April 5, 2004
Daniel Sessler, MD, a leading researcher on thermal regulation and the effects of hypothermia on patients, responded to questions about patient warming. He is vice dean for research, professor of anesthesiology, and director of the Outcomes Research Institute at the University of Louisville.
OR Manager: What is the most costeffective and efficacious method for warming surgical patients?
Dr Sessler: The answer is simple, forced air. It’s the most effective, inexpensive, and commonly available method of warming patients.
ORM: Is that being widely used?
Dr Sessler: Almost all institutions use forced air. The problem is they don’t use it with every patient. Probably only one half to one third of patients who should be warmed are getting warmed.
ORM: Do all surgical patients need to be warmed?
Dr Sessler: Patients become hypothermic initially because of a core-to-peripheral redistribution of body heat. This redistribution occurs even in warm rooms and in patients having small, short operations. Once clinicians recognize the importance of redistribution, it becomes clear that almost all surgical patients should be warmed.
ORM: What is the most effective method for measuring patientsí temperatures?
Dr Sessler: The easiest way in an intubated patient is to use an esophageal probe. The problem is when you have patients who aren’t intubated or have a laryngeal mask airway. There are other good sites such as the pulmonary artery or nasopharynx, but they are harder to use. Among those, only the nasopharynx is really a usable option. The nasopharynx is a perfectly good place to measure temperature in patients having general anesthesia. If the patient isn’t having general anesthesia, other options include forehead skin temperature or axillary, oral, or rectal temperature. Infrared tympanic membrane thermometers should be avoided. Those are unreliable. In fact, most studies suggest they are little better than random number generators.
ORM: What type temperature measurement do you recommend in the PACU?
Dr Sessler: Oral temperatures are probably the best.