8 9
F E B R U A R Y 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
even plastic. A single layer of protection reduces heat loss by about
30%. Although adding additional layers does not proportionally
increase the benefit, combining a triple layer can reduce heat loss by
about 50%. Keeping the patient's hair cover and foot covers on before
and during surgery can also reduce thermal loss. As your mother told
you as a child, a large amount of heat can be lost through the head
and feet.
•
Keep the OR warm.
According to AORN, you should maintain the
operating room at a temperature of approximately 23°C (73.4°F). You
can raise it even higher when active skin warming is not possible. It
should also be higher than 26°C (78.8°F) and prewarmed for neonates
or infants. Cool surgical environments can increase the rate by which
metabolic heat is lost. Also, large open cavities decrease the core
body temperature quickly, especially over a period of lengthy surgery.
• Actively warm patients.
Active warming of patients prevents most
heat loss and can reverse this trend. For example, you can use forced
hot air for at least 15 minutes before surgery, throughout the surgical
procedure and post-operatively. Warming of intravenous fluids and
blood further prevents unplanned hypothermia, especially when using 2
liters or more of fluids. It was found that 1 liter of crystalloid solution
administered at ambient temperature can decrease the mean body tem-
perature approximately 0.25°C in an average size adult. Irrigation solu-
tions used in the abdomen, pelvis or thorax enhance heat transfer from
the body core to the solution and will also increase heat loss. Warm
intravenous fluids and irrigation solutions to about 37°C to prevent heat
loss.
Monitor the core temperature of patients at risk for unplanned
hypothermia pre-operatively, intraoperatively and post-operatively.
Consider prewarming the patient for a minimum of 15 minutes immedi-
ately prior to induction of anesthesia for any patients at risk of
H Y P O T H E R M I A
OSE_1402_part2_Layout 1 2/6/14 2:58 PM Page 87
