1. Dr. P Bhakta, Dr. S. McGeary, Dr. C. Cody Connolly Hospital, Dublin 15
Maintaining Perioperative Normothermia in Surgical Patients: An Audit of Clinical Practice in Connolly Hospital
Dr. P Bhakta, Dr. S. McGeary, Dr. C. Cody
Connolly Hospital, Dublin 15
Introduction:
Inadvertent perioperative hypothermia (IPH) (core temperature ≤ 36° C) is a common occurrence.1 IPH can lead to several morbidities.1 Active warming measures should be instituted as soon as possible in patients who are hypothermic (≤ 36° C) and coming for elective surgery.2 NICE Guidelines are available to manage patients with inadvertent hypothermia.2
Aims and objectives:
We conducted a prospective audit in our hospital to assess the following:
 To investigate the current management of hypothermia in our hospital
To note the temperature of the patients in different phases of perioperative period.
To know the adequacy and effectiveness of current hypothermia preventive measures.
To see whether our practice adheres to the existing NICE guidelines.
Methods:
A prospective audit was conducted over a 9 week period in 35 patients scheduled for elective surgeries. Data collected included age, ASA classification, gender, type of surgery, type of anaesthesia, ambient theatre temperature, temperature of patient in the ward, on arrival to anaesthesia room, theatre and recovery room, on leaving the theatre and recovery room. Temperature controlling measures taken in ward, theatre and recovery room, amount of fluids used, duration of surgery and amount of blood loss were also recorded. Temperature measurement was obtained using infrared thermometer.
Discussion:
IPH is a common occurrence during anaesthesia. A number of factors cause this. Elimination of behavioural responses to temperature change under anaesthesia and impaired thermoregulatory responses are main factors leading to IPH.
Moderate to severe IPH may lead to patho-physiological derangements and increased perioperative morbidity. NICE guideline were devised to minimise and prevent this risk.
31.42 % of the patients were noted to be already hypothermic on arrival to theatre, which is against NICE guideline. Causes might include exposure to cold weather and lower ambient temperatures, reduced activity and inadequate clothing.  % of patient remained hypothermic after the end of surgery despite anti-hypothermic measures. Those who came to theatre in hypothermic condition, remained hypothermic at the end of procedure. This is probably due to the short time available to keep the patient warm, more intraoperative temperature loss compared to warming measures implemented. About 25.71% left PACU to ward in spite of remaining hypothermic which is against NICE guideline.
Although no adverse side effects were observed in this small number of patients, more effort might be put into prevention of hypothermia pre-operatively such as measures to keep the patient warm perioperatively, warming the patients actively at ward level before proceeding with elective surgery, maintenance of intraoperative temperature by recommended means and continuing them in the PACU if the patients are still hypothermic. No patient should leave the PACU in hypothermic state.
Results:
Mean age of the patient was 54 years (54 ± 18.44), mean ASA status was ASA II (ASAI-III), gender distribution was equal. 
Perioperative period
Audit result
Preoperative period
No of patient hypothermic
4/35 (11.4%)
Intraoperative period
No of patients hypothermic
Theatre in
11/35 (31.42%)
Theatre out
Average intraoperative period
± Min
Average amount of fluids given
1.41 ± 0.57 L
Average amount of blood loss
46.34 ± mL
No of patients receiving warmed fluids
27/35 (77.14%)
No of patients received forced air warming
34/35 (97.14%)
No of patients received HME
28/35 (80%)
Postoperative period
No of patients hypothermic
Recovery in
12/35 (34.28%)
Recovery out
9/35 (25.71%)
10/35 (28.57%)
Conclusion:
High incidence of pre-induction hypothermia was noted. Those who came to theatre in hypothermic state had higher probability of remaining hypothermic at the end of surgery. Prevention strategies directed at maintaining normothermia prior to arrival at theatre should be implemented and may result in significant reduction of morbidity. NICE guideline was not fully followed in our hospital regarding management of IPH. We plan to re audit after the strengthening of the NICE guideline in future. 
References:
Harper CM, Ansrzejowski JC, Alexander R. Nice and warm. Br J Anaesth 2008;101:293-5.
NICE. NICE Clinical Guideline 29. London: National Institute for Health and Clinical Excellence; Perioperative hypothermia (inadvertent): the management of inadvertent perioperative hypothermia in adults. Available from (accessed on 13th April, 2014).