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PERIOPERATIVE PRACTICE


a recommendation that practitioners should not use indirect estimates of core temperature in adults having surgery. In addition, during the intraoperative phase, there is new advice regarding warming patients from the induction of anaesthesia using a forced air warming device, if they are to have anaesthesia for more than 30 minutes; or less than 30 minutes and are at higher risk of inadvertent perioperative hypothermia with a new sub text that consideration should be given to a resistive heating mattress or resistive heating blanket if a forced air warming device is unsuitable.3


Devices available to warm patients


A plethora of devices are available to help the surgical team keep the patient warm. They include convection (forced air warming devices), radiation, or conduction (resistive heating mattresses). Exothermic reactions create warmth for patients and may best be used preoperatively or intraoperatively. There are active warming devices and passive ones such as warm blankets. The NICE guidelines have moved away from recommending forced air warming and changed the wording to active warming to include other options. The guidelines recommend warming IV fluids and blood prior to infusion and in addition ensuring that any irrigation fluids used are warmed to a suitable temperature. A range of devices are increasingly available for different aspects of warming fluids away from the sterile field and as part of it. How does the team and the budget holder(s) ensure that the correct choice is made for the patient for cost benefit analysis? A review of the literature, undertaken for a study which reported in 2016,4


comparing


the efficacy of resistive heating with forced air warming shows mixed results, with one nonclinical study favouring resistive heating,5 six showing equivalence in performance6-11 and three studies favouring forced air warming.12-14 A further study looked as devices available and their safety record, as well as the main


A single use device has recently been launched which may be useful for pre-warming


findings of a variety of studies reviewing the devices. For any teams wanting to make essential device choices to warm their patients, this is an invaluable study.15


In addition a


systematic review including 19 randomised controlled trials found that active warming reduced hypothermia helped reduce post operative wound pain and shivering.16 It is also suggested, although this is not evidence based, that the most effective technique used for patients during surgery is a mattress underneath them and a blanket (forced air warming) on top.


There has been some controversy in the past regarding the potential of forced air warming to disrupt laminar air flow patterns17 and contaminate the operation site with air moved from the floor by convection. A recent study using smoke to demonstrate visually the movement of air in a laminar flow theatre, showed effective ventilation patterns working in the presence of forced air warming. The balance also has to be considered with regard to the reduction in infection and surgical site infection risk reduction if the patient is normothermic during surgery. A summary


16 I WWW.CLINICALSERVICESJOURNAL.COM


MARCH 2017


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