Application of Thermal Heating to Prevent Intraoperative Hypothermia
Intraoperative hypothermia (IPH) is a common and potentially harmful complication of surgery, especially for patients undergoing general or regional anesthesia. IPH is defined as a core body temperature below 36°C and can have various adverse effects on the patient’s outcome, such as increased risk of surgical site infection, bleeding, cardiac complications, reduced drug metabolism and prolonged recovery [1]. Therefore, preventing IPH is a standard of care for all surgical patients and requires accurate measurement of core temperature and appropriate warming interventions [2].
One of the main causes of IPH is redistribution hypothermia, which occurs when anesthesia induces vasodilation and allows heat to transfer from the core to the periphery. This results in a rapid drop in core temperature within the first hour of anesthesia [3]. To minimize this effect, preoperative warming is recommended to reduce the temperature gradient between the core and the periphery. Preoperative warming can be achieved by using active warming devices, such as forced-air warmers or circulating-water mattresses, or by passive insulation methods, such as blankets or clothing [4].
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Another cause of IPH is heat loss during surgery, which can occur through radiation, convection, evaporation and conduction. To prevent heat loss during surgery, intraoperative warming is essential and can be delivered by various methods, such as:
– Forced-air warming (FAW): This is the most widely used method of intraoperative warming and involves blowing warm air over the patient’s body through a disposable cover. FAW can increase the patient’s temperature by 1-2°C per hour and has been shown to reduce the incidence of IPH and its complications [5].
– Circulating-water warming (CWW): This method involves circulating warm water through a mattress or a garment that covers the patient’s body. CWW can also increase the patient’s temperature by 1-2°C per hour and has similar efficacy to FAW [6].
– Intravenous fluid warming (IVFW): This method involves warming the fluids that are administered to the patient intravenously during surgery. IVFW can prevent heat loss through convection and reduce the risk of IPH by 0.5°C [7].
– Irrigation fluid warming (IFW): This method involves warming the fluids that are used to irrigate body cavities or wounds during surgery. IFW can prevent heat loss through evaporation and reduce the risk of IPH by 0.5°C [7].
The choice of intraoperative warming method depends on several factors, such as the type and duration of surgery, the availability and cost of devices, and the patient’s preference and comfort. Ideally, a combination of methods should be used to provide optimal warming and prevent IPH [8].
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In conclusion, IPH is a common and potentially harmful complication of surgery that can be prevented by preoperative and intraoperative warming interventions. The benefits of preventing IPH include reduced morbidity, mortality, length of stay and costs. Therefore, maintaining normothermia should be a priority for all surgical patients and their care providers.
References
[1] W.J. Fawcett, Prevention of Intraoperative Hypothermia, in: Enhanced Recovery After Surgery (Springer International Publishing AG 2020), pp. 163–166.
[2] National Institute for Health and Care Excellence (NICE), Hypothermia: prevention and management in adults having surgery (NICE Clinical Guideline 65), 2008.
[3] D.I. Sessler, Temperature monitoring and perioperative thermoregulation (Anesthesiology 2008) 109:318–38.
[4] A.M. Moola S., Body warming of people undergoing surgery to avoid complications and increase comfort after surgery (Cochrane Database Syst Rev 2019) CD009016.
[5] A. Kurz et al., Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization (N Engl J Med 1996) 334:1209–15.
[6] J.F. Frank et al., Comparison of perioperative heating modalities in major abdominal surgery (Br J Anaesth 2014) 112:1076–83.
[7] H. Xu et al., Safety of intraoperative hypothermia for patients: meta-analyses of randomized controlled trials and observational studies (BMC Anesthesiol 2020) 20:202.
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