The Relationship between Intra-Operative Normothermia and Patient Safety

Table of Contents

Introduction1

Literature Review1

Problem Analysis8

Discussion9

Implications for Practice11

Recommendations for Future Study12

References16

The Relationship between Intra-Operative Normothermia and Patient Safety

Introduction

Maintenance of core body temperature in surgical patients receiving general or regional anesthesia presents a constant challenge for intraoperative nurses because all patients are at risk for lowered body temperatures during surgery. A meta-analysis of outcomes and costs associated with the maintenance of intraoperative normothermia indicates that maintaining normothermia can reduce hospitalization costs by $2,500 to $7,000 per surgical patient by shortening hospital length of stay by 40% and decreasing the incidence of postoperative wound infections by 64%. (Frank et al, 2010) Promoting normothermia with the use of one or two active warming devices at approximate costs of $7 to $20 might offset an intensive care unit stay costing more than $1,000 per day or prevent a prolonged hospitalization at a cost of more than $465 per day.22,23 Given the availability of monitoring and warming technology, as well as the simplicity of use and cost effectiveness of interventions for the prevention of hypothermia, it is alarming that lack of intervention continues to place patients at risk for unplanned intraoperative hypothermia.

Literature Review

Prewarming of patients before induction of anesthesia has been studied as a method to maintain intraoperative normothermia (Camus et al, 2008). Studies have demonstrated the efficacy of intraoperative methods to prevent hypothermia; however, intraoperative cutaneous heat transfer, such as in forced- air warming, does not prevent initial redistribution-induced hypothermia (Bock et al, 2009). This initial hypothermia results from redistribution of heat from the warm core compartment to cold peripheral tissues, due to anesthesia-induced vasodilation (Kurz et al, 2009). Several studies have evaluated the effect of preoperative warming on this initial redistribution-induced hypothermia. One determined that redistribution hypothermia in surgical patients would be markedly reduced by the use of forced-air prewarming for 30 minutes and almost eliminated if active warming was maintained for 1 hour (Lenhardt et al, 2010). However, this study was performed using a group of seven healthy volunteers in a laboratory. Another randomized controlled study of women undergoing elective cesarean sections found that 15 minutes of prewarming in addition to routine intraoperative warming was sufficient to maintain core temperature and prevent hypothermia and shivering. One study of patients receiving 45 minutes of forced-air prewarming found that patients reported increased thermal comfort  and decreased complaints of shivering and that the patients maintained a significantly higher mean temperature on arrival to the postanesthesia care unit (PACU) (Harper, 2008). This result was supported by a later study demonstrating those 90 minutes of preinduction skin-surface warming reduced initial postinduction hypothermia and postoperative shivering for procedures lasting three hours or longer (Fleisher et al, 2010).

Assessment

Selecting equipment to monitor core temperature based on reliability and accessibility of the monitoring site (Mahoney & Odom, 2009).

Monitoring core temperature intraoperatively to allow early identification of temperature changes (ASA recommends that patient temperature be continually monitored and evaluated when “clinically significant changes in body temperature are intended, anticipated or ...