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Efficacy of IV Fluid Warming in Patients Undergoing Cesarean Section with Regional Anesthesia

Obstetric Anesthesia

CHARLES E. SMITH, JOHN R. FISGUS, MARGARET KAN, SARAH K. LENGEN, CLIFFORD MYLES, DENNIS JACOBS, EMIL CHOI, NORMAN BOLDEN, ALFRED C. PINCHAK AND JOAN F. HAGEN

Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio

Am. J. Anesthesiol., 27: 84–88, 2000

Whether warming intravenous (IV) fluids led to higher core temperatures and less intraoperative hypothermia (core temperature, <36°C) compared with room temperature fluid in patients who had a cesarean section was evaluated in a prospective, randomized study. Sixty-seven patients undergoing cesarean section with regional anesthesia were randomly assigned to two groups: warm (42°C) IV fluids (n = 35) and controls, who were given room temperature fluids (20 to 22°C, n = 32). Tympanic membrane (core) temperatures were measured during and after surgery, and the number and types of interventions for hypothermia were recorded. Compared with the warm fluid group, the controls had lower core temperatures at the end of surgery (mean ± SEM: 35.6 ± 0.10 vs. 36.1 ± 0.1°C) and were more hypothermic after surgery (75 vs. 46%). The maximum decrease in core temperature was greater in the controls compared with the warm fluid group (−1.4 ± 0.1 vs. −0.9 ± 0.1°C). No differences existed in the time to discharge (103 to 109 min), the incidence of shivering (31%), or the frequency of postoperative interventions for hypothermia.

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Comment:

This prospective study examined 67 patients undergoing cesarean delivery with regional anesthesia. Two groups were assessed: one receiving warmed IV fluid, the other receiving room temperature fluids. Not surprisingly, the control group, receiving room temperature fluid, had a lower core temperature at the end of the procedure than did those receiving warmed fluid. There was no difference in outcome; in a young, healthy population the perioperative morbidity is very low, and thus the lack of outcome difference does not preclude or eliminate the importance of warming IV fluid. As discussed in the editorial accompanying this paper, it is appropriate to maintain patients normothermic for their surgical procedures unless intentional hypothermia is indicated. Warming intravenous fluid is an easy and low/no risk intervention that should be considered in all patients.

Ferne B. Sevarino M.D.

© 2001 Lippincott Williams & Wilkins, Inc.