///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

Audit: Peri-operative warming for Caesarean sections

Abstract Number: 220
Abstract Type: Case Report/Case Series

Fuhazia Arif MBBS BSc1 ; Jeremy Howard MBBS FRCA2

C-section is considered a short procedure, but hypothermia may occur. In non-obstetric cases, guidelines recommend the use of warming devices in all patients having anaesthesia for longer than 30 minutes as perioperative hypothermia has been found to increase:

-wound infection rates

-length of hospital stay

-operative blood loss

Most Caesareans are performed under neuroaxial blockade, heat is redistributed from the core to the periphery leading to an impairment of central autonomic thermoregulatory control. The extent of the temperature drop is related to the height of the block, which is usually to T4. Additional opioids can exacerbate the hypothermia.

Shivering can occur in 60% of cases and causes increased O2 consumption, CO2 production, cardiac work and maternal discomfort. Studies by Horn et al 2002 showed improved maternal core temperature and intra-operative shivering with forced air warmer and warmed intravenous fluids.

Woolnough et al Study, Int J Obs Anaesthesia 2009

As a result of this RCT this group recommended that all patients should be given warmed fluids during C-section, and using pre-warmed fluids is as efficient but cheaper than using a fluid warmer.

Method

A retrospective audit was done in October 2009, looking at C-sections performed under regional anaesthesia.

53 case notes were reviewed and the following were documented

-Pre- and post-operative temperature from the midwifery notes

-Duration of procedure

-Blood loss

-Volume of fluid administered

-Warming technique used as documented on the anaesthetic chart

Temperature was monitored by an infra-red tympanic thermometer

Ambient temperature in obstetric theatre is 23C

Results

Average maternal age= 31.4 (range 17-44)

Of the 53 case notes reviewed 34 had both maternal pre- and post-operative temperature documented

There was no documentation of use of fluid warmer, forced air warmer or pre-warmed fluid for caesarean section in any case

Average temperature drop = 0.46˚C

On average 1.5 litres of fluid was given. There is a correlation between amount of intravenous fluids and temperature drop.

Average surgical time = 69 minutes (45mins-210 mins), and there is a larger temperature decrease with longer procedures.

Conclusion

Pre-warmed fluids should be used in all obstetric cases.

Improved documentation of pre- and post-operative temperatures in notes.

Improving documentation of warming methods used.

Re-audit in 6 months.



SOAP 2010