A systematic review on the effectiveness of prewarming to prevent perioperative hypothermia

Aims and objectives: To analyse available research on the effectiveness of prewarming to prevent perioperative hypothermia and identify knowledge gaps for future research. Background: Perioperative hypothermia is common and causes complications, such as coagulation and platelet function abnormalities; increased cardiac morbidity, surgical site infection, and pressure ulcer incidence levels. In this context, several methods have been investigated to prevent perioperative hypothermia, including prewarming. Prewarming is defined as the warming of peripheral tissues or the skin surface before anaesthetic induction and may consist of an active cutaneous warming system or the preoperative administration of vasodilation drugs. Design: Systematic review. Methods: We searched CINAHL, EMBASE, Cochrane Register of Controlled Trials and Medline (January 1990-November 2011) for randomised controlled trials on the effectiveness of prewarming for prevention of perioperative hypothermia, published in English, Spanish and Portuguese, and involving elective surgery patients aged 18 years or older. Results: Of 730 identified studies, only 13 met the inclusion criteria. After hand-searching the reference lists of included studies, an additional study was identified for a total sample of 14 studies. The results suggest that forced-air warming system is effective to reduce hypothermia when applied for the prewarming of surgical patients. Conclusion: Prewarming patients with the forced-air warming system might be effective to reduce perioperative hypothermia, and new studies are needed to examine the use of carbon fibre technology. Relevance to clinical practice: Nurses can use this review to inform decision-making on a prewarming programme in the perioperative period. They can also develop research on strategies to put in practice prewarming in the surgical context.