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OBSTETRIC ANESTHESIA

Active Warming During Cesarean Delivery

Ernst-Peter Horn, MD^*, Frank Schroeder, MD^*, Andrè Gottschalk, MD^*, Daniel I. Sessler, MD, Natascha Hiltmeyer, MD^*, Thomas Standl, MD^*, and Jochen Schulte am Esch, MD^*

*Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; and the Outcomes Research^TM Institute and Department of Anesthesiology, University of Louisville, Louisville, Kentucky

Address correspondence and reprint requests to E-P Horn, MD, Department of Anesthesiology, University Hospital Eppendorf, Martinistreet 52, 20246 Hamburg, Germany. Address e-mail to ephorn{at}12move.de

We tested the hypothesis that 15 min of forced-air prewarming, combined with intraoperative warming, prevents hypothermia and shivering in patients undergoing elective cesarean delivery. We simultaneously tested the hypothesis that maintaining maternal normothermia increases newborn temperature, umbilical vein pH, and Apgar scores. Thirty patients undergoing elective cesarean delivery were randomly assigned to forced-air warming or to passive insulation. Warming started 15 min before the induction of epidural anesthesia. Core temperature was measured at the tympanic membrane, and shivering was graded by visual inspection. Patients evaluated their thermal sensation with visual analog scales. Rectal temperature and umbilical pH were measured in the infants after birth. Results were compared with unpaired, two-tailed Student’s t-tests and ² tests. Core temperatures after 2 h of anesthesia were greater in the actively warmed (37.1°C ± 0.4°C) than in the unwarmed (36.0°C ± 0.5°C; P < 0.01) patients. Shivering was observed in 2 of 15 warmed and 9 of 15 unwarmed mothers (P < 0.05). Babies of warmed mothers had significantly greater core temperatures (37.1°C ± 0.5°C vs 36.2°C ± 0.6°C) and umbilical vein pH (7.32 ± 0.07 vs 7.24 ± 0.07).

IMPLICATIONS: Perioperative forced-air warming of women undergoing cesarean delivery with epidural anesthesia prevents maternal and fetal hypothermia, reduces maternal shivering, and improves umbilical vein pH.

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