similar to each other. There were no major statistical differences between the two groups.
If both groups are similar, at least at the end of the study we can conclude which ever the result maybe, it can be attributed to the intervention
Statistically difference bet groups
The group were similar at the beginning of the study, as we can see here in the baseline characteristic and ancillary treatments of each group, both groups are almost similar to each other. There were no major statistical differences between the two groups.
If both groups are similar, at least at the end of the study we can conclude which ever the result maybe, it can be attributed to the intervention
Statistically difference bet groups
The group were similar at the beginning of the study, as we can see here in the baseline characteristic and ancillary treatments of each group, both groups are almost similar to each other. There were no major statistical differences between the two groups.
If both groups are similar, at least at the end of the study we can conclude which ever the result maybe, it can be attributed to the intervention
