Wednesday, June 20, 2007

Cold Comfort


I've never hugged a bear, but I'm glad there are bair huggers. Because there's one way in which I'm in major conflict with my patients: I like it cold in the OR. They need it warm. Like the dual-control electric blanket that may have saved my marriage, heating devices in the OR allow dichotomy; the patient can be kept toasty while the surgical folk remain cool. Cooler.

Anyone who's arrived in an operating room awake enough to recall the experience is likely to have noticed it was cool as the frost on a champagne glass (some may know the rest of that one...) "Yeah, we're trying to cut down on heating bills," I'd say when a patient mentioned it. But the fact is, it's personal: it gets darn hot under surgical gowns, especially the newer water-proof ones. Add a little stress, a little anxiety, and a warm room becomes destructively uncomfortable. Nor is sweating a good thing. Dramatic and surgeon-affirming as it may be to ask the nurse to wipe one's brow (I've done it many a time: I find it more embarrassing than off-getting), dropping a bead or two into a wound is poor form. Not that you'd think it necessary, but there have been studies. I've asked more times than I can count to cool a room down. Some ORs have a a sort of power-cool mode, which is like a gift from above. I don't think I've ever complained about a room being too cold: my idea of perfection is seeing the anesthesia person wearing an extra gown and a towel around the neck. Seeing their bare feet in a pan of hot water would likely elicit chills of joy.

Unfortunately, it's also true that letting a patient get cold in the OR is a bad thing. A common explanation for the icy room used to be that it reduces infection. But it's been well-shown that when a patient's core temperature drops, wound infection goes up. And when there's low humidity, there's more static electricity, which (theoretically) can lead to explosions with some of the anesthetic gases. Plus, it's said that particulate matter floats around more easily in dry air. So rooms are kept on the muggy side, making it feel warmer.

Blowing warm air through a flexible hose connected to a puffy air-blanket with holes in it, segmented sausages of soothing sunniness, the bair-hugger keeps people comfy. It was originally a total-body cover, laid on as soon as a patient made it into the recovery room (where people used to arrive, frequently, shivering.) Now there are ones shaped in such a way as to lay across the chest and arms, or the legs, with adhesive strips to keep them in place, and they're becoming almost universal in operating rooms. Perfect. Warm patient, cold surgeon. Crank up the cooler, Carly: I'm goin' in.

[Note: not only do I have no connection to bair-huggers or their company stock, I'm using the term generically, like "kleenex" or "xerox." I'm pretty sure there are other companies and names for similar items.]

21 comments:

Joy said...

I'm quite disappointed that they don't appear to be actually bear-shaped.

Judy said...

That works everywhere except the C-section OR's where the OB types are constantly battling the NICU crowd. Yes, we're roasting under the warmer, so chilling the room would be nice, but we have to think about the baby - for whom that blasting heat often isn't enough.

Good thing C-sections are relatively short surgeries.

OTOH, if I'm having surgery myself, I sure don't want the surgeon passing out from the heat and I'd rather not freeze while I'm sleeping - so great solution in the main ORs.

Midwife with a Knife said...

judy: we get around that by having a separate resuscitation room for the tiny premies. Also, they're starting to put the smallest babies in baggies now to stop heat and water loss.

We wear the knee high boots (you know, the ones the orthopods wear) in addition to water proof gowns, hats, etc. and I am often dripping in sweat by the end, even though they do try to keep it cool.

rlbates said...

I like the OR room cold too, but the patient's lose a lot of heat by having the room below 70 degree (if the OR time is greater than one hour). There is a great article on the hypothermia patients often get and how to prevent it (Prevention of Perioperative Hypothermia in Plastic Surgery by V Leroy Young, MD and Maria Watson, MD; Aesthetic Surgery Journal, Sept/Oct 2006, pp 551-571). The minimum OR temperature recommended is 22 degrees Celcius (71.6 degrees F). I know to us surgeons that feels very warm. I now try to keep the room at least at 70, and then just roll up my scrub pant legs (heh, cropped pants are in, at least for us females)

Petri said...

70F must be very warm in the OR. The link below seems to suggest some like it much colder.

http://theunderweardrawer.blogspot.com/2007/04/even-though-i-did-embark-on-this-posts.html

Michelle in Colorado Springs said...

The warmers have very many differnt names, Bair Huggers, snuggle, equator. In some of the OR rooms they have water warmers and coolers. Most of them do not break that much.

They only problem is most have wheels and are hard to find for preventive maintenance. That and some night nurses like to use them to keep warm.

dr. nic said...

They even have ones for little babies that go under the baby for surgeries on the little ones.

enrico said...

Yeah, something about having one's abdomen ratcheted open in a cold room doesn't do well for one's internal thermostat. I thought it was the coolest thing (ha, punny!) that the anesthesiologists use insulating socks for the IV fluid bags, too.

I don't think anybody who's been truly suited up in the OR could stand anything less what the normally-attired person would consider frigid. I am, unfortunately, an easy "sweater."

Dr. H. said...

There are many compelling reasons to keep the OR warm and to actively warm the patient well during surgery.
A few really important ones include hypothermia-induced coagulopathy and subsequent bleeding, and increased oxygen consumption with postoperative shivering (not desirable in the fragile 80 year old with coronary artery disease).
I know a surgeon who wears a special vest while scrubbed, which circulates cold water through a system of tubes attached to the vest...I wonder if it's patented...

Anonymous said...

Dr. Schwab,

I'm new to your blog. If this information is posted somewhere else, I couldn't find it. Who are Lori and Shanti - the women whose headstones are on your front page?

Sid Schwab said...

Anonymous: thank you for asking. You're the first to comment. I could describe them in volumes. Lori is my brother's daughter; Shanti, the daughter of my wife's sister. Each was an amazing young woman, the kind that everyone felt was their best friend; the kind that made everyone happy to be around. They were each amazingly beautiful; head-turning. Each exuded a love of life and of the people in their lives to an extent far beyond the norm. They each died in their twenties, suddenly, unexpectedly, leaving their families devastated. An accident, a blood clot. I could go on without end.

BellaLinda said...

My sole experience with ORs is for c-sections. And though I did notice the cold, I was brought up on the theory that it reduces infection, so it did not seem unusual to me, and in all honesty it was the least of my concerns both times. (Not emergency sections, but I wasn't happy about it either time.) I only got shivery in the recovery room after the second one.

happyj said...

After my last surgery I told my old trauma surgeon that I'm surprised surgeons don't wear snow-suits to work!

Lynn Price said...

"Who are Lori and Shanti - the women whose headstones are on your front page?"

I'm so glad Anon asked. I've long wondered about who they were as well but was too chicken to ask for fear of being rude. How terrible to lose people so young and full of life. Please accept my heartfelt sympathies, Sid.

SeaSpray said...

Hi Dr S. - I'm with Lynn and wondered but didn't want to ask either. They sound like they were lovely girls.

Personally, I love the cold because I get hot too easily and then I am miserable.

I did notice how cold the pre-op and OR areas were. Of all the procedures I had last year, In May I woke up freezing in post-op and it felt like to my core. I needed more blankets and still was cold. It wasn't even my longest time in the OR, so I don't know why that happened.

all but 1 said...

I haven't done an actual study, but from what I've seen in the past 11 years in vet med, most of our patients (who generally have plenty of fur that you'd think would keep them warm) drop their temp the most in the period between premedding and induction. There's nothing more lovely than to slap a bair hugger on them prior to draping, and see their body temp rise to normal while intra-op.

Barbados Butterfly said...

Don't forget about the burns theatres!

28+ degrees celsius... ice vests that melt and drip condensation down your scrubs... perspiring brows... constant thirst with full bladders... heat induced lethargy... and a constant eye on the patient's temperature...

Sid Schwab said...

Barb!!! How great to hear from you!! I hope you are well; I miss reading you, I miss you. And yeah, that kind of heat is why I could never be a pediatric surgeon.

Thank you for surfacing, if only briefly. Give us a sign: are you well? I'm guessing you are, because I concluded long ago from your blog that you have it all...

Anonymous said...

Dr. Schwab, I've just found your blog and totally love it. As a veterinary epidemiologist interested in surgical procedure (both animal and human) I was intrigued by when you mentioned that static charges could in theory spark an explosion of inhalational general anaesthetics . . . but I thought these agents like halothane have almost totally been removed from human surgery in the US and western Europe since the early 1990s as better agents that won't go boom came into being? So are static charges still a problem?

Sid Schwab said...

anon: you are right. Which is not to say the rules are logical, of course: I refer to OHSA rules, by which (I might be wrong, but I don't think so) humidifiers are required to maintain a specified level. I know that to be the case at least for surgical centers.

Lilly said...

Interesting. I had sugery a couple of months ago and noticed that the OR was very cold when I was wheeled in. I actually liked it (I'm always on the warm side, anyway). They did put a warm blanket over me before knocking me out though. When I woke up in recovery I had no blankets and the nurse had removed my socks. She said I was very warm and sweating when I came out of surgery. Go figure.