The problem of warming on preoperative patients is very important. Traditionally, this problem remained a subject of numerous discussions since the patient’s warming was often viewed as a possibility to prevent possible negative effects of surgical operations. In such a situation comfort warming of preoperative patients often remained under-researched. Basically, it should be said that comfort warming is really important and needs a profound research since the research of this field can reveal many important facts about the possible effects of comfort warming on patients.
In fact, the research of this problem should involve a careful application of really effective methodology of the research and analysis of the major findings that will help make objective conclusion and work out essential recommendations concerning possible improvements of the practical application of comfort warming on preoperative patients in order to make it more effective. At any rate, the current research can reveal the major effects of comfort warming on patients’ state.
Purpose of the study
Basically, the purpose of the current research is to find out the effects of comfort warming on preoperative patients. To put it more precisely, the current research is supposed to reveal the effects of comfort warming and to answer the main question whether comfort warming is useful or probably it just creates additional inconveniences for patients as well as doctors.
Obviously, the research should target at the analysis of the application of comfort warming in practice. In fact, the purpose of the study is supposed to reveal the problem of effects of comfort warming on preoperative patients and their assessment. At the same time, it should be said that this problem is really important because, unlike active warming, for instance, comfort warming is under-researched and therefore needs to be carefully analyzed.
In fact, before the start of the study, it is possible to presuppose that comfort air warming may result in the reduction of the preoperative anxiety among surgical patients.
Review of literature
In fact, the use of warming is nowadays considered to be quite perspective. In this respect, it should be pointed out that the recent researches reveal the fact that warming can enforce the patients resistance to the surgical site infections (Wagner et al, 2006, p.429). It is not a secret that surgical operations are often accompanied by the increased risk of getting some infections. One of the greatest but under-treated risk factors for contracting surgical site infections is the development of intraoperative hypothermia, which affects approximately half of patients undergoing clean surgery (Wagner et al, 2006, p.433). At this point it is possible to presuppose that the use of warming on the preoperative stage could contribute to the minimization of such risks.
Furthermore, it should be said that specialists (Wagner et al, 2006, p.432) underline that hypothermia often occurs during general anesthesia because of impaired thermoregulation, redistribution of heat from the core to the periphery. In patients undergoing surgeries requiring postoperative hospitalization, intraoperative hypothermia has been shown to increase blood loss and transfusion requirements.
At the same time, it should be also pointed out that comfort warming of preoperative patients may be very important for the psychological as well as physiological state regulating the internal processes and decreasing the psychological tension of patients (Wagner et al, 2006, p.435). In fact, comfort warming is basically used to calm patients down and prevent possible disturbance of patients before the operation. Obviously, they need to feel comfortable before the surgery operation starts, otherwise, as specialists underline the possibility of complications or undesirable effects is quite high, while, in contrast, in the result of the use of comfort warming of preoperational patients their state may be maintained stable (Wagner et al, 2006, p.432).
In such a way, it is obvious that the existing studies emphasize the impact of warming on patients state but it is still necessary to pay a particular attention to the effects of comfort warming on preoperational patients since certain specialists (Wagner et al, 2006, p.434) estimate that the effectiveness of preoperational comfort warming is, at any rate, less significant that active warming during intraoperative stage, for instance. Consequently, the effectiveness of comfort warming is argued and, therefore, the current research should either prove or reject this presupposition since the analysis of the application of comfort warming can reveal its effects both positive and negative.
The research was based on the analysis of the comfort warming of preoperative patients and was basically focused on the preoperative state of the patients, its change during the operation and the post operation measurements which were supposed to fully reveal the effects of comfort warming in the postoperative period. The two groups of patients were used in the research. There was an experimental group which had undergone comfort warming and the control group where comfort warming was not applied. Before operations, patients received convective warming. In fact, it was Snuggle Warm Convective Warming System. To warm patients, the warming blanket was used which covered the lower and upper part of the body. In general, about 40% of patient’s body was covered with the warming blanket. The air delivered was warmed to the temperature approximate to 40 degrees by means of the drawing of ambient room temperature through an ultra fine glass inlet filter. The filtered air was passed through an outlet filter of 0.2 micron and then through the hose it was delivered to the blanket. The prewarming lasted for 30 minutes during which the observations of the arm and leg heat were made. It was important to note that the heat content increased by 69 kcal during this period of time that similar to redistribution in healthy volunteers (Wagner et al, 2006, p.440). During the operation the warmth was maintained by means of the convective blanket, which was removed at the end of the operation and, instead, the patient was covered with a standard hospital bath blanket. It should be pointed out that the warmth was provided by the circulation of IV fluids which circulated due to the fluid warming device that heated the water up to 42 degrees (Wagner et al, 2006, p.441).
Furthermore, the patients temperature was measured, including sublingual temperatures, by means of an electronic thermometer before and after the operation. The measurements were carried out by nurses who were experienced in the use of this device. During the operation, patients temperatures were also measured at 15 minutes intervals following induction until the end of the operation using an 18 or 9 Fr esophageal stethoscope with thermocouple sensor (Wagner et al, 2006, p.442). It should be pointed out that doctors were informed about the changes of the temperature of the patients which was displayed on a two channel monitor.
After the operation, essential postoperative data were recorded within 5 minutes of arrival to the PACU, and after 30- 60 minutes in the PACU by a nurse who was not informed whether the patient belong to the experiment group or not. The data collected comprised vital signs, sublingual temperature, time to discharge, presence or absence of shivering, severity of shivering if present, medication requirements, and use of heating devices, including radiant heat and warm hospital blanket (Wagner et al, 2006, p.438). Also, it should be said that such data as body surface area coverage of convective blanket, change in intraoperative temperature management, number of warm hospital blankets used during the intraoperative period, type and volume of intratoperative fluids administered were measured. After the surgery, patients had been observed during a fourteen days period by a general clinical research center nurse which worked with patient group without knowledge whether it is an experimental group or not. The nurse recorded the patients answers to questions about infections or complications, thermal comfort of patients that was reported by patients in accordance with the scale varying from comfortable, too warm, too cold, shivered and to no memory, patients satisfaction on the basis of four range scale excellent, good, fair, and poor. And finally, the patients were asked whether they would choose the same anesthetic again if offered or not.
The data collected were analyzed with the help of the SAS System and Statistix for Windows Version 8.0. Parametric data were analyzed with the help of unpaired Student’s test, while non-parametric data were compared between experimental and control groups with the help of Chi Squared analysis, Fishers Exact test, and the Cochran-Mantel-Haenszel test (Wagner et al, 2006, p.441).
In the result of the research, it has been found out that the general effect of comfort warming on preoperative patients is rather positive. On analyzing the results of the research, it is necessary to underline that comfort warming had a positive effect on preoperative patients’ thermal comfort and sense of well-being, patients using a forced-air warming gown also experienced a significant reduction in preoperative anxiety. Moreover, even during and after the surgery the general state of the patient was good that means that comfort warming can really contribute to the reduction of the nervous tension of the patient contributing to the stability of his/her state during the operation making its effects less negative to the patient’s postoperative state.
Conclusion and recommendations
Thus, taking into account all above mentioned, it is possible to conclude that the application of comfort warming of preoperative patients may be very effective and contribute consistently to the reduction of patient’s anxiety and disturbance. Consequently, it is possible to recommend the wide application of comfort warming, though it is necessary to remember that along with comfort effect, warming, during the operation, may fulfill an important function of the reduction of risks of surgery site infections.
Wagner, D., Byrne, M. Kolcaba, K. (September, 2006). “Effects of Comfort Warming on Preoperative Patients.” AORN Journal, p.427-448.
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