The influence of warmed infusion during C-section on the mother and child – a pilot randomised prospective study

Česká verzia

Authors: M. Kirchnerová ¹; Z. Mrozek ¹; I. Oborná ²; L. Kantor ³
Authors place of work: Klinika anesteziologie, resuscitace a intenzivní medicíny LF UP a FN, Olomouc, přednosta doc. MUDr. M. Adamus, Ph. D. ¹; Klinika porodnictví a gynekologie LF UP a FN, Olomouc, přednosta prof. MUDr. R. Pilka, Ph. D. ²; Novorozenecké oddělení FN, Olomouc ³
Published in the journal: Ceska Gynekol 2013; 78(3): 237-242

Summary

Aim of the study:
To evaluate the influence of warmed infusions on the mother’s and newborn’s well-being after C-section.

Design:
Prospective randomized study.

Setting:
Dept. of Anaesthesiology, Resuscitation and Intensive Care Medicine, Dept. of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry Palacký University and University Hospital Olomouc.

Methods:
Prospective randomized study including 29 pregnant women between 38^th and 42^nd week of pregnancy, that were indicated to elective caesarian section (SC) and from all of which the fetal distress was excluded. The women were randomized into four groups according to the temperature of applied infusion solution – colloids and afterwards crystalloids (pre-heated and non pre-heated), and according to the type of anaesthesia (general or SAB). These values were monitored in perioperative period: body temperature, differences of hemoglobin and hematocrit levels, tremor and pain level after the operation. In newborns the acid-base balance parameters and Apgar score were monitored.

Results:
The study is still going on, however up to now some of the results suggest that usage of pre-heated infusion solutions is effective both for mother and child in increasing of their comfort in the perioperative period. In the group of actively heated mothers we have noticed: lower perioperative blood loss – differences in haemoglobin levels were 8 g/l compared to 15 g/l in the group of non heated mothers. The umbilical cord blood of the newborns whose mothers were not actively heated and were operated in subarachnoid anaesthesia had the lowest pO₂ (0.9 kPa). The lowest level of umbilical cord blood lactate was noticed in the group of newborns whose mothers underwent the surgery under general anaesthesia and were actively heated.

Conclusion:
Up to now results suggest that the heating of mothers during the SC lowers the loss of body temperature, blood loss, and perception of pain by the mother. In combination with general anaesthesia it increases pO₂ and lowers the levels of lactate in umbilical arteria in the newborns.

Keywords:
section – warmed infusion – body temperature

Zdroje

1. Algert, CS., et al. Regional block versus general anaesthesia for Caesarean section and neonatal outcomes. BMC Medicine, 2009, (http://www.biomedcentral.com/1741-7015/7/20).

2. Davies, P., French, GWG. A randomised trial comparing 5 ml/kgand 10 ml/kg of pentastarch as a volume preload before spinal anaesthesia for elective caesarean section. Inter J Obstet Anesth, 2006, 15, p. 279–283.

3. Jabor, A., a kol. Vnitřní prostředí. Praha: Grada, 2008.

4. Chung, SH., Lee, BS., Yang, HJ., et al. Effect of preoperative warming during cesarean section under spinal anesthesia. Korean J Anesthesiol, 2012, 62, p. 45–460.

5. Horn, EP., Schroeder, F., Gottschalk, A., Sessler, D. Active warming during Cesarean delivery. Anesth Analg, 2002, 94, p. 409–414.

6. Larsen, R. Anestezie. Praha: Grada, 2004, s. 959–960.

7. Lee, SH., Kim, HK., Park, S., et al. The effect of infusion rate and catheter length on the temperature of warming fluids. KoreanJ Anestesiol, 2010, 58, p. 31–37.

8. Moola, S., Lockwood, C. Effectiveness of strategies for the management and/or prevention of hypotermia within the adult perioperative environment. Inter J Evidence – Based Healthcare, 2011, 4, p. 337–345.

9. Pařízek, A. Spinální anestezie u císařského řezu. Anesteziologie & intenzivní medicína, 2006, 17, s. 274–276.

10. Pařízek, A., a kol. Porodnická analgezie a anestezie. Praha: Grada, 2002, s. 327.

11. Reynolds, F., et al. Anaesthesia for Caesarean section and neonatal acid-base status: a metaanalysis. Anaesthesia, 2005, p. 636–653.

12. Woolnough, M., Allam, J., Hemingway, C., et al. Intra-operativ fluid warming in elective caesarean section: a blinded randomised controlled trial. Int J Obstet Anesth, 2009, 18, p. 346–351.

13. Yokoyama, K., Shimada, Y., Matsushima, T., et al. Effect of administration of pre-warmed intravenous fluids on the frequency of hypotermia following spinal anesthesia for Cesarean delivery. J Clin Anesth, 2009, 21, p. 242–248.