Assesses the use of preoperative forced-air warming and its effects on minimizing inadvertent perioperative hypothermia. Six studies were analyzed. Forced-air prewarming of patients undergoing surgery helped to minimize inadvertent perioperative hypothermia in adult surgical patients undergoing general anesthesia.

Inadvertent Perioperative Hypothermia (IPH) is defined as a patient's core body temperature unintentionally dropping below 36°C at any point in the perioperative environment. IPH occurs most frequently in the first hour after induction of general anesthesia secondary to vasodilation and heat transfer from the patient's core to the periphery. Despite well-known detrimental intraoperative and postoperative outcomes associated with IPH, it continues to occur in approximately half of all surgical patients. Literature reviews reveal that promotion of normothermia throughout the perioperative environment reduces the incidence of complications of IPH, improves patient outcomes, and lowers health care costs. Current preoperative practice is to monitor a patient's temperature only once on admission and subsequently deploy passive warming interventions with no further monitoring. Ensuring that patients are appropriately monitored and actively warmed preoperatively has been identified as a strategy to reduce the incidence of IPH both intraoperatively and postoperatively due to maintenance of peripheral temperature and limiting of heat-transfer following general anesthetic onset. As Orem's Self-Care Deficit Theory maintains the nursing role in purposefully assisting patients to meet their self-care needs, known and unknown, actively ensuring euthermia in the preoperative environment promotes optimal outcomes in surgical patients and aligns nurses with the priorities of patient care and patient advocacy. Active intraoperative warming is effective but frequently insufficient to prevent the occurrence of IPH alone. A standardized, intentional preoperative warming strategy which includes continual patient temperature monitoring and purposeful intervention will reduce the incidence of IPH and associated complications.

It is said that anywhere between 60% and 90% of surgical patients will become hypothermic(Hegarty and others, 2009). This paper will discuss this problem, as well as the nursing theory behind the proposal. Research for the proposal is based on the PICOT question: In adult surgical patients, will pre-warming the patient at least 15 minutes prior to induction of anesthesia, compared to only intraoperative warming, result in decreased incidence of perioperative hypothermia within the first two hours following surgery? Pre-operative warming of surgical patients for at least 30 minutes by means of forced air will be proposed to the nurse leaders, administration, and stakeholders at Tallahassee Memorial Hospital. The fifteen research articles sound in the CINAHL database show there are a multitude of factors that contribute to the occurrence of hypothermia as well as preventing it. This paper provides evidence the preoperative warming with a forced-air warmer, in addition to intraoperative warming on adult surgical patients helps in maintaining normothermia. Preoperative warming is safe, tolerated well, and increases patient satisfaction. Maintaining normothermia throughout all surgical phases will decrease healthcare costs to hospitals and patients. Implementing this proposal will not only prevent inadvertent hypothermia, but increase patient satisfaction, and lower costs to the hospital and patient.

Inadvertent hypothermia is a common and preventable issue among surgical patients. This paper will describe the problem and provide research data to support the proposed solution. The problem asks the question, in surgical patients; will the use of pre and intra operative core warming, as compared to the use of standard care to maintain normothermia, decrease the incidence of inadvertent postoperative hypothermia in the Post Anesthesia Recovery Unit? Research has proven that one to two hours of preoperative core warming will significantly reduce the incidence of inadvertent hypothermia. The prevention of inadvertent hypothermia is extremely important for surgical patients because hypothermia can cause serious poor outcomes related to surgery. Such poor outcomes include surgical site infection, delayed wound healing, increased surgical blood loss, cardiac events, and an increase in time spent in the PACU. All events associated with inadvertent hypothermia can cost the hospital large amounts of money as well as increase the time a patients stays at the hospital which effects patient satisfaction. The plan is to implement a preoperative core warming policy in addition to the standard of care intraoperative hypothermia prevention policy. The change will use evidence based research to support the use of forced-air warming machines in the preoperative department. The preoperative staff will also receive education on assessing for inadvertent hypothermia risks. The intraoperative staff will also use forced-air warming machines to maintain normothermia as well as monitor the patient's core temperature. The PACU staff will document the patient's core temperature immediately upon arrival. These protocols will significantly reduce the events of inadvertent hypothermia and provide better outcomes for surgical patients as well as reduce hospital costs and increase patient satisfaction.

The definition of perioperative hypothermia is a body temperature less than 36 degrees C. (Fettes, Mulvaine, and Van Doren, 2013). Even mild perioperative hypothermia have been associated with increased incidence of serious adverse effects including decreased metabolic rate decreased cardiac output metabolic acidosis and altered clotting function and increased surgical site infections (Fetts and others 2013). In addition to the adverse effects, patient's comfort is also significantly diminished by perioperative hypothermia specially preoperative and postoperative hypothermia. Research has shown that the use of forced air warming blankets has been beneficial in prevent perioperative hypothermia, in combination with other warming measures (Moola, and Lockwood, 2011). The project was done to implement the use of forced air warming blankets in the perioperative area to prevent perioperative hypothermia. An implementation plan was developed, the staff involved was assessed on their knowledge of perioperative hypothermia and the effect it has on the patients. An educated plan was developed to educate the staff on ways to prevent perioperative hypothermia. The plan to use forced air warming blankets for all the patients, that did not have contraindication for use, were presented to the staff. An audit form was developed to measure the compliance by the staff in applying the warming blankets, and the patient's temperature at different times during their perioperative stay. The audit forms was to be collected in the post anesthesia unit (PACU) after the patient were discharge from PACU. The audit was to be completed after two months. At that time the result were to be presented to the involved staff. Were there any adjustments or changes found necessary, they will also be presented to the staff at this time.

Learning Track:t14. Perioperative MedicineTitle:tThe impact of prewarming on core temperature and cases of inadvertant perioperative hypothermia in oncogynecologal surgeryAuthor(s):tPasheev A.1, 2 Sayetgaraev A.1,2 Muftahutdinova G.2Institute(s):t1Kazan State Medical Academy, Dept of Anaesthesiology & Intensive Care, Kazan, Russian Federation, 2Tatarstan Regional Clinical Cancer Center, Dept of Anaesthesiology & Intensive Care, Kazan, Russian FederationText:tBackground: Inadvertent perioperative hypothermia (IPH) occurs in many patients , undergoing oncogynecological operations, due to the influence of the spinal anesthesia and sedation. The effect of warming techniques are insufficient to counteract thermal redistribution resulting from the peripheral vasodilatation, associated with spinal anesthesia. We tested the efficiency of the preoperative forced-air warming (FAW) device (Bair Paws) in combination with intravenous injection of tramadol in preventing IPH.Methods: Eighty adult patients undergoing oncogynecological surgery under spinal anesthesia were randomized to receive either normal care or prewarming for 30 min, at 43C, using the Bair Paws, in combination with the injection of (0,5 mg/kg) tramadol preoperatively. Results: There was smaller decrease in mean core temperature in the prewarmed group at 15, 30, 75, 90 min post-induction (P

This dissertation, "An Evidence-based Guideline on Preoperative Warming of Patients Undergo General Anesthesia to Reduce Postoperative Hypothermia" by Tan-ning, Cheng, 鄭丹寧, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Operating theatre is a cold environment and hypothermia (core body temperature lower than 36C) is prevalent among patients undergoing operations. Possible causes of this adverse condition include anesthetic effect, body part exposure, blood loss, and the low room temperature in the theatre. Hypothermia can impair wound healing, decrease drug metabolism, increase oxygen consumption, which in turn causing respiratory distress, bradycardia as well as atrial fibrillation. In extreme cases, it can be lethal. Numerous research studies have explored ways of interventions and new technologies to maintain normal body temperature of patients during operations. However, perhaps without proper translation to clinical practice, the rate of postoperative hypothermia still remains high in many hospital setting. The objectives of this thesis are to systematically review the current literature on the effectiveness of preoperative warming on reducing postoperative hypothermia of patients undergoing general anesthesia. Data from the relevant literature is extracted for setting up a table of evidence. Also, quality assessment is performed. An evidence-based practice guideline for preoperative warming is developed and its feasibility and transferability to the target patients is examined. The purpose of the guideline is to provide better care for patients undergoing general anesthesia. In this thesis, preoperative forced air warming is proposed. The target setting is the operating theatre department and day surgery centre in a local public acute hospital. The target population is patients who undergo general anesthesia. Data is extracted from six articles. The implementation potential of the proposed guideline is high, because of the high transferability, feasibility and cost-effective ratio. An evidence-based practice guideline is developed based on the evidence. Well-designed implementation and evaluation plan are developed for the implementation of the proposed guideline. DOI: 10.5353/th_b5088268 Subjects: Preoperative care Hypothermia - Prevention