{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:32:00Z","timestamp":1747182720873,"version":"3.40.5"},"reference-count":23,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,10,26]],"date-time":"2023-10-26T00:00:00Z","timestamp":1698278400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The objective of this study was to compare the efficacy of a low\u2010cost heat\u2010preserving method in preventing intraoperative hypothermia with that of forced\u2010air warming in a resource\u2010limited setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this randomized controlled non\u2010inferiority trial, we recruited children younger than 12\u2009years scheduled for cranial neurosurgery in a large East\u2010African hospital. Patients were block\u2010randomized by age to intraoperative warming measures using Hibler's method (intervention) or warm air (comparator). Hibler's group patients were circumferentially wrapped in transparent plastic sheeting (providing a vapor\u2010trap) over a layer of cotton blankets, then laid on an insulating foam mattress. Warm air group patients were treated with forced\u2010air convection via an underlying Snuggle Warm\u2122 Pediatric Full Body mattress. Allocated warming measures were initiated in the operating theatre and discontinued upon anesthesia emergence. Perioperative temperatures were measured using noninvasive forehead probes (SpotOn\u2122). The primary outcome was incidence of hypothermia (core temperature\u2009&lt;\u200936.0\u00b0 for longer than 5\u2009min). Our null hypothesis was that Hibler's method is inferior in efficacy to the warm air method by a margin exceeding 20%. Among secondary outcomes were duration of hypothermia as proportion of surgical duration, incidence of postoperative shivering and rescue measure requirements.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We analyzed data for 77 participants (Hibler's\u2009=\u200938; warm air\u2009=\u200939). There was no significant difference between the Hibler's and warm air arms of the study in the primary outcome of incidence of hypothermia (59.0% vs. 60.5% respectively; OR 1.07; 95% CI 0.43\u20132.65; <jats:italic>p<\/jats:italic>\u2009=\u2009.890). However, the risk difference (1.55%; 95% CI \u22120.20 to \u22120.24) exceeded the 0.2 margin and non\u2010inferiority could not be declared. There was considerable need for rescue measures in both groups (71.1 0% vs. 69.2%; OR 1.09; 95% CI 0.41\u20132.90; <jats:italic>p<\/jats:italic>\u2009=\u2009.861). There was no statistically significant difference between groups for any prespecified secondary outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Although perioperative core temperatures were not significantly different, we could not declare an inexpensive heat\u2010preserving method non\u2010inferior to warm air convection in preventing intraoperative hypothermia in children undergoing anesthesia for cranial neurosurgery in a resource\u2010limited setting. The extensive need for rescue measures may have masked important differences.<\/jats:p><jats:p><jats:bold>Trial Registration<\/jats:bold>: US National Institutes of Health <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">Clinicaltrials.gov<\/jats:ext-link> database (ID no. NCT02975817).<\/jats:p><\/jats:sec>","DOI":"10.1111\/aas.14341","type":"journal-article","created":{"date-parts":[[2023,10,26]],"date-time":"2023-10-26T09:55:09Z","timestamp":1698314109000},"page":"167-177","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preventing hypothermia in pediatric neurosurgery in Africa\u2014A randomized controlled non\u2010inferiority trial of insulation versus active warming"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4096-2509","authenticated-orcid":false,"given":"Anders C.","family":"Feyling","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Division of Emergencies &amp; Critical Care Oslo University Hospital Ullev\u00e5l  Oslo Norway"},{"name":"Institute of Clinical Medicine University of Oslo  Oslo Norway"},{"name":"Department of Research &amp; Development, Division of Emergencies &amp; Critical Care Oslo University Hospital  Oslo Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick D.","family":"Kamalo","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Central Hospital  Blantyre Malawi"},{"name":"Kamuzu University of Health Sciences  Blantyre Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terje","family":"Hanche\u2010Olsen","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Division of Emergencies &amp; Critical Care Oslo University Hospital Ullev\u00e5l  Oslo Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Singatiya S.","family":"Chikumbanje","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Central Hospital  Blantyre Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aina S.","family":"Zsidek","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Acute Care Division Oslo University Hospital  Oslo Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erica","family":"Ponzi","sequence":"additional","affiliation":[{"name":"Oslo Center for Biostatistics &amp; Epidemiology University of Oslo  Oslo Norway"},{"name":"Department for Research Support for Clinical Trials Oslo University Hospital  Oslo Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2487-0839","authenticated-orcid":false,"given":"Johan","family":"R\u00e6der","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Division of Emergencies &amp; Critical Care Oslo University Hospital Ullev\u00e5l  Oslo Norway"},{"name":"Institute of Clinical Medicine University of Oslo  Oslo Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,10,26]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31824b7e35"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0188-4409(01)00272-7"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.anes.0000296719.73450.52"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200108000-00040"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200605000-00025"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199110000-00009"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.4172\/2155-6148.1000102"},{"key":"e_1_2_12_9_1","unstructured":"Clinical practice guideline.The management of inadvertent perioperative hypothermia in adults. 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