Hypertensive intracerebral hemorrhage is a common acute critical condition in neurosurgery. When the disease progresses to the early stage of cerebral herniation, surgery is often the key intervention to save the patient's life. However, these procedures are lengthy and highly invasive. Combined with the inhibitory effect of general anesthesia on the thermoregulatory center and the use of large volumes of room‑temperature irrigation fluid, patients are at high risk of developing intraoperative hypothermia — which not only compromises surgical outcomes but may also trigger a cascade of complications such as shivering and surgical site infections.

How can intraoperative temperature stability be effectively maintained? The operating room team at Puyang Traditional Chinese Medicine Hospital in Henan Province conducted a clinical study to evaluate the combined effect of a watercirculating warming blanket and intravenous fluid warming. The findings were published in Henan Medical Research (Wang J. Effects of intraoperative watercirculating warming blanket combined with intravenous fluid warming on patients with early cerebral herniation due to hypertensive intracerebral hemorrhage. Henan Med Res. 2019;28(22):4213-4214), providing a valuable reference for perioperative temperature management.

I. Why Are Patients Undergoing Surgery for Cerebral Hemorrhage More Prone to Hypothermia?

Following hypertensive intracerebral hemorrhage, intracranial pressure rises sharply, and brain tissue may become compressed and displaced, potentially leading to cerebral herniation. Evacuation of the intracranial hematoma is an effective means of relieving this compression. However, the surgery itself carries a hidden risk — hypothermia.

Under general anesthesia, the body's thermoregulatory center is suppressed. Prolonged surgical exposure, large‑volume room‑temperature irrigation fluid, and the vasodilatory effects of anesthetic agents all accelerate heat loss. Moreover, since these patients are predominantly middle‑aged or elderly, their baseline metabolic rate and thermal reserve are often low, making intraoperative temperature decline almost inevitable.

Hypothermia is no minor issue — it impairs platelet function and thrombin activity, increasing blood loss; it suppresses the immune response, raising the risk of surgical site infection; and it can trigger postoperative shivering, which increases oxygen consumption and cardiac workload. For patients with intracerebral hemorrhage, whose condition is already fragile, these complications can be particularly detrimental.

II. Study Design: Two‑Group Comparison to Evaluate Warming Effects

The study enrolled 86 patients undergoing surgery for early cerebral herniation due to hypertensive intracerebral hemorrhage between January 2016 and January 2019. Patients were divided into a control group and an observation group based on admission time, with 43 patients in each group. There were no significant differences between the two groups in terms of sex, age, or volume of hemorrhage, ensuring comparability.

1. Control group: Received conventional warming measures, with operating room temperature maintained at 20–22°C and the patient's body surface covered only with a standard blanket during surgery.

2. Observation group: Received two additional active warming measures on top of conventional care:

(1) Water‑circulating warming blanket: A constant‑temperature (38°C) water‑circulating blanket was placed on the operating table and preheated for 30 minutes. The patient lay supine on the blanket, receiving continuous heat through conduction and convection.

(2) Intravenous fluid warming: All intravenous fluids administered during surgery were warmed to 37–38°C using a fluid warmer before infusion.

III. Results: Active Warming Showed Significant Differences

1. Temperature maintenance:

There was no significant difference in preoperative temperature between the two groups (36.67°C in the control group vs. 36.71°C in the observation group). However, from 30 minutes into surgery onward, a divergence emerged — the control group's temperature dropped below 36°C by 90 minutes into the procedure, whereas the observation group maintained a temperature above 36.3°C throughout.

2.Complication rates:

All three differences were statistically significant, clearly demonstrating the protective effect of the combined warming strategy.

The researchers monitored nasopharyngeal temperatures in both groups at baseline, at 30, 60, and 90 minutes during surgery, and at the end of the procedure. They also recorded the incidence of hypothermia, postoperative shivering, and surgical site infections.

IV. Analysis: Why Is "Blanket + Fluid Warming" More Effective Than a Simple Blanket?

A standard blanket can only passively slow heat loss; it cannot actively supply heat. In contrast, the water‑circulating blanket uses 38°C constant‑temperature water as a heat source, providing sustained and stable heat conduction and radiation through broad contact with the body surface, directly compensating for heat lost by the patient.

Fluid warming addresses the problem from the "inside" — large volumes of room‑temperature fluids entering the body can deplete core heat. By prewarming fluids to 37–38°C, this source of cold stimulus is eliminated, while also helping to maintain core temperature from within.

Together, these two measures work synergistically, addressing heat loss both externally and internally to form a "thermal barrier" against temperature decline. The study suggests that this dual protection effectively reduces the stress response and immunosuppression induced by hypothermia, thereby lowering the risk of shivering and infection.

V. Clinical Implications

Although this study has a relatively small sample size, its data are solid and its conclusions clear: for high‑risk, lengthy surgeries under general anesthesia such as those for hypertensive intracerebral hemorrhage, active warming measures should be considered a "standard" rather than an "option."

Many primary hospitals in China still rely on traditional blanket‑only methods, with the assumption that hypothermia is "unavoidable" or "of little consequence." The evidence from this study suggests that a simple combination of a water‑circulating warming blanket and intravenous fluid warming can significantly improve patients' temperature status and yield clear benefits in reducing complications.

Of course, the study has limitations — it is a single‑center study with non‑randomized grouping (based on admission time), which may introduce selection bias. Larger, multicenter randomized controlled trials are needed for further validation. Nevertheless, based on the current evidence, operating room nursing teams should prioritize integrating active warming into routine protocols, especially for elderly and critically ill surgical patients.

Reference:

Wang J. Effects of intraoperative water‑circulating warming blanket combined with intravenous fluid warming on patients with early cerebral herniation due to hypertensive intracerebral hemorrhage[J]. Henan Medical Research, 2019, 28(22): 4213-4214.

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