Procedure-Specific Effectiveness of Warmed Versus Room-Temperature Irrigation Fluids for Preventing Perioperative Hypothermia: A Systematic Review

Alia Rahmi Harlasgunawan; Cecep Eli Kosasih; Aan  Nuraeni

doi:10.56303/jhnresearch.v4i3.525

Authors

Alia Rahmi Harlasgunawan Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
Cecep Eli Kosasih Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
Aan Nuraeni Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia

Keywords:

Irrigation Fluids, Perioperative Hypothermia, Thermal Management

Abstract

This study investigates the impact of using warmed irrigation fluid over room-temperature fluid on patient body temperature during surgery, while also exploring the variables that influence its effectiveness. Systematic review following PRISMA guidelines. Comprehensive searches were conducted in PubMed/MEDLINE, Embase, Cochrane Central, and Web of Science (inception to March 2024) using PICO framework-derived search terms. Inclusion criteria: randomized controlled trials (RCTs) and systematic reviews comparing warmed irrigation fluids (≥36°C) versus room temperature in adult surgical patients. Quality assessment used Joanna Briggs Institute (JBI) critical appraisal tools. Data synthesis included descriptive analysis and meta-analysis where appropriate. Ten studies (eight randomized controlled trials and two systematic reviews/meta-analyses) met inclusion criteria, comprising 2,459 participants across various surgical procedures. Overall methodological quality was high (mean JBI score 10.2/11, 93%). Effectiveness analysis revealed that 67% of individual studies (6/9) demonstrated significant benefits, with clear procedure-specific patterns. Arthroscopic shoulder surgery showed the highest success rate (75%, 3/4 studies) with effect sizes of 67–80% reduction in hypothermia incidence when using 37°C irrigation. TURP procedures demonstrated conditional effectiveness (50% success rate) depending on anesthesia type, while laparoscopic surgery showed no benefit (0% success rate) due to competing heat loss mechanisms. Warmed irrigation fluids at 37°C demonstrate procedure-specific effectiveness, with arthroscopic shoulder surgery showing highest success rates (75%) and laparoscopic surgery showing no benefit.

Downloads

Download data is not yet available.

References

He Y, Feng Y-G, He J, Liang B, Jiang M-D, Liu J, et al. Effects of irrigation fluid temperature during flexible ureteroscopic holmium laser lithotripsy on postoperative fever and shivering: a randomized controlled trial. BMC Urol. 2021;21(1):72.

Dau JJ, Hall TL, Maxwell AD, Ghani KR, Roberts WW. Effect of chilled irrigation on Caliceal fluid temperature and time to thermal injury threshold during laser lithotripsy in vitro model. J Endourol. 2021;35.

Peteinaris A, Pagonis K, Vagionis A, Adamou C, Tsaturyan A, Ballesta Martínez B, et al. What is the impact of pulse modulation technology, laser settings and intraoperative irrigation conditions on the irrigation fluid temperature during flexible ureteroscopy? An in vivo experiment using artificial stones. World J Urol. 2022;40(7):1853–8.

Wongyingsinn M, Pookprayoon V. Incidence and associated factors of perioperative hypothermia in adult patients at a university-based, tertiary care hospital in Thailand. BMC Anesthesiol. 2023;23(1):137.

Xinyue L, Jiafu J, Fan S. Research progress of prevention and treatment of inadvertent perioperative hypothermia with traditional Chinese medicine and Western medicine. J Clin Anesth. 2022;38.

Zhang B, Zhou H, Wang X, Zheng Y, Hu L. Advances in the multimodal management of perioperative hypothermia: approaches from traditional Chinese and Western medicine. Perioper Med. 2024;13(1):107.

Sessler DI. Perioperative Thermoregulation and heat balance. Lancet. 2016;387.

Rauch S, Miller C, Bräuer A, Wallner B, Bock M, Paal P. Perioperative Hypothermia-A Narrative Review. Int J Env Res Public Heal. 2021;18.

Recio-Pérez J, Miró Murillo M, Martin Mesa M. Effect of Prewarming on Perioperative Hypothermia in patients undergoing Loco-Regional or General Anesthesia: a Randomized Clinical Trial. Med. 2023;59.

Ji N, Wang J, Li X, Shang Y. Strategies for perioperative hypothermia management: advances in warming techniques and clinical implications: a narrative review. BMC Surg. 2024;24(1):425.

Simegn GD, Bayable SD, Fetene MB. Prevention and management of perioperative hypothermia in adult elective surgical patients: a systematic review. Ann Med Surg. 2021;72.

Ribeiro E, Ferreira RC, Montanari FL, Botelho MTSL, Correia MDL, Duran ECM. Conceptual and operational definition of the components of the nursing diagnosis hypothermia (00006) in the perioperative period. Rev Bras Enferm. 2021;74.

Akers JL, Dupnick AC, Hillman EL, Bauer AG, Kinker LM, Hagedorn Wonder A. Inadvertent perioperative hypothermia risks and postoperative complications: a retrospective study. AORN J. 2019;109.

Bu N, Zhao E, Gao Y, Zhao S, Bo W, Kong Z. Association between perioperative hypothermia and surgical site infection: a meta-analysis. Med. 2019;98.

JBI. The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews 2017. The Joanna Briggs Institute Critical. 2017.

Kim Y-S, Lee J-Y, Yang S-C, Song J-H, Koh H-S, Park W-K. Comparative study of the influence of room-temperature and warmed fluid irrigation on body temperature in arthroscopic shoulder surgery. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc. 2009 Jan;25(1):24–9.

Pan Z, Xin M, Ping Y. Resilience and its influencing factors of breast cancer patients. Chin J Nurs. 2015;50.

Singh R, Asthana V, Sharma JP, Lal S. Effect of irrigation fluid temperature on core temperature and hemodynamic changes in transurethral resection of prostate under spinal anesthesia. Anesth Essays Res. 2014;8.

Jaffe JS, McCullough TC, Harkaway RC, Ginsberg PC. Effects of irrigation fluid temperature on core body temperature during transurethral resection of the prostate. Urology. 2001 Jun;57(6):1078–81.

Kelly JA, Doughty JK, Hasselbeck AN, Vacchiano CA. The effect of arthroscopic irrigation fluid warming on body temperature. J perianesthesia Nurs Off J Am Soc PeriAnesthesia Nurses. 2000 Aug;15(4):245–52.

Moore SS, Green CR, Wang FL, Pandit SK, Hurd WW. The role of irrigation in the development of hypothermia during laparoscopic surgery. Am J Obstet Gynecol. 1997 Mar;176(3):598–602.

Pan X, Ye L, Liu Z, Wen H, Hu Y, Xu X. Effect of irrigation fluid temperature on core body temperature and inflammatory response during arthroscopic shoulder surgery. Arch Orthop Trauma Surg. 2015 Aug;135(8):1131–9.

Lin Y, Zhou C, Liu Z, Wu K, Chen S, Wang W, et al. Room Temperature Versus Warm Irrigation Fluid Used for Patients Undergoing Arthroscopic Shoulder Surgery: A Systematic Review and Meta Analysis. J perianesthesia Nurs Off J Am Soc PeriAnesthesia Nurses. 2020 Feb;35(1):48–53.

Campbell G, Alderson P, Smith AF, Warttig S. Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia. Cochrane Database Syst Rev. 2015;2015.

Park S-R, Yoon Y-H, Kim N-H, Kwon J-W, Suk K-S, Kim H-S, et al. Effect of saline irrigation temperature difference on postoperative acute pain and hypothermia during biportal endoscopic spine surgery. Eur Spine J. 2024;33(11):4378–84.

Cao J, Sheng X, Ding Y, Zhang L, Lu X. Effect of warm bladder irrigation fluid for benign prostatic hyperplasia patients on perioperative hypothermia, blood loss and shiver: a meta-analysis. Asian J Urol. 2019;6.

Bakry AEAA, Ibrahim ES. Prophylactic dexamethasone or pethidine for the prevention of postoperative shivering during transurethral resection of the prostate under spinal anesthesia. Ain Shams J Anesth. 2016;9.

Moawad HES, Elawdy MM. Efficacy of intrathecal dexmedetomidine in prevention of shivering in patients undergoing transurethral prostatectomy: a randomized controlled trial. Egypt J Anaesth. 2015;31.

Salehi M, Imani B, Zandi S, Haghiabi H, Souri S. Effect of tranexamic acid dissolved in warm, cold, and room-temperature irrigation fluid on complications during and after TURP surgery: a double-blind, randomized clinical trial. African J Urol. 2025;31(1):4.