PERIOPERATIVE PRACTICE
review of 10 studies found that forced air warming does contaminate ultra clean air ventilation but no link was found to increased infection rates. However, the studies did not include high quality randomised trials and were not systematic.18
Pre-operative warming
A further technique to mitigate the effect of the temperature redistribution effect, pre- warming. The temperature of the patient on induction following pre-warming will still fall but the effect is considerably reduced. This was demonstrated by a systematic review of 14 randomised controlled trials which found that hypothermia was reduced among those patients who had been pre-warmed.19 A single-use device has recently been launched which may be useful for pre- warming; an exothermic reactive blanket which needs only to be exposed to the air for it to become warm. The manufacturers report that it reaches operation warmth in approximately 30 minutes and maintains an average temperature of 44˚C for up to 10 hours.20
An important study looking at how long the optimum period for pre-warming was found that just 15 minutes was sufficient; this could be undertaken as the patient enters theatre in the pre-waiting bay or in the anaesthetic room.21
Conclusion
There is no doubt that despite current efforts to keep patients warm during surgery, more can be done. The whole surgical team, including ward staff, porters collecting patients and transporting them along cold draughty corridors and members of perioperative teams have a role in ensuring that ‘comfortably warm’ is a state maintained throughout surgery and subsequent recovery.
References
1 Tanner J, Kay J. Chambers K. Avoiding inadvertent peri-operative hypothermia. Nursing Times, 12; 2016 . Accessed at
https://www.nursingtimes.net/ clinical-archive/perioperative-care/avoiding- inadvertent-peri-operative-hypothermia/
7010472.article
2 Sessler D, Kurtz A. Mild perioperative hypothermia. New Engl J Med; 336: 2007 24, 1730-1737
3 NICE. Hypothermia: prevention and management in adults having surgery. December 2016 Accessed at
https://www.nice.org.uk/guidance/cg65?unlid=389 982603201651720359
4 John M, Crook D, Kasari K, Eljelani F et al. Comparison of resistive heating and forced air warming to prevent inadvertent perioperative hypothermia. Br J Anaesth 2016; 116 (2): 249-254. 5 Perl T, Flöther L, Weyland W, Quintel M, Bräuer A.
Comparison of forced-air warming and resistive heating, Minerva Anestesiol 2008; 74: 687
6 Negishi C, Hasegawa K, Mukai S, Nakagawa F, Ozaki M, Sessler DI, Resistive-heating and forced air warming are comparably effective. Anesth Analg 2003; 96 1683-7
CSJ
7 Matsuzaki Y, Matsukawa.T, Ohki K, YamamotoY, Nakamura M, Oshibuchi T. Warming by resistive heating maintains perioperative normothermia as well as forced air heating. Br J Anaesth 2003; 90: 689-91.
8 Egan C, Bernstein E, Reddy D, et al. A randomized comparison of intraoperative PerfecTemp and forced-air warming during open abdominal surgery. Anesth Analg 2011; 113: 1076-81
9 Brandt S, Oguz R, Hüttner H, et al. Resistive polymer versus forced-air warming: comparable efficacy in orthopaedic patients. Anesth Analg 2010; 110:834-8
10 Fanelli A. Danelli G. Ghisi D. Ortu A. Moschini E. Fanelli G. The efficacy of a resistive heating under-patient blanket versus a forced-air warming system: a randomized controlled trial. Anesth Analg 2009; 108:199-201
11 Ng V, Lai A, Ho V. Comparison of forced-air warming and electric heating pad for maintenance of body temperature during total knee replacement. Anaesthesia 2006; 61: 1100-4.
12 Leung KK, Lai A, Wu A, A randomised controlled trial of the electric heating pad vs forced-air warming for preventing hypothermia during
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.
18 I
WWW.CLINICALSERVICESJOURNAL.COM laparotomy. Anaesthesia; 2007; 62: 605-8.
13 Röder G, Sessler DI, Roth G, Schopper C, Mascha EJ, Plattner O. Intra-operative rewarming with HotDog resistive heating and forced-air heating: a trial of lower-body warming. Anaesthesia 2011; 66: 667-74.
14 Engelen S, Himpe D, Borms S, et al. An evaluation of underbody forced-air and resistive heating during hypothermic, on-pump cardiac surgery. Anaesthesia 2011; 66: 104-10.
15 John M, Ford J, Harper M. Perioperative warming devices: performance and clinical application. Anaesthesia 2014; 69: 623-638. Accessed at
http://onlinelibrary.wiley.com/doi/10.1111/anae.126 26/pdf
16 Sajid MS, Shakir AJ, Khatri K, Baig MK. The role of perioperative warming in surgery: a systematic review. Sao Paulo Medical Journal 2009; 127: 4, 231-237
17 Dasari KB, Albrecht M, Harper M. Effect of forced air-warming on the performance of operating theatre laminar flow ventilation. Anaesthesia 2012; 67:244-9.
18 Wood AM, Moss C, Keenan A, Reed MR, Leaper DJ. 2014 Infection control hazards associated with the use of forced air warming in operating theatres. Journal of Hospital Infection 2014; 88:3, 132-140 accessed at
http://www.journalofhospitalinfection.com/article/ S0195-6701(14)00245-X/pdf
19 De Brito Poveda V, Clark AM, Galvao CM. A systematic review on the effectiveness of pre- warming to prevent perioperative hypothermia. J Clin Nurs 2013; 22 (7-8) 2013, pp 906-918
20 Molnlycke, 2014. How to use Barrier Easy Warm
www.molnlycke.co.uk/education/patient- warming/how-to-use-barrier-easywarm-plus
21 Horn EP , Bein B, Böhm R, Steinfath M, Sahili N, Höcker J 2012 The effect of short time periods of pre-operative warming in the prevention of perioperative hypothermia. Anaesthesia 2012; 67:6,612-617.
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