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Archive Ambulatory Anesthesia 2014

Why Warming Matters

Patient normothermia is a key concern for successful anesthesia outcomes.

Gary Lawson, MD

BIO

cooling core temperature HEAD OF THE TABLE Anesthesia's gases, oxygen and IV fluids play significant roles in cooling a patient's core temperature.

Perioperative patient warming is typically viewed through the lens of surgical quality measures, infection prevention efforts or even patient satisfaction scores. Less frequently discussed is the role that patients' core temperatures play in anesthesia effects and PACU stays. Let's review the reasons why maintaining normothermia is critical to successful ambulatory anesthesia.

Where the risks lie
Hypothermia carries many risks through the potentially hazardous physiological changes it triggers, including the following conditions:

  • Increased oxygen demand. Shivering increases the body's demand for oxygen by 300%. A patient who is shivering after a case may experience blood oxygen desaturation that causes hypoxia, which may exacerbate coronary artery disease, leading to myocardial ischemia and arrhythmias.
  • Impaired consciousness, which can prolong a patient's awakening and discharge. After the use of paralytic agents during general surgery, anesthesia providers perform a test called the "Train of Four," an electrical stimulation of the peripheral nerves that measures the level of neuromuscular blockade remaining in the patient's system, to determine whether they're able to breathe on their own again. A hypothermic core temperature may trigger a false positive response and an overestimation of the patient's paralysis. If unneeded reversal agents are administered, there is a risk of post-op nausea and vomiting.
  • Vasoconstriction, which can hinder peripheral perfusion and deliver false desaturation readings on the pulse oximeter.
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