Effect of Prewarming On Skin Temperature Changes

Effect of Prewarming On Skin Temperature Changes After Spinal Anesthesia in Transurethral Resection of The Bladder

In this randomized prospective single-blind study,American Society of Anesthesiologists physical status classification system ( ASA )I-II-III patients aged 50-80 years undergoing transurethral bladder resection will be randomly divided into two groups. First group will be covered with 41 centigrade degrees double layered cotton cloth. Second group will receive active prewarming. Core temperature of all patients will be monitorized via tympanic membrane. Skin temperature will be monitorized from 4 different body areas. Spinal anesthesia will be applied at the level of L3-L4 by a 25 Gauge quincke needle with a dose of 12.5-15 mg hyperbaric bupivacaine. Pinprick test will be used for sensorial block assessment. T10 sensorial block will be our goal. Hemodynamic parameters will be recorded. Skin temperature will be monitorized before and after spinal anesthesia and changes will be recorded. Operation time, amount and temperature of irrigation fluids, transfusion requirement, discharge time from postoperative care unit will also be recorded. Shivering score and thermal comfort scale will be used. The two groups will be compared for the temperature changes.

In this prospective single-blind study, patients will be divided into 2 groups with computer-based randomization technique. All patients will have a fasting time of 2 hours for clear fluid and 6 hours for solid food. Patients will be taken to the premedication room before the operation. Written and verbal approval will be taken from all patients. Tympanic membrane will be used for core temperature measurement by Citizen ear thermometer,every 15 minutes.Adult skin temperature probe will be used for continuous peripheral temperature measurement from four different body areas (T1:Cervical7 (C7) dermatome, T2:C6 dermatome T3:Lumbar 5( L5 )dermatome, T4: L4 dermatome). The two groups will have an infusion of balanced electrolyte solution with a rate of 8 Mililitre/Kilogram/ hour(mL/kg/hour). Patients in Group I will be covered with a 41 centigrade degrees double layered cotton clothes. Patients in Group II will receive active prewarming with a forced-air warming blanket (WarmCare full body blanket) 30 minutes prior to the operation. 0.1 mg/kg intravenous (iv) midazolam hydrochloride will be administered for premedication. Patients will be transferred to operating room, covered with warmed double layered cotton clothes. Standard monitoring (pulse oximetry, noninvasive blood pressure, electrocardiography) will be applied to the patients. Core temperature and 4-points skin temperature measurements will be recorded. Patients will be delivered 2 Liter/minute oxygen with a nasal cannula. Iv hydration will be continued by room temperature balanced electrolyte solution with an infusion rate of 2mililiter/kilogram/hour. Spinal anesthesia will be applied at the level of L3-L4 by a 25 Gauge Quincke needle with a dose of 12.5-15 mg hyperbaric bupivacaine in the sitting position. Then patients will be taken supine position. Hemodynamic measurements will be continued. Core temperature measurements will be done every 15 minutes. Peripheral skin temperature measurements will be continuous. 1st, 2nd ,3rd,4th ,5th ,6th, 7th, 8th, 9th and 10th minutes and every 5 minutes measurements will be recorded during the operation. Pinprick test will be used for sensorial block assessment. T10 sensorial block will be our goal. The time for adequate sensorial block (T10) will be recorded. The patients will be repositioned (lithotomy) before the beginning of surgery. 5 mg iv ephedrine and 0.5 mg iv atropine will be administered when the blood pressure will be %80 of the baseline pressure and heart rate. Operating time, amount and temperature of irrigation fluids, transfusion requirement will be recorded. All patients will be transferred to post anesthesia care unit (PACU). Core temperature measurements will be continued every 15 minutes at PACU. Shivering scale and thermal comfort scale will be used during and after the operation. 25 mg iv meperidine will be administered when the patient's shivering score will be more than 3. Length of PACU stay will be recorded.

The study covers 2 groups. Group I will be covered with warmed double layered cotton cloth. Group II will be covered with air forced blanket.

Patients receive active prewarming with an air forced blanket ( full body blanket) 30 minutes prior to the operation

Patients in Group II will receive active prewarming with an air forced blanket (full body blanket) 30 minutes prior to the operation

Core temperature and 4-points skin temperatures measurements will be recorded all over the operation. Patients will be delivered 2 Litre/minute oxygen with a nasal cannula.Iv hydration will be continued by room temperatured balanced electrolyte solution with an infusion rate of 2mL/kg/hr. Spinal anesthesia will be applied at the level of L3-L4 by a 25 Gauge Quincke needle with a dose of 12.5-15 mg hyperbaric bupivacaine in the sitting position.

F0 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

S0 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

T0 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

M0 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

F1will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F2 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F3 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F4 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F5 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F6 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F7 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F8 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F9 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F10 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F15 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F20 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F25 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F30 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F35 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F40 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F45 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F50 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F55 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

F60 will be defined as temperature which measured at C7 dermatome from palmar side of the 3rd finger with adult skin probe

S1 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S2 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S3 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S4 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S5 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S6 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S7 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S8 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S9 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S10 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S15 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S20 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S25 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S30 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S35 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S40 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S45 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S50 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S55 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

S60 will be defined as temperature which measured at C6 dermatome from ventral side of styloid process with adult skin probe

T1 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

T2 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

T3 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

T4 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

T5 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

T6 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

T7 will be defined as temperature which measured at L5 deramatome plantar side of 1st toe with adult skin probe

T8 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

T9 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

T10 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

T15 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

T20 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

T25 will be defined as temperature which measured L5 dermatome at plantar side of 1st toe with adult skin probe

T30 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

T35 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

T40 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

T45will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

T50 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

T55 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

T60 will be defined as temperature which measured at L5 dermatome plantar side of 1st toe with adult skin probe

M1 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M2 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M3 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M4 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M5 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M6 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M7 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M8 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M9 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M10 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M15 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M20 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M25 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M30 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M35 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M40 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M45 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M50 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M55 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

M60 will be defined as temperature which measured at L4 dermatome above the medial malleolus with adult skin probe

centigrade degree , Timpanic membrane will be used for core temperature measurement by Citizen ear thermometer, CTD504,

centigrade degree , Tympanic membrane will be used for core temperature measurement by Citizen ear thermometer, CTD504,

centigrade degree , Tympanic membrane will be used for core temperature measurement by Citizen ear thermometer, CTD504,

centigrade degree , Tympanic membrane will be used for core temperature measurement by Citizen ear thermometer, CTD504,

centigrade degree , Tympanic membrane will be used for core temperature measurement by Citizen ear thermometer, CTD504,

thermal comfort will be rated on a 100mm visual analog scale (VAS),with zero indicating intense cold and 100mm representing intense heat

0: no shivering 1:piloerection or peripheral vasoconstriction but no visible shivering 2: muscular activity in only one muscle group 3:muscular activity in more then one muscle group but not generalized shivering 4:shivering involving the whole body

0: no shivering 1:piloerection or peripheral vasoconstriction but no visible shivering 2: muscular activity in only one muscle group 3:muscular activity in more then one muscle group but not generalized shivering 4:shivering involving the whole body

0: no shivering 1:piloerection or peripheral vasoconstriction but no visible shivering 2: muscular activity in only one muscle group 3:muscular activity in more then one muscle group but not generalized shivering 4:shivering involving the whole body

0: no shivering 1:piloerection or peripheral vasoconstriction but no visible shivering 2: muscular activity in only one muscle group 3:muscular activity in more then one muscle group but not generalized shivering 4:shivering involving the whole body

0: no shivering 1:piloerection or peripheral vasoconstriction but no visible shivering 2: muscular activity in only one muscle group 3:muscular activity in more then one muscle group but not generalized shivering 4:shivering involving the whole body

0: no shivering 1:piloerection or peripheral vasoconstriction but no visible shivering 2: muscular activity in only one muscle group 3:muscular activity in more then one muscle group but not generalized shivering 4:shivering involving the whole body

0: no shivering 1:piloerection or peripheral vasoconstriction but no visible shivering 2: muscular activity in only one muscle group 3:muscular activity in more then one muscle group but not generalized shivering 4:shivering involving the whole body

0: no shivering 1:piloerection or peripheral vasoconstriction but no visible shivering 2: muscular activity in only one muscle group 3:muscular activity in more then one muscle group but not generalized shivering 4:shivering involving the whole body

0: no shivering 1:piloerection or peripheral vasoconstriction but no visible shivering 2: muscular activity in only one muscle group 3:muscular activity in more then one muscle group but not generalized shivering 4:shivering involving the whole body

Inclusion Criteria: ASA I-II-III 50-80 years old Patients scheduled for transurethral baldder resection Exclusion Criteria: Female gender Uncoordinated patients Have coagulopathy, Known allergies to drugs to be used, Patients diagnosed with severe hypovolemia Skin infection at the injection site. Body mass index greater than 35m2/kg patients with severe endocrinological disease Patients with cardiovascular diseases patients with severe aortic stenosis or severe mitral stenosis patients with increased intracranial pressure

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