Editorials

Maintaining perioperative normothermia

BMJ 2003; 326 doi: http://dx.doi.org/10.1136/bmj.326.7392.721 (Published 05 April 2003) Cite this as: BMJ 2003;326:721

A simple, safe, and effective way of reducing complications of surgery

  1. Christopher Mark Harper, research fellow ([email protected]),
  2. Thomas McNicholas, consultant urologist ([email protected]),
  3. S Gowrie-Mohan, consultant anaesthetist
  1. Centre for Anaesthesia, Middlesex Hospital, London W1T 3AA
  2. Lister Hospital, Stevenage, Hertfordshire SG1 4AB

    Perioperative hypothermia can have a wide range of underappreciated, detrimental effects. These include increased rates of wound infection, morbid cardiac events, blood loss, and length of stay in both recovery and hospital. Maintaining core temperature at or above 36°C can be beneficial for the patient and cost effective.

    Frank et al studied high risk cardiac patients undergoing thoracic, abdominal, and vascular surgery.1 Patients randomised to routine thermal care were, on average, 1.3°C cooler than patients warmed more aggressively. Despite this small difference the incidence of perioperative morbid cardiac events, assessed in a double blind fashion, was 300% higher in the cooler group. Frank et al thought that this may be the a consequence of the dramatic increase in noradrenaline release seen in even mild hypothermia.

    It has also been said that the increase in noradrenaline may contribute to the higher number of wound infections seen in hypothermic patients. A randomised study of patients undergoing colorectal surgery showed that 1.9°C hypothermia resulted in an infection rate of 19% compared with 6% in the normothermic …

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