Patient warming
aims to achieve climate neutrality by 2050 and reduce greenhouse emissions by 55% by 2030.4 It focuses on the key areas where the greatest environmental gains may be made: l Medication Use: discourage the use of anaesthetic gases and agents such as nitrous oxide and desflurane for anaesthetics with lower global warming potential.
l Energy Use: the setting of HVAC systems to 6 air changes when ORs are not in use, maintaining temperature to 18-23˚C. Reduce energy from lighting through energy efficient lighting. Use automatic lighting and water sensors.
l Circularity in Processes and Waste: where applicable, consider purchasing reusable or reprocessed equipment, avoid single-use items that do not provide a clear benefit in patient care, and reduce waste generated and landfill.
But for all these initiatives to work and to make healthcare more sustainable, it needs to be adopted across the wider community, in different disciplines and by all healthcare stakeholders and organisations. One area where small sustainable changes in practice can be made, that will maintain patient care, support environmental health, and improve surgical outcomes, is patient warming.
the impact of redistribution temperature drop following induction of anaesthesia, by increasing the patient’s peripheral temperature and reducing its gradient with the core. Prewarming has been shown to maintain perioperative normothermia and significantly reduce the incidence of intraoperative and postoperative hypothermia.8,9,10
In contrast, when initiating Patient warming to reduce the incidence of
perioperative hypothermia has been used for decades. Since the first convective warming system was introduced in the mid 1980s, single-use forced-air warming blankets have been used routinely in most hospitals. In April 2008, NICE published CG65,6
active warming after induction of anaesthesia, and only once the patient has been prepped and draped, more than 50% of patients still experience perioperative hypothermia.11 Prewarming the patient for as little as 10
minutes before induction of anaesthesia has shown to be effective,12
and can be carried out in The Management
of Inadvertent Perioperative Hypothermia in Adults, and recommended warming patients with a forced-air warming device from induction of anaesthesia. This was later updated in December 2016, with the recommendations that all patients should be warmed before induction of anaesthesia (prewarmed), and to consider the use of a resistive warming system if forced air was unsuitable.7 The objective of prewarming is to reduce
the anaesthetic room or operating theatre, while the patient is being prepared for anaesthesia. Simply putting the warming device on the patient as soon as they arrive in the anaesthetic room can help to reduce the incidence of perioperative hypothermia and therefore reduce the risk this can cause the patient. While forced-air warming has been shown
to be effective at maintaining normothermia and preventing the incidence of perioperative hypothermia, resistive conductive warming has been shown to provide equivalence.13,14
No
single system will be suitable for all surgical procedures and patients, but having the
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