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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, PhD*,†; Osborne, Sonya, PhD; Yates, Patsy, PhD; Sturgess, David, MBBS, PhD*,§; Jones, Lee, AStat, BSc (Hons); Gosden, Edward, MSc

doi: 10.1213/ANE.0000000000002026
Obstetric Anesthesiology: Original Clinical Research Report

BACKGROUND: Rates of hypothermia for women undergoing spinal anesthesia for cesarean delivery are high and prevention is desirable. This trial compared the effectiveness of preoperative warming versus usual care among 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 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, χ2 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 at http://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 = .28. There were no other statistically significant differences between groups in any of the secondary outcomes.

CONCLUSIONS: A short period of preoperative 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.

Published ahead of print May 12, 2017.

From the *Mater Health Services, Raymond Terrace, South Brisbane, Australia

School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Australia

Australian Centre for Health Services Innovation (AusHI), School of Public Health and Social Work/Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia

§University of Queensland, St Lucia, Brisbane, Australia; and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia.

Published ahead of print May 12, 2017.

Accepted for publication February 6, 2017.

Funding: Perioperative Nurses Association of Queensland Research Grant ($5000).

The authors declare no conflicts of interest.

Clinical Trial number: ANZCTR 367160.

Ethical approval: Mater Human Research Ethics Committee full ethical approval; Queensland University of Technology Ethics Committee administrative approval.

Reprints will not be available from the authors.

Address correspondence to Judy Munday, PhD, School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, 4059, Australia. Address e-mail to judy.munday@qut.edu.au.

© 2018 International Anesthesia Research Society
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