Wednesday, March 31, 2010

Keeping Patients Warm Perioperatively

Last week I read this article in the Medical Industry News written by Kaye Spector: Warm wakeup from surgery has roots with Cleveland doctor. I am impressed with this new patient gown that works with the Bair Hugger System (photo credit)

It would work well to pre-warm patients in the holding area. It would work well for facial, abdominal, or extremity surgery as shown in the photo. For chest case, perhaps it is possible to roll the gown downward covering the abdomen and legs. If not then the traditional lower-body Bair Hugger blanket could still be used.

If kept clean in the operating room, then it could be used in recovery to continue warming the patient there.

The 2006 article by Dr. Leroy Young on preventing perioperative hypothermia in plastic surgery patients is a very good article – well written, easy to read, covers the topic thoroughly. Here are the big suggestions for prevention given:

  • Actively prewarm patients in preoperative area for approximately 1 hour with forced-air heating or resistive-heating blanket.
  • Keep the ambient temperature of the operating room at a minimum of 73°F.
  • Monitor core temperature throughout administration of general and regional anesthesia.
  • Cover as much body surface area as possible with blankets or drapes to reduce radiant and convective heat loss through the skin.
  • Actively warm patients intraoperatively with forced-air heaters or resistive-heating blanket to prevent heat loss and add heat content. Rearrange covers every time patient is repositioned to warm as much surface area as possible.
  • Minimize repositioning time as much as possible so that the active warming method can be quickly continued.
  • Warm intravenous fluids and/or infiltration fluids if large volumes are used. Warm incision irrigation fluids.
  • Aggressively treat postoperative shivering with forced-air heater or resistive-heating blanket and consider pharmacologic intervention.

Perioperative hypothermia is associated with increased surgical site infections, slower wound healing, coagulation disorders, and increased bleeding. So it is very important to keep patients warm. It also makes them more comfortable, so improved hospital and surgeon ratings.

As the surgeon (and one with the occasional hot flash), I can tell you it is difficult to work in an OR with temperatures higher than 70°F. My fellow female colleagues (scrub nurses, circulating nurses, etc) at the surgery center I work most frequently often want the temperature even lower. It is a struggle to keep everyone happy and comfortable.

The article referenced below states

The minimum OR temperature recommended in the literature is 22°C (71.6°F), and most researchers agree that an ambient temperature of at least 23°C (73.4°F) is better. Sessler recommends an OR temperature of 25°C (77°F). One study by El-Gamal and colleagues determined that nearly all cases of perioperative hypothermia could be eliminated if OR temperatures were 26°C (79°F).

REFERENCES

Prevention of perioperative hypothermia in plastic surgery; Aesthetic Surgery Journal September 2006, Vol. 26, Issue 5, Pages 551-571; V. Leroy Young, Marla E. Watson

2 comments:

ER's Mom said...

73 degrees? At that temp, most nurses and docs would be close to passing out!

I don't like my OR more than 66, prefer it closer to 63 or 64. Even then, I'm frequently drenched in sweat during some of my longer cases.

My hospital has a 100% normothermic periop rate, so it is possible to maintain the patient's temp while keeping the people working comfortable. Our anesthesia department works very aggressively to keep core body temp up. We prewarm the OR table by having the bair hugger shoot warm air under the sheets before patient is in the room. Warmed blankets, fluids, etc. I secretly think that bonuses are based on postop patient temps. ;)

DBenzil said...

I have to agree about save the surgeon! As I read the post, I thought perhaps only neurosurgeons feel the heat...obviously not. Other than little kids who are more fragile, I insist the room set for the surgeon and employ other techniques for my patient Having said that, the importance of this has to be a "system" concern as your blog so effectively demonstrates-start early and carry on at each stage of surgery and recovery. Nice post.