PREWARMING IN PATIENTS UNDERGOING ELECTIVE NEUROSURGERY: CRITICALLY APPRAISED TOPIC

Abstract

Summary: Clinical setting: A 20-year-old patient with a diagnosis of glioma multiforme, will be taken to a scheduled craniotomy for resection of his tumor. No medical or surgical pathological history. On physical examination, a patient with normal vital signs, without neurological focus. His neoplasm was excised by craniotomy under general anesthesia, with warm-up for 30 minutes and active intraoperative warm-up, without complications. He was transferred to the ICU for neurological surveillance. Discharge 7 days after surgery without complications. Clinical problem: In adults who will undergo programmed neurosurgery, does warm-up decrease in-hospital mortality? Objetives: Perform a Critically Appraised Topic (CAT) to (I) analyze existing research related to warming in patients undergoing neurosurgery, and (II) apply the results to the clinical setting. Methods: A systematic search was carried out in 3 databases in search of publications about the clinical problem in adults over 18 years of age. Results: Three studies met the inclusion criteria. The evidence about the usefulness of warming in reducing episodes of hypothermia during the intraoperative period is highlighted, however, no study was found that evaluated the outcomes of warming in the postoperative period. Conclusion: Warming up for at least 10 minutes is a useful measure to increase comfort and reduce hypothermic episodes. The prevention of hypothermic episodes during the perioperative period has been shown to be useful for reducing multiple complications including mortality. However, the usefulness of postoperative warming in neurosurgery is unknown, despite this its use is recommended due to its causal relationship with the decrease in perioperative hypothermia for at least a period of 10 minutes and to continue it even during induction.