{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T20:17:44Z","timestamp":1790194664420,"version":"4.1.0"},"reference-count":45,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T00:00:00Z","timestamp":1701043200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Redistribution hypothermia occurs during anesthesia despite active intraoperative warming. Prewarming increases the heat absorption by peripheral tissue, reducing the central to peripheral heat gradient. Therefore, the addition of prewarming may offer a greater preservation of intraoperative normothermia as compared to intraoperative warming only. Materials and Methods: A single-center clinical trial of adults scheduled for non-cardiac surgery. Patients were randomized to receive or not a prewarming period (at least 10 min) with convective air devices. Intraoperative temperature management was identical in both groups and performed according to a local protocol. The primary endpoint was the incidence, the magnitude and the duration of hypothermia (according to surgical time) between anesthetic induction and arrival at the recovery room. Secondary outcomes were core temperature on arrival in operating room, surgical site infections, blood losses, transfusions, patient discomfort (i.e., shivering), reintervention and hospital stay. Results: In total, 197 patients were analyzed: 104 in the control group and 93 in the prewarming group. Core temperature during the intra-operative period was similar between groups (p = 0.45). Median prewarming lasted 27 (17\u201338) min. Regarding hypothermia, we found no differences in incidence (controls: 33.7%, prewarming: 39.8%; p = 0.37), duration (controls: 41.6% (17.8\u201378.1), prewarming: 45.2% (20.6\u201371.1); p = 0.83) and magnitude (controls: 0.19 \u00b0C \u00b7 h\u22121 (0.09\u20130.54), prewarming: 0.20 \u00b0C \u00b7 h\u22121 (0.05\u20130.70); p = 0.91). Preoperative thermal discomfort was more frequent in the prewarming group (15.1% vs. 0%; p &lt; 0.01). The interruption of intraoperative warming was more common in the prewarming group (16.1% vs. 6.7%; p = 0.03), but no differences were seen in other secondary endpoints. Conclusions: A preoperative prewarming period does not reduce the incidence, duration and magnitude of intraoperative hypothermia. These results should be interpreted considering a strict protocol for perioperative temperature management and the low incidence of hypothermia in controls.<\/jats:p>","DOI":"10.3390\/medicina59122082","type":"journal-article","created":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T07:56:10Z","timestamp":1701071770000},"page":"2082","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Effect of Prewarming on Perioperative Hypothermia in Patients Undergoing Loco-Regional or General Anesthesia: A Randomized Clinical Trial"],"prefix":"10.3390","volume":"59","author":[{"given":"Jesus","family":"Recio-P\u00e9rez","sequence":"first","affiliation":[{"name":"Department of Anesthesia, Torrejon University Hospital, 28850 Torrej\u00f3n de Ardoz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Mir\u00f3 Murillo","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Torrejon University Hospital, 28850 Torrej\u00f3n de Ardoz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Martin Mesa","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Torrejon University Hospital, 28850 Torrej\u00f3n de Ardoz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Silva Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, 12 Octubre Hospital, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Santonocito","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, University Hospital \u201cPoliclinico-San Marco\u201d, 95124 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5144-0776","authenticated-orcid":false,"given":"Filippo","family":"Sanfilippo","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, University Hospital \u201cPoliclinico-San Marco\u201d, 95124 Catania, Italy"},{"name":"Department of Surgery and Medical-Surgical Specialties, University of Catania, 95124 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7898-4685","authenticated-orcid":false,"given":"Angel","family":"As\u00fansolo","sequence":"additional","affiliation":[{"name":"Department of Public Health, Alcala University, 28801 Alcala de Henares, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1097\/00000542-199503000-00008","article-title":"Heat flow and distribution during induction of general anesthesia","volume":"82","author":"Matsukawa","year":"1995","journal-title":"Anesthesiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1097\/00000542-199512000-00011","article-title":"Desflurane slightly increases the sweating threshold but produces marked, nonlinear decreases in the vasoconstriction and shivering thresholds","volume":"83","author":"Annadata","year":"1995","journal-title":"Anesthesiology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1097\/00000542-199705000-00007","article-title":"Meperidine decreases the shivering threshold twice as much as the vasoconstriction threshold","volume":"86","author":"Kurz","year":"1997","journal-title":"Anesthesiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1111\/j.1749-6632.1997.tb51780.x","article-title":"Isoflurane produces marked and nonlinear decreases in the vasoconstriction and shivering thresholds","volume":"813","author":"Kurz","year":"1997","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1097\/00000542-199710000-00017","article-title":"Dexmedetomidine does not alter the sweating threshold, but comparably and linearly decreases the vasoconstriction and shivering thresholds","volume":"87","author":"Talke","year":"1997","journal-title":"Anesthesiology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1097\/00000542-199508000-00009","article-title":"Alfentanil slightly increases the sweating threshold and markedly reduces the vasoconstriction and shivering thresholds","volume":"83","author":"Kurz","year":"1995","journal-title":"Anesthesiology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1097\/00000542-199512000-00012","article-title":"Desflurane reduces the gain of thermoregulatory arteriovenous shunt vasoconstriction in humans","volume":"83","author":"Kurz","year":"1995","journal-title":"Anesthesiology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1097\/00000542-199804000-00004","article-title":"Isoflurane alters shivering patterns and reduces maximum shivering intensity","volume":"88","author":"Ikeda","year":"1998","journal-title":"Anesthesiology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.jclinane.2015.12.025","article-title":"Remifentanil and worse patient-reported outcomes regarding postoperative pain management after thyroidectomy","volume":"31","author":"Sanfilippo","year":"2016","journal-title":"J. Clin. Anesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1097\/00000542-199511000-00008","article-title":"Heat flow and distribution during epidural anesthesia","volume":"83","author":"Matsukawa","year":"1995","journal-title":"Anesthesiology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1097\/00000542-199606000-00008","article-title":"Reduction in the shivering threshold is proportional to spinal block height","volume":"84","author":"Leslie","year":"1996","journal-title":"Anesthesiology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/00000542-199402000-00006","article-title":"Epidural anesthesia impairs both central and peripheral thermoregulatory control during general anesthesia","volume":"80","author":"Joris","year":"1994","journal-title":"Anesthesiology"},{"key":"ref_13","first-page":"564","article-title":"Clinical practice guideline. Unintentional perioperative hypothermia","volume":"65","author":"Vecino","year":"2018","journal-title":"Rev. Esp. Anestesiol. Reanim."},{"key":"ref_14","unstructured":"National Collaborating Centre for Nursing and Supportive Care (UK) (2023, October 05). The Management of Inadvertent Perioperative Hypothermia in Adults, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK53797\/."},{"key":"ref_15","unstructured":"(2023, October 05). S3 Leitlinie: Vermeidung Perioperativer Hypothermie. Available online: https:\/\/www.awmf.org\/leitlinien\/detail\/ll\/001-018.html."},{"key":"ref_16","unstructured":"SIAARTI (2023, October 05). Normotermia Perioperatoria. Available online: https:\/\/www.siaarti.it\/news\/371375."},{"key":"ref_17","first-page":"26","article-title":"Proposta de Consensos de Manuten\u00e7\u00e3o da Normotermia no Per\u00edodo Perioperat\u00f3rio","volume":"26","author":"Azenha","year":"2017","journal-title":"Rev. Soc. Port. Anestesiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2655","DOI":"10.1016\/S0140-6736(15)00981-2","article-title":"Perioperative thermoregulation and heat balance","volume":"387","author":"Sessler","year":"2016","journal-title":"Lancet Lond. Engl."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1097\/00000542-199608000-00003","article-title":"Isoflurane Produces Marked and Nonlinear Decreases in the Vasoconstriction and Shivering Thresholds","volume":"85","author":"Xiong","year":"1996","journal-title":"J. Am. Soc. Anesthesiol."},{"key":"ref_20","first-page":"1212","article-title":"Nitrous oxide decreases the threshold for vasoconstriction less than sevoflurane or isoflurane","volume":"80","author":"Ozaki","year":"1995","journal-title":"Anesth. Analg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1213\/00000539-199705000-00014","article-title":"The threshold for thermoregulatory vasoconstriction during nitrous oxide\/sevoflurane anesthesia is reduced in the elderly","volume":"84","author":"Ozaki","year":"1997","journal-title":"Anesth. Analg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/00000542-199207000-00003","article-title":"Central temperature changes are poorly perceived during epidural anesthesia","volume":"77","author":"Glosten","year":"1992","journal-title":"Anesthesiology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1097\/00000542-199804000-00002","article-title":"Epidural anesthesia reduces the gain and maximum intensity of shivering","volume":"88","author":"Kim","year":"1998","journal-title":"Anesthesiology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/S0022-5223(19)34842-1","article-title":"Effect of skin temperature on platelet function in patients undergoing extracorporeal bypass","volume":"104","author":"Valeri","year":"1992","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1097\/00005373-199209000-00022","article-title":"The disparity between hypothermic coagulopathy and clotting studies","volume":"33","author":"Reed","year":"1992","journal-title":"J. Trauma."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1097\/01.anes.0000296719.73450.52","article-title":"The effects of mild perioperative hypothermia on blood loss and transfusion requirement","volume":"108","author":"Rajagopalan","year":"2008","journal-title":"Anesthesiology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1097\/ALN.0000000000000551","article-title":"Intraoperative Core Temperature Patterns, Transfusion Requirement, and Hospital Duration in Patients Warmed with Forced Air","volume":"122","author":"Sun","year":"2015","journal-title":"Anesthesiology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1016\/S0140-6736(01)06071-8","article-title":"Effects of preoperative warming on the incidence of wound infection after clean surgery: A randomised controlled trial","volume":"358","author":"Melling","year":"2001","journal-title":"Lancet Lond. Engl."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1097\/00000542-200605000-00025","article-title":"Impact of hypothermia on the response to neuromuscular blocking drugs","volume":"104","author":"Heier","year":"2006","journal-title":"Anesthesiology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1097\/00000542-199712000-00009","article-title":"Mild intraoperative hypothermia prolongs postanesthetic recovery","volume":"87","author":"Lenhardt","year":"1997","journal-title":"Anesthesiology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1097\/00000542-199810000-00012","article-title":"Non-thermoregulatory shivering in patients recovering from isoflurane or desflurane anesthesia","volume":"89","author":"Horn","year":"1998","journal-title":"Anesthesiology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1034\/j.1399-6576.2003.00156.x","article-title":"Blood pressure response to thermoregulatory vasoconstriction during isoflurane and desflurane anesthesia","volume":"47","author":"Greif","year":"2003","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/00000542-199501000-00012","article-title":"The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia. A randomized clinical trial","volume":"82","author":"Frank","year":"1995","journal-title":"Anesthesiology"},{"key":"ref_34","first-page":"155","article-title":"Maintaining intraoperative normothermia: A meta-analysis of outcomes with costs","volume":"67","author":"Mahoney","year":"1999","journal-title":"AANA J."},{"key":"ref_35","first-page":"166","article-title":"Preventing inadvertent perioperative hypothermia","volume":"112","author":"Torossian","year":"2015","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Guschlbauer, M., Maul, A.C., Yan, X., Herff, H., Annecke, T., Sterner-Kock, A., B\u00f6ttiger, B.W., and Schroeder, D.C. (2016). Zero-Heat-Flux Thermometry for Non-Invasive Measurement of Core Body Temperature in Pigs. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0150759"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"21746","DOI":"10.1038\/s41598-020-78753-w","article-title":"Accuracy of zero-heat-flux thermometry and bladder temperature measurement in critically ill patients","volume":"10","author":"Fazliu","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.jopan.2015.11.010","article-title":"The Optimal Time and Method for Surgical Prewarming: A Comprehensive Review of the Literature","volume":"32","author":"Connelly","year":"2017","journal-title":"J. PeriAnesthesia Nurs."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1111\/j.1365-2044.2012.07073.x","article-title":"The effect of short time periods of pre-operative warming in the prevention of peri-operative hypothermia","volume":"67","author":"Horn","year":"2012","journal-title":"Anaesthesia"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"5","DOI":"10.30445\/rear.v11i4.805","article-title":"Protocolo de prevenci\u00f3n de la hipotermia perioperatoria","volume":"11","author":"Salinero","year":"2019","journal-title":"Rev. Electr\u00f3nica Anestesiar"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1093\/bja\/aen272","article-title":"Effect of prewarming on post-induction core temperature and the incidence of inadvertent perioperative hypothermia in patients undergoing general anaesthesia","volume":"101","author":"Andrzejowski","year":"2008","journal-title":"Br. J. Anaesth."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1007\/s12630-018-1161-8","article-title":"Effect of preoperative warming on intraoperative hypothermia: A randomized-controlled trial","volume":"65","author":"Lau","year":"2018","journal-title":"Can. J. Anaesth."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Jun, J.-H., Chung, M.H., Kim, E.M., Jun, I.-J., Kim, J.H., Hyeon, J.-S., Lee, M.H., Lee, H.S., and Choi, E.M. (2018). Effect of pre-warming on perioperative hypothermia during holmium laser enucleation of the prostate under spinal anesthesia: A prospective randomized controlled trial. BMC Anesthesiol., 18.","DOI":"10.1186\/s12871-018-0668-4"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1016\/S0140-6736(22)00560-8","article-title":"Aggressive intraoperative warming versus routine thermal management during non-cardiac surgery (PROTECT): A multicentre, parallel group, superiority trial","volume":"399","author":"Sessler","year":"2022","journal-title":"Lancet Lond. Engl."},{"key":"ref_45","first-page":"351","article-title":"A Review of the Evidence for Active Preoperative Warming of Adults Undergoing General Anesthesia","volume":"81","author":"Roberson","year":"2013","journal-title":"AANA J."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/12\/2082\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:31:21Z","timestamp":1760131881000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/12\/2082"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,27]]},"references-count":45,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["medicina59122082"],"URL":"https:\/\/doi.org\/10.3390\/medicina59122082","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,27]]}}}