Wednesday, June 20, 2007
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.]