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Perioperative core temperature

Toronto, Ontario

To the Editor:

Kamitani et al.,¹ in their study on perioperative core temperature, are to be congratulated on preventing core hypothermia and thus the potential complications i.e. myocardial ischemia; shivering; impaired wound healing, immunity and coagulation; prolonged hospital stay.

However, I think the title of the paper and conclusion reached were misleading. The conclusion that "covering the patients head and face maintains intra operative core temperature" implies that performing this sole step prevents core hypothermia. This was not true. The patients were also wrapped in aluminium sheets and had surgery in a relatively warm ambient temperature; both these steps help to prevent heat loss.^2,3 Another important omission was that it was not stated whether intravenous fluids were warmed to body temperature, another excellent strategy for preventing hypothermia.⁴

I suspect that the reason why neither group of patients developed core hypothermia was that both groups of patients were well covered up anyway, the ambient temperature was relatively high, and the iv fluids may well have been warmed. The correct conclusion is that covering the head and face as well as the limbs/chest/pelvis, undergoing surgery in a warm ambient temperature, and warming iv fluids retards the development of core hypothermia.

References

1 Kamitani K, Higuchi A, Takebayashi T, Miyamoto Y, Yoshida H. Covering the head and face maintains intra operative core temperature. Can J Anesth 1999; 46: 649–52.[Abstract/Free Full Text]

2 Frank SM, Beattie C, Christopherson R, et al. Epidural versus general anesthesia, ambient operating room temperature, and patient age as predictors of inadvertent hypothermia. Anesthesiology 1992; 77: 252–7.[Medline]

3 Hindsholm KB, Bredahl C, Herlevsen P, Kruhoffer PK. Reflective blankets used for reduction of heat loss during regional anaesthesia. Br J Anaesth 1992; 68: 531–3.[Abstract/Free Full Text]

4 Smith CE, Desai R, Glorioso V, Cooper A, Pinchak AC, Hagen KF. Preventing hypothermia: convective and intravenous fluid warming versus convective warming alone. J Clin Anesth 1998; 10: 380–5.[Medline]

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