COMPARİSON OF THE EFFECTS OF ANESTHESİA TECHNİQUE AND MATERNAL WARMİNG ON NEONATAL BODY TEMPERATURE İN CESAREAN SECTİON OPERATİONS: A RETROSPECTİVE STUDY

Year 2024, Volume: 7 Issue: 2, 189 - 195, 30.06.2024

Kamuran Uluç , Ayşe Surhan Cinar , Hacer Şebnem Türk , Elif Filiz Gökdemir

Abstract

Objective: Both general and spinal anesthesia are preferred methods in cesarean section operations. Inadequate thermoregulation mechanisms of newborns and changes in maternal body temperature caused by anesthetic approaches adversely affect the newborn. Our study aimed to retrospectively compare the effects of different anesthetic techniques and maternal warming on neonatal body temperature in cesarean section operations.
Methods: Our study was performed retrospectively on the data of 112 American Society of Anesthesiologists (ASA) I-II-III patients who underwent cesarean section after ethics committee approval. General anesthesia was defined as Group G1 (n:28) heated with a hot air blower system and Group G2 (n:28) without heating. Spinal anesthesia was defined as Group S1 (n:28) heated with a hot air blower system and Group S2 (n:28) without heating. Demographic data, number, and week of pregnancy were recorded. Apical heart peak (AHP), non-invasive blood pressure (BP) [systolic blood pressure (SBP), diastolic blood pressure (DBP)], peripheral capillary oxygen saturation (SpO2), and body temperatures at baseline, at 5, 15, and 20 min and at the time the baby left the womb were recorded. Newborns were recorded at 0 and 1 minute. APGAR scores of the newborn at 1 and 5 minutes were recorded. Patients with chills, shivering, nausea, and vomiting were recorded in all groups.
Results: Infant temperature and APGAR scores were significantly higher in the groups receiving spinal anesthesia (Group S1+S2) than in the groups receiving general anesthesia (Group G1+G2), respectively (p<0.05). Maternal temperature averages were statistically significantly higher in Groups G1 and S1 than in Groups G2 and S2, respectively (p<0.05).
Conclusions: Maternal warming and spinal anesthesia increase maternal and neonatal body temperature and APGAR scores. Therefore, maternal warming and spinal anesthesia techniques are recommended for pregnant women.

Keywords

Neonatal hypothermia, cesarean section, general anesthesia, spinal anesthesia, maternal warming, APGAR score

Ethical Statement

Ethics committee approval was obtained for the study at Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital. (approval dated 13/06/2017 and numbered 1576)

SEZARYEN OPERASYONLARINDA UYGULANAN ANESTEZİ TEKNİĞİ VE MATERNAL ISITMANIN YENİDOĞAN VÜCUT SICAKLIĞINA ETKİLERİNİN KARŞILAŞTIRILMASI: RETROSPEKTIF ÇALIŞMA

Abstract

Amaç: Sezaryen operasyonlarında genel ya da spinal anestezi uygulamasının her ikisi de tercih edilen yöntemlerdir. Yenidoğanların termoregülasyon mekanizmalarının yetersizliği ve anestezik yaklaşımların maternal vücut ısısında oluşturduğu değişimler yenidoğanı olumsuz etkilemektedir. Çalışmamızın amacı; sezaryen operasyonlarında uygulanan farklı anestezi teknikleri ve maternal ısıtmanın yenidoğan vücut sıcaklığına etkilerini retrospektif olarak karşılaştırmaktır.
Yöntem: Çalışmamız etik kurul onayı alındıktan sonra sezeryan operasyonu geçiren Amerikan Anesteziyoloji Derneği’nin fiziksel durum sınıflaması (ASA) I-II-III olan 112 hastanın verileri üzerinden retrospektif olarak yapıldı. Genel anestezi uygulanan sıcak hava üflemeli sistem ile ısıtılan Grup G1 (n:28), ısıtma uygulanmayan Grup G2 (n:28) olarak tanımlandı. Spinal anestezi uygulanan sıcak hava üflemeli sitem ile ısıtılan Grup S1 (n:28), ısıtma uygulanmayan Grup S2 (n:28) olarak tanımlandı. Demografik veriler, gebelik sayısı ve haftası kaydedildi. Hastaların kalp tepe atımları (KTA), non-invaziv kan basıncı [sistolik kan basıncı, diyastolik kan basıncı], periferik oksijen saturasyonu (SpO2) ve vücut sıcaklıklarının başlangıç, 5. ,15. , 20. dk ve bebeğin anne karnından çıktığı andaki değerleri kayıt edildi. Yenidoğanın 0. dk ve 1. dakikada kaydedildi. Yenidoğanın 1. ve 5. dakikadaki APGAR skorları kaydedildi. Tüm gruplarda üşüme, titreme, bulantı, kusma görülen hastalar kaydedildi.
Bulgular: Bebek sıcaklığı ve APGAR skorları spinal anestezi yapılan (Grup S1+S2) gruplarda genel anestezi alan (Grup G1+G2) gruplardan sırasıyla anlamlı yüksek bulundu (p<0,05). Anne sıcaklık ortalamları Grup G1 ve S1 de sırasıyla G2 ve S2 istatiksel olarak anlamlı yüksek bulundu (p<0,05).
Sonuç: Maternal ısıtma uygulaması ve spinal anestezi anne ve yenidoğan vücut sıcaklığını ve yenidoğanın APGAR skorunu arttırmaktadır. Bu nedenle gebelerde maternal ısıtma ve spinal anestezi tekniği tercih edilmesi önerilir.

Keywords

Yenidoğan hipotermisi, sezeryan, genel anestezi, spinal anestezi, maternal ısıtma, APGAR skoru

Ethical Statement

Çalışma için Sağlık Bilimleri Üniversitesi Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi'nden etik kurul onayı alınmıştır. (13/06/2017 tarih ve 1576 sayılı onay)

References

• The Turkish Anaesthesiology and Reanimation Society Guidelines for the prevention of inadvertent perioperative hypothermia. Turk J Anaesthesiol Reanim. 2013;41(5):188-190. doi:10.5152/TJAR.2013.64
• Egan C, Bernstein E, Reddy D, et al. A randomized comparison of intraoperative perfectemp and forced-air warming during open abdominal surgery. Anesth Analg. 2011;113(5):1076-1081. doi:10.1213/ANE.0b013e31822b896d
• Hasegawa K, Nakagawa F, Negishi C, Ozaki M. Core temperatures during major abdominal surgery in patients warmed with new circulating-water garment, forced-air warming, or carbon-fiber resistive-heating system. J Anesth. 2012;26(2):168-173. doi:10.1007/s00540-011-1306-1
• Fanelli A, Danelli G, Ghisi D, Ortu A, Moschini E, Fanelli G. The efficacy of a resistive heating under-patient blanket versus a forced-air warming system: a randomized controlled trial. Anesth Analg. 2009;108(1):199-201. doi:10.1213/ane.0b013e31818e6199
• Quality AHR. AHRQ quality indicators - Guide to inpatient quality indicators: quality of care in hospitals. Volume: Mortality, and utilization. Revision 4. IQI 21. Cesarean delivery rate. http://www.qualityindicators.ahrq.gov/iqi_overview. htm.
• Anderson GM. Making sense of rising caesarean section rates. BMJ. 2004;329(7468):696-697. doi:10.1136/bmj.329.7468.696
• Abboud TK, Nagappala S, Murakawa K, et al. Comparison of the effects of general and regional anesthesia for cesarean section on neonatal neurologic and adaptive capacity scores. Anesth Analg. 1985;64(10):996-1000.
• Kimberger O, Held C, Stadelmann K, et al. Resistive polymer versus forced-air warming: Comparable heat transfer and core rewarming rates in volunteers. Anesth Analg. 2008;107(5):1621-1626. doi:10.1213/ane.0b013e3181845502
• Perl T, Flöther L, Weyland W, Quintel M, Bräuer A. Comparison of forced-air warming and resistive heating. Minerva Anestesiol. 2008;74(12):687-690.
• Sessler DI. Perioperative heat balance. Anesthesiology. 2000;92(2):578-596. doi:10.1097/00000542-200002000-00042
• Workhoven MN. Intravenous fluid temperature, shivering, and the parturient. Anesth Analg. 1986;65(5):496-498.
• Arkiliç CF, Akça O, Taguchi A, Sessler DI, Kurz A. Temperature monitoring and management during neuraxial anesthesia: An observational study. Anesth Analg. 2000;91(3):662-666. doi:10.1097/00000539-200009000-00031
• Matsukawa T, Sessler DI, Christensen R, Ozaki M, Schroeder M. Heat flow and distribution during epidural anesthesia. Anesthesiology. 1995;83(5):961-967. doi:10.1097/00000542-199511000-00008
• Woolnough MJ, Hemingway C, Allam J, Cox M, Yentis SM. Warming of patients during Caesarean section: a telephone survey. Anaesthesia. 2009;64(1):50-53. doi:10.1111/j.1365-2044.2008.05677.x
• Zhuo Q, Xu J Bin, Zhang J, Ji B. Effect of active and passive warming on preventing hypothermia and shivering during cesarean delivery: a systematic review and meta-analysis of randomized controlled trials. BMC Pregnancy Childbirth. 2022;22(1):720. doi:10.1186/s12884-022-05054-7
• de Bernardis RC, Siaulys MM, Vieira JE, Mathias LA. Perioperative warming with a thermal gown prevents maternal temperature loss during elective cesarean section. A randomized clinical trial. Braz J Anesthesiol. 2016;66(5):451-455. doi:10.1016/j.bjane.2014.12.007
• Munday J, Hines S, Wallace K, Chang AM, Gibbons K, Yates P. A Systematic review of the effectiveness of warming interventions for women undergoing cesarean section. Worldviews Evid Based Nurs. 2014;11(6):383-393. doi:10.1111/wvn.1206
• Cobb B, Cho Y, Hilton G, Ting V, Carvalho B. Active warming utilizing combined ıv fluid and forced-air warming decreases hypothermia and ımproves maternal comfort during cesarean delivery: a randomized control trial. Anesth Analg. 2016;122(5):1490-1497. doi:10.1213/ANE.0000000000001181
• Butwick AJ, Lipman SS, Carvalho B. Intraoperative forced air-warming during cesarean delivery under spinal anesthesia does not prevent maternal hypothermia. Anesth Analg. 2007;105(5):1413-1419. doi:10.1213/01.ane.0000286167.96410.27
• Horn EP, Schroeder F, Gottschalk A, et al. Active warming during cesarean delivery. Anesth Analg. 2002;94(2):409-414. doi:10.1097/00000539-200202000-00034
• Negishi C, Ozaki M, Suzuki H, Ohno T. Temperature changes and thermoregulatory responses during epidural anesthesia in women undergoing cesarean delivery. Japanese Journal of Anesthesiology. 1996;45(5):558-564.
• Yentur EA, Topcu I, Ekici Z, Ozturk T, Keles GT, Civi M. The effect of epidural and general anesthesia on newborn rectal temperature at elective cesarean section. Braz J Med Biol Res. 2009;42(9):863-867. doi:10.1590/s0100-879x2009000900014
• Horn EP, Bein B, Steinfath M, Ramaker K, Buchloh B, Höcker J. The incidence and prevention of hypothermia in newborn bonding after cesarean delivery: a randomized controlled trial. Anesth Analg. 2014;118(5):997-1002. doi:10.1213/ANE.0000000000000160
• Sendağ F, Terek C, Oztekin K, Sağol S, Asena U. Comparison of epidural and general anaesthesia for elective caesarean delivery according to the effects of apgar scores and acid-base status. Aust N Z J Obstet Gynaecol. 1999;39(4):464-468. doi:10.1111/j.1479-828x.1999.tb03134.x
• Kolatat T, Somboonnanonda A, Lertakyamanee J, Chinachot T, Tritrakarn T, Muangkasem J. Effects of general and regional anesthesia on the neonate (a prospective, randomized trial). J Med Assoc Thai. 1999;82(1):40-45.
• Kavak ZN, Başgül A, Ceyhan N. Short-term outcome of newborn infants: spinal versus general anesthesia for elective cesarean section. a prospective randomized study. Eur J Obstet Gynecol Reprod Biol. 2001;100(1):50-54. doi:10.1016/s0301-2115(01)00417-1
• Sultan P, Habib AS, Cho Y, Carvalho B. The Effect of patient warming during Caesarean delivery on maternal and neonatal outcomes: a meta-analysis. Br J Anaesth. 2015;115(4):500-510. doi:10.1093/bja/aev325
• Hoefnagel AL, Vanderhoef KL, Anjum A, et al. Improving intraoperative temperature management in elective repeat cesarean deliveries: a retrospective observational cohort study. Patient Saf Surg. 2020;19;14:14. doi:10.1186/s13037-020-00241-x
• Akdag Topal C, Yucel Ozcirpan C, Ozyuncu O. The effect of forced-air warming in the cesarean section on maternal hypothermia, shivering, and thermal comfort: a randomized controlled trial. Health Care Women Int. 2023;11:1-18. doi:10.1080/07399332.2023.2245366