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P A T I E N T W A R M I N G tions by preventing hypothermia, only 5 of quality improvement project compared the 26 studies included pre-op warming inter- temperatures of 128 patients undergoing ventions. As Mark Twain said, supposing is surgery who didn't receive forced-air body is 98.6°F. When the core of the good, but finding out is better. We weren't warming before induction of anesthesia body drops to less than 96.8°F, the comfortable supposing that trying to pre- (74) with patients who did receive forced- patient is considered to be hypothermic and vent inadvertent hypothermia by actively air warming before anesthesia (54). at risk for serious complications. The human pre-warming our patients was worth the Somewhat surprisingly, we found that pre- body has a thermoregulatory system that effort and expense. warming patients before surgery had no THERMOREGULATION The 3 Levels of Hypothermia T Mild ..................... 93.2°F to 96.8°F Moderate ............... 86°F to 93.2°F he normal core temperature of the Severe ................................. < 86°F effect on their post-op temperatures. includes shivering and vasoconstriction. This system helps to regulate and keep the over-riding of the thermoregulatory system is Inside our QI project We defined hypothermia (see "The 3 In 2009, we took matters into our own body at a desirable temperature. During surgical Levels of Hypothermia") as a core temper- hands. The lack of evidence led us to eval- ature below 96.8°F (36°C) as measured by uate the effectiveness of pre-op warming a temporal artery-scanning thermometer. on our patients' post-op temperatures. Our We defined warming as placing a forced- called "heat redistribution." anesthesia, these protective regulatory mecha— Deborah Edgeworth, BSN, CNOR nisms are inhibited. Anesthetics induce vasodilation, which in turn promotes heat loss. The body, in its attempt to keep warm, redistributes heat Ms. Edgeworth (edg eworthd@genesishea lth.com) is interim manager of surgical services at Genesis Medical Center in Davenport, Iowa. medium (100°F, 37.8°C) setting. from the core outward to the periphery. This in post-op. They suggested that we con- tive effect on their post-op temperatures sider actively warming patients with the and help us prevent hypothermia's many forced-air warming blankets in the hold- complications. Right? Not so fast. ing area before they received anesthesia. Although there's an abundance of litera- Under this plan, the forced-air units ture that validates intraoperative and post- would remain on patients throughout operative warming to ward off hypother- their perioperative stay. Plus, we'd save mia, there's a surprising lack of literature the costs of laundering cotton blankets. on pre-warming's usefulness in this regard. It was hard to argue with their thinking. One systemic review in particular is typical Just as sure as forced-air warming blan- of the lack of evidence that we found. In kets comfort and calm patients while 2006, when Scott and Buckland examined they're in pre-op, they'd also have a posi- studies on decreasing patient complica- 4 9 SUPPLEMENT TO air warming blanket set on a O U T PAT I E N T S U R G E R Y M A G A Z I N E | M AY 2013 Our QI project sought resolutions to 2 problems that plague every recovery room: hypothermia and delayed discharge. We asked 2 questions: • Will forced-air warming techniques decrease the number of patients presenting to the PACU in a hypothermic state? • Will pre-warming patients decrease the length of stay in PACU? M AY 2013 | S U P P L E M E N T 5 0