Investigation of the effects of preoperative warming on patient hemodynamics and post operative tremors in transurethral surgeries performed with spinal anesthesia

Introduction and Purpose: Although trembling is a complication with an incidence rate of 39% after spinal anesthesia, it is often an overlooked condition in clinical practice. However, it has been demonstrated that trembling increases oxygen consumption (up to 400%), carbon dioxide production, and metabolic rate, contributing to arterial hypoxia and acidosis. Hypothermia and trembling development can be prevented with compressed air heaters; however, the intraoperative effects of these devices are limited. With this study, the purpose was to investigate the effects of preoperative compressed air heaters on perioperative hypothermia and trembling in patients between the ages of 45 and 80. Material and Method: The ethics committee approval for the study was obtained from the Ethics Committee of Clinical Research (17.04.2019/09) of Van Yuzuncu Yil University. A total of 120 patients who were scheduled for Elective Transurethral Surgery with ASA scores between I-II and with an age range of 45-80 were included in the study. The patients were randomized with Closed Envelope Method, and were then divided into 3 groups. The patients were taken to preoperative evaluation room 60 minutes before the surgery. Wide vascular access was opened in all patients, and crystalloid fluid was administered i.v. at a dose of 10cc/kg. Non-Invasive Blood Pressure, Heart Rate, Peripheral Oxygen Saturation, and Tympanic Membrane Temperatures of the patients were evaluated. Group A was heated 60 minutes before the surgery, and Group B 30 minutes before the surgery with a compressed air heating system set to 38oC. Group C was taken to the preoperative evaluation room and was evaluated there. However, the heating process was not applied to Group C. After the patients were provided with necessary asepsis and antisepsis conditions in sitting position, spinal anesthesia was performed through L2-L3 or L3-L4 spinal range with 25 G Quincke-type spinal needle. Surgical durations and patient and surgeon satisfactions (good, bad, and moderate) were evaluated and recorded. The trembling during the postoperative period was evaluated with the Trembling Test, which was developed by Crossley and Mahajan. The data were analyzed with statistical analysis methods, and were then interpreted. The significance level was considered as p<0.05. Findings: No differences were detected between the groups in terms of demographic data (p>0.05). In Group A and Group B, hypothermia and trembling scores were lower at significant levels compared to Group C (p<0.05). No significant differences were detected in none of the groups in terms of hemodynamic parameters (p>0.05). Conclusion: It was concluded that preoperative heating reduces intraoperative hypothermia and trembling degrees, does not have significant effects on blood pressures, heart rates, and peripheral oxygenation, and increases patient and surgeon satisfaction.