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Archive February 2019 XX, No. 2

Hot Takes on Patient Warming

Answers to your 5 burning questions on how to safely and effectively prevent hypothermia.

Paul Austin

Paul Austin, CRNA, PhD


Gregory P. DeConciliis, PA-C, CASC
FORCING THE ISSUE A minimum of 30 minutes of pre-operative forced-air convective warming can decrease intraoperative hypothermia, researchers found.

We know that pre-operative warming can help prevent hypothermia, which will lead to improved surgical outcomes, fewer surgical site infections, and much happier patients who won't miss shivering and chattering teeth. We're less certain about the ideal warming protocols. How long should you warm patients in pre-op? At what temperature should you warm the blankets that will warm your patients? Is forced-air warming really an infection risk? Luckily, there's no shortage of research on patient warming. Let's look at 5 recent studies for some guidance.

1. No patient can live on intraop warming alone. Many believe that warming a patient during surgery is enough to prevent hypothermia, but intraoperative warming alone isn't nearly as effective as actively warming patients both before and during surgery. A June 2018 study in the Canadian Journal of Anesthesia ( compared 2 groups of patients, each of which was warmed during the case with a forced-air warmer (FAW). One group received a minimum of 30 minutes of pre-op FAW, while the control group received a warmed blanket upon request.

Prewarmed patients had less hypothermia than those who were only warmed during surgery. The key finding: Combining prewarming with intraop warming is more effective at maintaining normothermia than warming in the OR alone. While warming patients before and during surgery is no guarantee against redistribution hypothermia, researchers conclude that "their combined application results in greater preservation of intraoperative normothermia compared with intraoperative forced-air warming alone."

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