Patient warming
availability of both forced-air and resistive conductive warming will enable clinicians to meet patient normothermia goals, while simultaneously contributing to reducing the carbon footprint of the healthcare facility. Resistive conductive systems are reusable
and, like the operating table mattress, they will require wiping down between patient use, but with no additional waste. They also consume very little energy compared to forced-air warmers. For example, the ASTOPAD System by Gentherm, at its peak, consumes around 160W of energy compared to 1500W from a forced-air warmer. This means that it will take the ASTOPAD more than nine hours of continual use to consume the same amount of energy that a forced-air warmer uses in one hour. Low energy consumption also allows the system to operate on battery power, maintaining blanket temperature for up to two hours.15 The European Society of Anaesthesiology
and Intensive Care consensus document on sustainability unanimously recommended, with a 97% agreement, the use of conductive fabric warming systems as they are more energy efficient compared to forced-air.16 Resistive conductive systems produce
much less waste, consume significantly less energy, require no periodic filter change, which itself produces additional waste and, when used correctly, will maintain normothermia and reduce the incidence of perioperative hypothermia. Climate change is a global problem and no one person or solution will provide a resolution. But if each of us can make just a 1% improvement in our practices, the aggregation may prove to be truly significant.
References 1. Met Office.
https://www.metoffice.gov.uk/ research/climate/understanding-climate/ uk-and-global-extreme-events-heatwaves Accessed 12.6.2024
2. Wolfgang Buhre. ESAIC’s declaration for sustainability within anaesthesiology and intensive care. Eur J Anaesthesiol 2023; 40:457–458.
3. Brighton & Sussex Medical School, Centre for Sustainable Healthcare, and UK Health Alliance on Climate Change (2023). Green surgery: Reducing the environmental impact of surgical care (v1.1). London: UKHACC. https://
ukhealthalliance.org/sustainable-healthcare/ green-surgery-report
4. Buhre W, De Robertis E and Gonzalez-Pizarro P. The Glasgow declaration on sustainability in Anaesthesiology and Intensive Care. Eur J Anaesthesiol 2023; 40:461–464
5. Royal College of Surgeons England. 58
www.clinicalservicesjournal.com I July 2024
Sustainability in the Operating Theatre. A guide to good practice. May 2022
6. NICE CG65, The management of inadvertent perioperative hypothermia in adults. April 2008. Clinical practice guideline (
nice.org.uk)
7. NICE CG65. Hypothermia: prevention and management in adults having surgery. December 2016. Hypothermia: prevention and management in adults having surgery (nice.
org.uk)
8. Andrzejowski J, et al. Effect of prewarming on post-induction core temperature and the incidence of inadvertent perioperative hypothermia in patients undergoing general anaesthesia. Br J Anaesth 2008; 101: 627–31
CSJ
9. Grote R, et al. Prewarming according to the AWMF S3 guidelines on preventing inadvertant perioperative hypothermia 2014. Retrospective analysis of 7786 patients. Anaesthesist 2018. 67:27–33
https://doi.org/10.1007/s00101-017- 0384-3
10. Ucak, A.; Tat Catal, A.; Karadag, E.; Cebeci, F. The Effect of Prewarming on Perioperative Hypothermia: A Systematic Review and Meta- analysis of Randomized Controlled Studies. J. Perianesth. Nurs.2024, in press. [CrossRef]
11. Alfonsi P, Bekka S, Aegerter P, on behalf of the SFAR Research Network investigators (2019) Prevalence of hypothermia on admission to recovery room remains high despite a large use of forced-air warming devices: Findings of a nonrandomized observational multicenter and pragmatic study on perioperative hypothermia prevalence in France. PLoS ONE 14(12): e0226038.
https://doi.org/10.1371/ journal.pone.0226038
12. Horn E.-P, Bein B, Bohm R. , Steinfath M, Sahili N and Hocker J. The effect of short time periods of pre-operative warming in the prevention of peri-operative hypothermia. Anaesthesia 2012, 67, 612–617
13. Kümin M, et al, Resistant fabric warming is a viable alternative to forced-air warming to prevent inadvertent perioperative hypothermia during hemiarthroplasty in the elderly. Hosp Infect. 2021:118:79-86.
14. Shuyan Liu et al. The effectiveness of air- free warming systems on perioperative hypothermia in total hip and knee arthroplasty. A systematic review and meta-analysis. Medicine (2019) 98:19
15. Gentherm data on file 16. Gonzalez-Pizarro P, et al, On behalf of the Sustainability National Representatives. European Society of Anaesthesiology and Intensive Care consensus document on sustainability. Eur J Anaesthesiol 2024; 41:1–18
About the author
Kevin Robinson is currently Clinical and Technical Services Manager EMEA at Gentherm Medical. Kevin is a qualified Operating Department Practitioner with over 10 years’ experience working at hospitals in London, UK and has over 20 years’ industry experience specialising in active patient thermal management.
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