Peri-operative temperature measurement. Guideline or fantasy?

Abstract

Introduction Perioperative hypothermia is common but associated with adverse outcomes and is defined as patient core temperature below 36.0°C. During the first 30 to 40 minutes of anaesthesia, a patient's temperature can drop to below 35.0°C. National guidelines advise1: • Temperature to be measured and documented in the hour before patient leaves ward • If • Maintain active warming throughout intraoperative phase • Temperature should be 36.0°C before transfer from/to the ward Additionally it is suggested that: - Induction of anaesthesia should not begin unless temperature is 36.0°C - Intravenous fluids (500 ml or more)/blood products should be warmed to 37°C using a fluid warming device - Warm patients intraoperatively from induction of anaesthesia, using a forced-air warming device if they are undergoing anaesthesia for more than 30 minutes, or anaesthesia for less than 30 minutes but are at higher risk of inadvertent perioperative hypothermia. - The patient's temperature should be measured and documented before induction and every 30 minutes until the end of surgery - Temperature should be measured and documented on admission to the recovery room and then every 15 minutes. If the patient's temperature is Methods The electronic charts of 31 patients undergoing routine thoracic surgery of duration over 30 minutes in a dedicated cardiothoracic unit over a two-week period were reviewed. The use of peri-operative temperature measurement was examined. Results 41% of patients had a temperature measured on arrival in the operating department. At 30 minutes into the procedure only 29% had temperature recorded. In the PACU 11 (32%) of patients had temperature measured, and of these only 6 (19%) had an arrival temperate over 36.0oC. Subsequently 1/31 patient had temperature measured every 15 minutes and just 4/31 patients had temperature recorded every 30 minutes. However 42% of patients had temperature recorded at discharge from the PACU. Discussion These data show a small improvement when compared to a previous audit of a similar cohort of patients (38 patients undergoing elective thoracic surgery over 30 minute duration) as shown below: Temperature recorded 2018 2017 Arrival O R 41% 24% 30 min O R 29% 24% Arrival PACU 32% 24% Leave PACU 42% 5% However no single data point exceeded 50% despite efforts to educate operating department staff on the requirement to record temperature and the benefits of actively warming patients.