Hypothermia in the PACU

Postanesthetic hypothermia is a common, significant, and costly problem in the PACU. The scope of the problem ranges from an adverse outcome for the patient to undue financial burden to the institution providing the care. All of these problems can be minimized or prevented with active warming therapy. From the quality assurance perspective, patient temperatures in the PACU should be measured and documented at appropriate intervals. When hypothermia is detected, even in a mild state, it ought to be assertively treated, particularly in the elderly or patients compromised by systemic disease. When hypothermia is encountered in a moderate to severe form, however, it should be recognized as a grave threat to the patient. Hypothermia has been associated with the most serious postanesthetic complications, including MI, congestive heart failure, respiratory failure, recurarization (reparalyzation), renarcotization, stroke, and bleeding. Inability to control variables makes it exceedingly difficult to identify the contribution of hypothermia to these forms of anesthesia-related morbidity and mortality, but it is undoubtedly significant. For this reason, failure to treat postanesthetic hypothermia is beginning to be recognized as a potential cause of action for a malpractice suit in the presence of an adverse anesthetic outcome. This article evaluates and compares the existing warming therapies with respect to effectiveness, safety, and cost. Fluid warmers, warmed cotton blankets, and infra-red warming devices show no effectiveness in treating hypothermia in the PACU. Only active warming, as characterized by the Bair Hugger warming system, succeeds. With respect to budgetary concerns, Convective Warming Therapy is less expensive to use than warmed cotton blanket treatment. Perioperative temperature management is an emerging science in nursing and medicine. The problem is as ancient as surgery and anesthesia, but the implications are only beginning to be appreciated. Analysis of the problem of hypothermia in terms of clinical and financial outcome are proceeding, with new studies appearing in the literature monthly. More investigation is indicated in the area of patient temperature regulation, which is likely to identify additional situations when active warming therapy is indicated, as a mechanism to protect patients during emergence from anesthesia and to insure cost-effective use of PACU time.