Journal of the American College of Surgeons
Volume 209, Issue 4 , Pages 492-503.e1 , October 2009

Evidence-Based Guidelines for Prevention of Perioperative Hypothermia

Abstract presented at the Canadian Surgical Forum, Halifax, Nova Scotia, September 2008.

  • Shawn S. Forbes, MD

      Affiliations

    • Department of Surgery, University of Toronto, Toronto, Ontario, Canada
    • Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
    • Dr. Zane Cohen Digestive Diseases Clinical Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
  • ,
  • Cagla Eskicioglu, MD

      Affiliations

    • Department of Surgery, University of Toronto, Toronto, Ontario, Canada
    • Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
    • Dr. Zane Cohen Digestive Diseases Clinical Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
  • ,
  • Avery B. Nathens, MD, FACS

      Affiliations

    • Department of Surgery, University of Toronto, Toronto, Ontario, Canada
    • Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
  • ,
  • Darlene S. Fenech, MD

      Affiliations

    • Department of Surgery, University of Toronto, Toronto, Ontario, Canada
    • Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
    • Dr. Zane Cohen Digestive Diseases Clinical Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
  • ,
  • Claude Laflamme, MD

      Affiliations

    • Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
  • ,
  • Richard F. McLean, MD

      Affiliations

    • Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
  • ,
  • Robin S. McLeod, MD, FACS

      Affiliations

    • Department of Surgery, University of Toronto, Toronto, Ontario, Canada
    • Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
    • Dr. Zane Cohen Digestive Diseases Clinical Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
    • Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
    • Corresponding Author InformationCorrespondence address: Robin S McLeod, MD, FACS, Mount Sinai Hospital, 600 University Avenue, Suite 449, Toronto, ON
  • ,
  • Best Practice in General Surgery Committee, University of Toronto

      Affiliations

    • See Appendix 1 for Members of the Best Practice in General Surgery Committee, University of Toronto.

Received 22 May 2009 ,Revised 29 June 2009 ,Accepted 7 July 2009.

References 

  1. Vaughan MS, Vaughan RW, Cork RC. Postoperative hypothermia in adults: relationship of age, anesthesia, and shivering to rewarming. Anesth Analg. 1981;60:746–751
  2. Kurz A, Sessler DI, Lenhardt R Study of Wound Infection and Temperature Group. Perioperative normothermia to reduce the incidence of surgical wound infection and shorten hospitalization. N Engl J Med. 1996;334:1209–1215
  3. Melling AC, Ali B, Scott EM, et al. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomized controlled trial. Lancet. 2001;358:876–880
  4. Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: a randomized clinical trial. JAMA. 1997;277:1127–1134
  5. Kumar S, Wong PF, Melling AC, et al. Effects of perioperative hypothermia and warming in surgical practice. Int Wound J. 2005;2:193–204
  6. Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20:250–278
  7. Kirkland KB, Briggs JP, Trivette SL, et al. The impact of surgical site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20:725–730
  8. McGarry SA, Engemann JJ, Schmader K, et al. Surgical-site infection due to Staphylococcus aureus among elderly patients: mortality, duration of hospitalization, and cost. Infect Control Hosp Epidemiol. 2004;25:461–467
  9. Frank SM, Higgins MS, Breslow MJ, et al. The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia: a randomized clinical trial. Anesthesiology. 1995;82:83–93
  10. Devereaux PJ, Goldman L, Cook DJ, et al. Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ. 2005;173:627–634
  11. Forbes SS, Stephen WJ, Harper W, et al. The implementation of evidence-based practices for surgical site infection prophylaxis: results of a pre- and post-intervention study. J Am Coll Surg. 2008;207:336–341
  12. Hedrick TL, Heckman JA, Smith RL, et al. Efficacy of protocol implementation on incidence of wound infection in colorectal operations. J Am Coll Surg. 2007;205:432–438
  13. Harris RP, Helfand M, Woolf SH, et al. Current methods of the US Preventive Services Task Force: a review of the process. Am J Prev Med. 2001;20(Suppl):21–35
  14. Byrne DJ, Malek MM, Davey PG, et al. Postoperative wound scoring. Biomed Pharmacother. 1989;43:669–673
  15. Wong PF, Kumar S, Bohra A, et al. Randomized clinical trial of perioperative systemic warming in major elective abdominal surgery. Br J Surg. 2007;94:421–426
  16. Elmore JR, Franklin DP, Youkey JR, et al. Normothermia is protective during infrarenal aortic surgery. J Vasc Surg. 1998;28:984–994
  17. Lefrant JY, Muller L, Emmanuel Coussaye J, et al. Temperature measurement in intensive care patients: comparison of urinary bladder, oesophageal, rectal, axillary, and inguinal methods versus pulmonary artery core method. Intensive Care Med. 2003;29:414–418
  18. Rotello LC, Crawford L, Terndrup TE. Comparison of infrared ear thermometer derived and equilibrated rectal temperatures in estimating pulmonary artery temperatures. Crit Care Med. 1996;24:1501–1506
  19. Erickson RS, Kirklin SK. Comparison of ear-based, bladder, oral, and axillary methods for core temperature measurement. Crit Care Med. 1993;21:1528–1534
  20. Farnell S, Maxwell L, Tan S, et al. Temperature measurement: comparison of non-invasive methods used in adult critical care. J Clin Nurs. 2005;14:632–639
  21. Lawson L, Bridges EJ, Ballou I, et al. Accuracy and precision of noninvasive temperature measurement in adult intensive care patients. Am J Crit Care. 2007;16:485–496
  22. Suleman MI, Doufas AG, Akca O, et al. Insufficiency in a new temporal-artery thermometer for adult and pediatric patients. Anesth Analg. 2002;95:67–71
  23. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;327:307–310
  24. Myles PS, Cui J. Editorial I (Using the Bland-Altman method to measure agreement with repeated measures). Br J Anaesth. 2007;99:309–311
  25. Cork RC, Vaughan RW, Humphrey LS. Precision and accuracy of intraoperative temperature monitoring. Anesth Analg. 1983;62:211–214
  26. Camus Y, Delva E, Cohen S, et al. The effects of warming intravenous fluids on intraoperative hypothermia and postoperative shivering during prolonged abdominal surgery. Acta Anaesthesiol Scand. 1996;40:779–782
  27. Smith CE, Gerdes E, Sweda S, et al. Warming intravenous fluids reduces perioperative hypothermia in women undergoing ambulatory gynecological surgery. Anesth Analg. 1998;87:37–41
  28. Lindwall R, Svensson H, Soderstrom S, et al. Forced air warming and intraoperative hypothermia. Eur J Surg. 1998;164:13–16
  29. Butwick AJ, Lipman SS, Carvalho B. Intraoperative forced air-warming during caesarean delivery under spinal anesthesia does not prevent maternal hypothermia. Anesth Analg. 2007;105:413–419
  30. Camus Y, Delva E, Sessler DI, et al. Pre-induction skin-surface warming minimizes intraoperative core hypothermia. J Clin Anesth. 1995;7:384–388
  31. Horn EP, Schroeder F, Gottschalk A, et al. Active warming during cesarean delivery. Anesth Analg. 2002;94:409–414
  32. Bock M, Muller J, Bach A, et al. Effects of preinduction and intraoperative warming during major laparotomy. Br J Anaesth. 1998;80:159–163
  33. Leung KK, Lai A, Wu A. A randomized controlled trial of the electric heating pad vs forced-air warming for preventing hypothermia during laparotomy. Anaesthesia. 2007;62:605–608
  34. Wilson S, Szerb J. Failure of an iv fluid warming device. Can J Anesth. 2007;54:324–325
  35. Truell KD, Bakerman PR, Teodori MF, et al. Third-degree burns due to intraoperative use of a Bair Hugger warming device. Ann Thorac Surg. 2000;69:1933–1934
  36. FDA Patient Safety News: Show #9, October 2002 (Burns from misuse of forced-air warming devices). http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/psn/printer.cfm?id=56Accessed June 12, 2009
  37. Health Canada, Advisories, Warnings, and Recalls. Fire and burn risks associated with certain heating units for electrically heated blankets. http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2005/2005_14-eng.phpAccessed June 25, 2009
  38. Avidan MS, Jones N, Ing R, et al. Convection warmers—not just hot air. Anaesth. 1997;52:1073–1076
  39. Baker N, King D, Smith EG. Infection control hazards of intraoperative forced air warming. J Hosp Inf. 2002;51:153–154
  40. Dellinger EP, Hausmann SM, Bratzler DW, et al. Hospitals collaborate to decrease surgical site infections. Am J Surg. 2005;190:9–15

 Disclosure Information: Nothing to disclose.

 Reviewed and endorsed by the Canadian Association of General Surgeons, September 2008.

PII: S1072-7515(09)01107-7

doi: 10.1016/j.jamcollsurg.2009.07.002

Journal of the American College of Surgeons
Volume 209, Issue 4 , Pages 492-503.e1 , October 2009