A systematic review of the effectiveness of warming interventions for women undergoing cesarean section

Women undergoing cesarean section are vulnerable to adverse effects associated with inadvertent perioperative hypothermia, but there has been a lack of synthesized evidence for temperature management in this population. This systematic review aimed to synthesize the best available evidence in relation to preventing hypothermia in mothers undergoing cesarean section surgery.

Dynamic and complex microclimate responses to warming and grazing manipulations

Synthesis efforts that identify patterns of ecosystem response to a suite of warming manipulations can make important contributions to climate change science. However, cross-study comparisons are impeded by the paucity of detailed analyses of how passive warming and other manipulations affect microclimate. Here we document the independent and combined effects of a common passive warming manipulation, open-top chambers (OTCs), and a simulated widespread land use, clipping, on microclimate on the Tibetan Plateau. OTCs consistently elevated growing season averaged mean daily air temperature by 1.0-2.0 degrees C, maximum daily air temperature by 2.1-7.3 degrees C and the diurnal air temperature range by 1.9-6.5 degrees C, with mixed effects on minimum daily air temperature, and mean daily soil temperature and moisture. These OTC effects on microclimate differ from reported effects of a common active warming method, infrared heating, which has more consistent effects on soil than on air temperature. There were significant interannual and intragrowing season differences in OTC effects on microclimate. For example, while OTCs had mixed effects on growing season averaged soil temperatures, OTCs consistently elevated soil temperature by approximately 1.0 degrees C early in the growing season. Nonadditive interactions between OTCs and clipping were also present: OTCs in clipped plots generally elevated air and soil temperatures more than OTCs in nonclipped plots. Moreover, site factors dynamically interacted with microclimate and with the efficacy of the OTC manipulations.These findings highlight the need to understand differential microclimate effects between warming methods, within warming method across ecosystem sites, within warming method crossed with other treatments, and within sites over various timescales. Methods, sites and scales are potential explanatory variables and covariables in climate warming experiments. Consideration of this variability among and between experimental warming studies will lead to greater understanding and better prediction of ecosystem response to anthropogenic climate warming.

Preoperative warming combined with intraoperative skin-surface warming does not avoid hypothermia caused by spinal anesthesia in patients with midazolam premedication

CONTEXTO E OBJETIVO: Hipotermia inadvertida no perioperatório é freqüente durante anestesia subaracnóidea e após a administração de midazolam. O objetivo foi avaliar os efeitos do aquecimento da pele no intra-operatório, associado ou não ao aquecimento da pele durante o período de 45 minutos no pré-operatório, na prevenção de hipotermia intra- e pós-operatória determinada pela anestesia subaracnóidea em pacientes com medicação pré-anestésica com midazolam. TIPO DE ETUDO E LOCAL: Estudo prospectivo e aleatório, realizado no Hospital das Clínicas, Universidade Estadual Paulista (Unesp), Botucatu, SP. MÉTODOS: O estudo foi realizado em 30 pacientes com estado físico ASA (da Sociedade Norte-americana de Anestesiologistas) I e II submetidos à cirurgia eletiva do abdômen. Como medicação pré-anestésica, utilizou-se o midazolam, 7,5 mg via intramuscular (IM) e anestesia subaracnóidea padrão. em 10 pacientes (Gcontrole) utilizou-se isolamento térmico passivo; 10 pacientes (Gpré+intra) foram submetidos a aquecimento ativo no pré- e intra-operatório; e 10 pacientes (Gintra) foram aquecidos ativamente somente no intra-operatório. RESULTADOS: Após 45 minutos de aquecimento no pré-operatório, os pacientes do Gpré+intra apresentaram temperatura central mais elevada em relação aos dos grupos não aquecidos antes da anestesia (p < 0,05) mas não no início da cirurgia (p > 0,05). Os pacientes que receberam aquecimento no intra-operatório apresentaram temperatura central mais elevada no final da cirurgia em relação aos de Gcontrole (p < 0,05). Todos os pacientes estavam hipotérmicos na admissão da sala de recuperação pós-anestésica (temperatura central < 36º C). CONCLUSÕES: 45 minutos de aquecimento no pré-operatório combinado com aquecimento no intra- operatório não evita, mas minimiza a ocorrência de hipotermia determinada pela anestesia subaracnóidea em pacientes que receberam midazolam como medicação pré-anestésica.

Preoperative combined with intraoperative skin-surface warming avoids hypothermia caused by general anesthesia and surgery

Study Objectives: To evaluate the effects of intraoperative skin-surface warming with and without 1 hour of preoperative warming, in preventing intraoperative hypothermia, and postoperative hypothermia, and shivering, and in offering good conditions to early tracheal extubation. Design: Prospective, randomized, blind study. Setting: Teaching hospital. Patients: 30 ASA physical status I and II female patients scheduled for elective abdominal surgery. Interventions: Patients received standard general anesthesia. In 10 patients, no special precautions were taken to avoid hypothermia. Ten patients were submitted to preoperative and intraoperative active warming. Ten patients were only warmed intraoperatively. Measurements and Main Results: Temperatures were recorded at 15-minute intervals. The patients who were warmed preoperatively and intraoperatively had core temperatures significantly more elevated than the other patients during the first two hours of anesthesia. All patients warmed intraoperatively were normothermic only at the end of the surgery. The majority of the patients warmed preoperatively and intraoperatively or intraoperatively only were extubated early, and none had shivering. In contrast, five unwarmed patients shivered. Conclusions: One hour of preoperative warning combined with intraoperative skin-surface warming, not simply intraoperative warming alone, avoided hypothermia caused by general anesthesia during the first two hours of surgery. Both methods prevented postoperative hypothermia and shivering and offered good conditions for early tracheal extubation. © 2003 by Elsevier B.V.

Resistive polymer versus forced-air warming: comparable heat transfer and core rewarming rates in volunteers

BACKGROUND: Mild perioperative hypothermia increases the risk of several severe complications. Perioperative patient warming to preserve normothermia has thus become routine, with forced-air warming being used most often. In previous studies, various resistive warming systems have shown mixed results in comparison with forced-air. Recently, a polymer-based resistive patient warming system has been developed. We compared the efficacy of a standard forced-air warming system with the resistive polymer system in volunteers. METHODS: Eight healthy volunteers participated, each on two separate study days. Unanesthetized volunteers were cooled to a core temperature (tympanic membrane) of 34 degrees C by application of forced-air at 10 degrees C and a circulating-water mattress at 4 degrees C. Meperidine and buspirone were administered to prevent shivering. In a randomly designated order, volunteers were then rewarmed (until their core temperatures reached 36 degrees C) with one of the following active warming systems: (1) forced-air warming (Bair Hugger warming cover #300, blower #750, Arizant, Eden Prairie, MN); or (2) polymer fiber resistive warming (HotDog whole body blanket, HotDog standard controller, Augustine Biomedical, Eden Prairie, MN). The alternate system was used on the second study day. Metabolic heat production, cutaneous heat loss, and core temperature were measured. RESULTS: Metabolic heat production and cutaneous heat loss were similar with each system. After a 30-min delay, core temperature increased nearly linearly by 0.98 (95% confidence interval 0.91-1.04) degrees C/h with forced-air and by 0.92 (0.85-1.00) degrees C/h with resistive heating (P = 0.4). CONCLUSIONS: Heating efficacy and core rewarming rates were similar with full-body forced-air and full-body resistive polymer heating in healthy volunteers.

Pulsioximetría de pacientes en hemodiálisis, de la unidad de terapia renal – fundación cardioinfantil, análisis para establecer recomendaciones

Introducción. En Colombia, el 80% de los pacientes con enfermedad renal crónica en hemodiálisis tienen fístula arteriovenosa periférica (FAV) que asegura el flujo de sangre durante la hemodiálisis (1), la variabilidad en el flujo de sangre en el brazo de la FAV hacia la parte distal, puede afectar la lectura de la oximetría de pulso (SpO2) (2), llevando a la toma de decisiones equivocadas por el personal de salud. El objetivo de este estudio es aclarar si existe diferencia entre la SpO2 del brazo de la FAV y el brazo contralateral. Materiales y métodos. Se realizó un estudio de correlación entre los valores de SpO2 del brazo con FAV contra el brazo sin FAV, de 40 pacientes que asistieron a hemodiálisis. La recolección de los datos se llevó a cabo, con un formato que incluyó el resultado de la pulsioximetria y variables asociadas, antes, durante y después de la hemodiálisis. Se comparó la mediana de los deltas de las diferencias con pruebas estadísticas T Student – Mann Whitney, aceptando un valor significativo de p < 0,05. Resultados. No se encontraron diferencias estadísticamente significativas de la SpO2 entre el brazo con FAV y el brazo sin FAV, antes, durante y después de la diálisis, sin embargo si se apreció una correlación positiva estadísticamente significativa. Conclusiones. Se encontró correlación positiva estadísticamente significativa, donde no hubo diferencias en el resultado la pulsioximetría entre el brazo con FAV y brazo sin FAV, por lo tanto es válido tomar la pulsioximetría en cualquiera de los brazos.

Active cutaneous warming systems to prevent intraoperative hypothermia: a systematic review

This study analyzed the evidence available in the literature concerning the effectiveness of different active cutaneous warming systems to prevent intraoperative hypothermia. This is a systematic review with primary studies found in the following databases: CINAHL, EMBASE, Cochrane Register of Controlled Trials and Medline. The sample comprised 23 randomized controlled trials. There is evidence in the literature indicating that the circulating water garment system is the most effective in maintaining patient body temperature. These results can support nurses in the decision-making process concerning the implementation of effective measures to maintain normothermia, though the decision of health services concerning which system to choose should also take into account its cost-benefit status given the cost related to the acquisition of such systems.

Subseasonal extremes of precipitation and active-break cycles of the Indian summer monsoon in a climate-change scenario

Changes to the behaviour of subseasonal precipitation extremes and active-break cycles of the Indian summer monsoon are assessed in this study using pre-industrial and 2 × CO2 integrations of the Hadley Centre coupled model HadCM3, which is able to simulate the monsoon seasonal cycle reasonably. At 2 × CO2, mean summer rainfall increases slightly, especially over central and northern India. The mean intensity of daily precipitation during the monsoon is found to increase, consistent with fewer wet days, and there are increases to heavy rain events beyond changes in the mean alone. The chance of reaching particular thresholds of heavy rainfall is found to approximately double over northern India, increasing the likelihood of damaging floods on a seasonal basis. The local distribution of such projections is uncertain, however, given the large spread in mean monsoon rainfall change and associated extremes amongst even the most recent coupled climate models. The measured increase of the heaviest precipitation events over India is found to be broadly in line with the degree of atmospheric warming and associated increases in specific humidity, lending a degree of predictability to changes in rainfall extremes. Active-break cycles of the Indian summer monsoon, important particularly due to their effect on agricultural output, are shown to be reasonably represented in HadCM3, in particular with some degree of northward propagation. We note an intensification of both active and break events, particularly when measured against the annual cycle, although there is no suggestion of any change to the duration or likelihood of monsoon breaks. Copyright © 2009 Royal Meteorological Society

Radiative efficiencies for fluorinated esters: indirect global warming potentials of hydrofluoroethers

Density Functional Theory (DFT) has been used with an empirically-derived correction for the wavenumbers of vibrational band positions to predict the infrared spectra of several fluorinated esters (FESs). Radiative efficiencies (REs) were then determined using the method of Pinnock et al. and these were used with atmospheric lifetimes from the literature to determine the direct global warming potentials of FESs. FESs, in particular fluoroalkylacetates, alkylfluoroacetates and fluoroalkylformates, are potential greenhouse gases and their likely long atmospheric lifetimes and relatively large REs, compared to their parent HFEs, make them active contributors to global warming. Here, we use the concept of indirect global warming potential (indirect GWP) to assess the contribution to the warming of several commonly used HFEs emitted from the Earth's surface, explicitly taking into account that these HFEs will be converted into the corresponding FESs in the troposphere. The indirect GWP can be calculated using the radiative efficiencies and lifetimes of the HFE and its degradation FES products. We found that the GWPs of those studied HFEs which have the smallest direct GWP can be increased by 100-1600% when taking account of the cumulative effect due to the secondary FESs formed during HFE atmospheric oxidation. This effect may be particularly important for non-segregated HFEs and some segregated HFEs, which may contribute significantly more to global warming than can be concluded from examination of their direct GWPs.

Global warming potentials and radiative efficiencies of halocarbons and related compounds: a comprehensive review

In the mid-1970s it was recognized that, as well as being substances that deplete stratospheric ozone, chlorofluorocarbons (CFCs) were strong greenhouse gases that could have substantial impacts on radiative forcing of climate change. Around a decade later, this group of radiatively active compounds was expanded to include a large number of replacements for ozone-depleting substances such as chlorocarbons, hydrochlorocarbons, hydrochlorofluorocarbons (HCFCs), hydrofluorocarbons (HFCs), perfluorocarbons (PFCs), bromofluorocarbons, and bromochlorofluorocarbons. This paper systematically reviews the published literature concerning the radiative efficiencies (REs) of CFCs, bromofluorocarbons and bromochlorofluorocarbons (halons), HCFCs, HFCs, PFCs, SF6, NF3, and related halogen containing compounds. In addition we provide a comprehensive and self-consistent set of new calculations of REs and global warming potentials (GWPs) for these compounds, mostly employing atmospheric lifetimes taken from the available literature. We also present Global Temperature change Potentials (GTPs) for selected gases. Infrared absorption spectra used in the RE calculations were taken from databases and individual studies, and from experimental and ab initio computational studies. Evaluations of REs and GWPs are presented for more than 200 compounds. Our calculations yield REs significantly (> 5%) different from those in the Intergovernmental Panel on Climate Change Fourth Assessment Report (AR4) for 49 compounds. We present new RE values for more than 100 gases which were not included in AR4. A widely-used simple method to calculate REs and GWPs from absorption spectra and atmospheric lifetimes is assessed and updated. This is the most comprehensive review of the radiative efficiencies and global warming potentials of halogenated compounds performed to date.

Active processes, morphology, and dynamics of icy debris fans: Landform evolution along rapidly degrading escarpments in alpine regions undergoing recent deglaciation

In the past few decades the impacts of climate warming have been significant in alpine glaciated regions. Many valley glaciers formerly linked as distributary glaciers to high-level icecaps have decoupled at their icefalls, exposing major escarpments and generating a suite of dynamic landforrns dominated by mass wasting. Ice-dominated landforms, here termed icy debris fans, develop rapidly by ice avalanching, rockfall, and icy debris flow. Field-based reconnaissance studies at two alpine settings, the Wrangell Mountains of Alaska and the Southern Alps of New Zealand, provide a preliminary morphogenetic model of spatial and temporal evolution of icy debris fans in a range of alpine settings. The influence of these processes on landform evolution is largely unrecognized in the literature dealing with post-glacial landform adjustment known as the paraglacial. A better understanding of these dynamic processes will be increasingly important because of the extreme geohazards characterizing these areas. Our field studies show that after glacier decoupling, icy debris fans begin to form along the base of bedrock escarpments at the mouths of catchments and prograde over valley glaciers. The presence of a distinct catchment, apex, and fan morphology distinguishes these landforms from other landforms common in periglacial hillslope settings receiving abundant clastic debris and ice. Ice avalanching is the most abundant process involved in icy debris fan formation. Fans developed below weakly incised catchments are dominated by ice avalanching and are composed primarily of ice with minor lithic detritus. Typically, avalanches fall into the fan catchments where sediments transform into grainflows that flow onto the fans. Once on the fans, avalanche deposits ablate rapidly, flattening and concentrating lithic fragments at the surface. Icy debris fans may become thick enough to become glaciers with splay crevasse systems. Fans developed below larger, more complex catchments are composed of higher proportions of lithic detritus resulting from temporary storage of ice and lithic detritus deposits within the catchment. Episodic outbursts of meltwater from the icecap may mix with the stored sediments and mobilize icy debris flows (mixture of ice and lithic clasts) onto the fans. Our observations indicate that the entire evolutionary cycle of icy debris fans probably occurs during an early paraglacial interval (i.e., decades to 100 years). Observations comparing avalanche frequency, volume, and fan morphologic evolution at the Alaska site between 2006 and 2010 illustrate complex response between icy debris fans even within the same cirque - where one fan may be growing while others are downwasting because of differences in ice supply controlled by their respective catchments and icecap contributions. As ice supply from the icecap diminishes through time, icy debris fans rapidly downwaste and eventually evolve into talus cones that receive occasional but ephemeral ice avalanches.

Drought stress and carbon assimilation in a warming climate: Reversible and irreversible impacts

Abstract Global change is characterized by increased {CO2} concentration in the atmosphere, increasing average temperature and more frequent extreme events including drought periods, heat waves and flooding. Especially the impacts of drought and of elevated temperature on carbon assimilation are considered in this review. Effects of extreme events on the subcellular level as well as on the whole plant level may be reversible, partially reversible or irreversible. The photosynthetically active biomass depends on the number and the size of mature leaves and the photosynthetic activity in this biomass during stress and subsequent recovery phases. The total area of active leaves is determined by leaf expansion and senescence, while net photosynthesis per leaf area is primarily influenced by stomatal opening (stomatal conductance), mesophyll conductance, activity of the photosynthetic apparatus (light absorption and electron transport, activity of the Calvin cycle) and {CO2} release by decarboxylation reactions (photorespiration, dark respiration). Water status, stomatal opening and leaf temperature represent a "magic triangle" of three strongly interacting parameters. The response of stomata to altered environmental conditions is important for stomatal limitations. Rubisco protein is quite thermotolerant, but the enzyme becomes at elevated temperature more rapidly inactivated (decarbamylation, reversible effect) and must be reactivated by Rubisco activase (carbamylation of a lysine residue). Rubisco activase is present under two forms (encoded by separate genes or products of alternative splicing of the pre-mRNA from one gene) and is very thermosensitive. Rubisco activase was identified as a key protein for photosynthesis at elevated temperature (non-stomatal limitation). During a moderate heat stress Rubisco activase is reversibly inactivated, but during a more severe stress (higher temperature and/or longer exposure) the protein is irreversibly inactivated, insolubilized and finally degraded. On the level of the leaf, this loss of photosynthetic activity may still be reversible when new Rubisco activase is produced by protein synthesis. Rubisco activase as well as enzymes involved in the detoxification of reactive oxygen species or in osmoregulation are considered as important targets for breeding crop plants which are still productive under drought and/or at elevated leaf temperature in a changing climate.

Impacts of passive warming chambers on soil parameters in Antarctica

Passive chambers are used to examine the impacts of summer warming in Antarctica but, so far, impacts occurring outside the growing season, or related to extreme temperatures, have not been reported, despite their potentially large biological significance. In this review, we synthesise and discuss the microclimate impacts of passive warming chambers (closed, ventilated and Open Top Chamber-OTC) commonly used in Antarctic terrestrial habitats, paying special attention to seasonal warming, during the growing season and outside, extreme temperatures and freeze-thaw events. Both temperature increases and decreases were recorded throughout the year. Closed chambers caused earlier spring soil thaw (8-28 days) while OTCs delayed soil thaw (3-13 days). Smaller closed chamber types recorded the largest temperature extremes (up to 20°C higher than ambient) and longest periods (up to 11 h) of above ambient extreme temperatures, and even OTCs had above ambient temperature extremes over up to 5 consecutive hours. The frequency of freeze-thaw events was reduced by ~25%. All chamber types experienced extreme temperature ranges that could negatively affect biological responses, while warming during winter could result in depletion of limited metabolic resources. The effects outside the growing season could be as important in driving biological responses as the mean summer warming. We make suggestions for improving season-specific warming simulations and propose that seasonal and changed temperature patterns achieved under climate manipulations should be recognised explicitly in descriptions of treatment effects.