To the Editor
The battle to prevent perioperative hypothermia is a battle that anesthesiologists and nurse anesthetists lose all too often. It is bad enough that the realities of human physiology and anesthetic pharmacology are working against us. To add insult to injury our own colleagues and co-workers frequently sabotage our efforts at maintaining normothermia by adjusting the OR thermostat down to near arctic levels.
I read with interest an article in the Winter 2006 APSF Newsletter written by Dr. John Eichhorn discussing some of the newest technical products that were on display at the recent ASA meeting in Atlanta. While discussing various products intended to help us keep our patients warm, he mentioned that one item getting plenty of notice was a vest that is intended to warm shivering anesthesiologists, nurse anesthetists and circulating nurses. Apparently it was a real hit at the convention.
The facts regarding the consequences of hypothermia in surgical patients are well documented and profound. Unlike some of the more complicated issues facing our specialty, prevention of hypothermia could easily become a reality if we would simply stand up for our patients and demand that OR temperatures be kept at a “reasonable” level. The evidence is clear that if ambient temperatures are in the range of 74° F, the incidence of hypothermia can be significantly reduced.1
Many assume that this is just a fantasy, as our surgical comrades would never allow themselves to be subjected to such inhospitable conditions. I disagree. What we must do is completely rethink our temperature management strategies. Contemporary practice involves placing the patient in a frigid room and then employing a series of expensive active warming measures in an effort to preserve normothermia. All too often we fail. What if our ORs were kept warm enough to avoid hypothermia, and in order to keep our surgical friends content we placed them in their own “micro-environment” which would allow them to be as “cool” as they wanted to be?
Think about it, the surgeons and techs occupy <5% of the total air space of a typical OR, and yet we currently cool the entire room in order to accommodate them at great risk to the patient’s health and safety. Existing technology allows individuals to wear lightweight, non-obtrusive vests which circulate cold liquid and allow the wearer to be kept in his or her own comfort zone. Surgeons in many parts of the country are already utilizing these products with great satisfaction.
If we are truly the leaders in patient safety that we claim we are, it is time we demand a complete change in the way this issue is addressed. Using “micro-environment” technology will allow us to keep our patients warm and safe and our surgeons happy. It is entirely possible that cost savings will be realized because the need for expensive disposable forced air warming blankets would be significantly reduced.
Maybe I will cancel my order for that electric warming vest.
J. William Kinsinger, MD Oklahoma City OK
1. Macario A, Dexter F. What are the most important risk factors for a patient’s developing intraoperative hypothermia?2002;94:2015-20.