2. Anesthesia's chilling effect
Shorter outpatient procedures have a lower risk of infection than
longer operations, which are typically more complex and expose
wounds for longer periods of time. A study currently in press that I
reviewed included a series of patients who underwent complicated
procedures and found that patients with lower intraoperative tem-
peratures had a higher risk of SSI. That risk increased when lower
intraoperative temperatures persisted for longer durations.
But that doesn't mean patient warming is any less important for
seemingly less complex procedures because redistribution
hypothermia can occur in any surgical patient. Here's why: The
body maintains core temperature by keeping blood flow and heat
loss away from the skin. But as soon as general anesthesia is
administered, the body's vascular control is immediately lost, core
heat moves to the periphery to compensate and the core body
temperature drops. Pre-warming the skin and subcutaneous tissue
before the patient goes into the operating room prevents the early
anesthetic-induced temperature drop from occurring.
Start active warming in pre-op and make sure the methods remain
applied even if patients claim they feel warm enough. Informing
patients that warming helps protect them from infection will make
them understand why you're continuing to warm them, even if they
feel comfortable. Here's another tip: Restart active warming if it's
paused as patients receive regional blocks before heading to the OR.
(I've noticed that pre-op staff at my facility sometimes forget to reap-
ply warming measures after blocks are placed.)
3. Forced-air warming is fine
Research has not definitively shown one active warming method
to be more effective than another in maintaining normothermia.
2 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A y 2 0 1 8
