Our readers are always interested in knowing more about surgical procedures. As a means of broadening how we think about surgery, we have decided to put some questions before our Anesthesiologists.
HOI: We would like to know more about patient warming. We understand that active patient warming is associated with normalizing patient temperature. What is the role of the anesthesiologist in normalizing patient temperature?
Anesthesiologists: The Hoag Orthopedic Institute and the Department of Anesthesiology are working hard to stay at the forefront of this important issue. HOI’s approach includes not only our Anesthesiologists, but our Surgeons and our Peri-Operative Nurses as part of a team-based approach that allows us to maximize the benefit to the patient. Specifically, the Anesthesiologist will consult with the surgeon and agree on how best to warm the patient. Once that decision is made our doctors and nurses can begin warming the patient in the pre-operative area and the Anesthesiologist can continue the warming process throughout the entire procedure, given that there are no circumstances that contraindicate active warming. Our goal is to maintain normal body temperature throughout the procedure in order to maximize patient safety and comfort.
HOI: Can peri-operative hypothermia have serious consequences?
Anesthesiologists: Despite the best efforts of doctors and nurses, a patient may become hypothermic (for a variety of reasons). At the Hoag Orthopedic Institute we are examining ways to minimize this risk. Our efforts may help reduce incidence of infection, blood loss and the need for a blood transfusion. It may also reduce the risk of something as serious a heart attack. It can make waiting for surgery more comfortable, reducing post-operative shivering or reducing time in the post-operative care unit. This low-risk, easily controllable intervention can help minimize many of the risks associated with surgery.
HOI: The American Society of Anesthesiologists recommends that normothermia should be a goal during emergence and recovery, and that when available, forced-air warming systems should be used for treating hypothermia. What type of patient warming is used at Hoag Orthopedic Institute, and is there more than one type depending upon the patient or the circumstances?
Anesthesiologists: At the Hoag Orthopedic Institute we are attempting to go beyond government recommendations and find ways to maximize our patients’ safety. The Departments of Anesthesiology and Surgery are collaborating to examine the various modalities available for patient warming. They are working to determine whether forced-air, or convection warming, is the safest and most effective method of warming a patient. The Hoag Orthopedic Institute is at the forefront of warming patients
before they enter the operating room, in an effort to prevent hypothermia. The Hoag Orthopedic Institute and its Anesthesiologists and Surgeons will continue to go beyond the standard guidelines to bring the best care to its patients.
HOI: Are some patients more at risk for peri-operative hypothermia than others?
Anesthesiologists: Our Anesthesiologists and Surgeons recognize that patient care is a unique process that requires personal attention to each individual. Patients who require a large portion of their body to be exposed or surgeries of particularly long duration are at increased the risk of hypothermia. In addition, numerous medical conditions can increase the risk of infection, blood loss, and heart problems, all of which can be reduced by maintaining normothermia.
HOI: Are there preventive warming measures?
Anesthesiologists: The Hoag Orthopedic Institute and its Doctors and Nurses are committed to patient care and to providing the best outcomes possible. Therefore we are examining the benefits of warming patients immediately upon their arrival as a method for significantly improving outcomes, and also evaluating various techniques for preventing hypothermia. The hospital, its Surgeons, Anesthesiologists, and Nurses will continue to evaluate this critical issue in order to provide the safest surgical experience possible to its patients.
We’d like to thank Dr. S. Todd Newman of Newport Harbor Anesthesia Consultants who has responded to our questions on behalf of the Hoag Orthopedic Institute Department of Anesthesiology.