Chapter 31

Temperature Control Equipment

Physiologic Temperature Control
Numerous studies have shown that si gni f icant t emperature changes routi nel y occur
i n anestheti zed pati ents (1). I nadvertent hypothermi a is by f ar t he most common
di sturbance. Wi thout speci f i c i nterventi ons, up to 90% of pat ients enteri ng the
postanest hesi a care uni t (PACU) may be hypothermi c (2). An except ion may be
pati ents undergoing magnet ic resonance i magi ng (MRI) i n whom the absorpt i on of
radi o f requency radi ati on may part ial l y of fset heat l oss.
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I n t he unanestheti zed pati ent , vasoconst ri ct i on maintai ns a temperature gradi ent
bet ween t he core and peri phery of 2C to 4C. Core body t emperat ure i s normal ly
mai ntai ned wi thi n a narrow range of 37 0.2C. When core body t emperat ure goes
out of t hi s range, physi ol ogi c mechani sms are i ni ti ated to reestabl i sh the norm.
Anesthesi a al ters the response t hreshold, al l owi ng t he body to experi ence greater
vari ati ons in temperat ure before i t attempts to reestabli sh a 37C core temperature.
Responses to al tered temperatures are l ess eff ect ive under anesthesi a.
Hypothermi a under anesthesi a usual l y f oll ows a characteri st ic pattern (1,3, 4). Core
body temperature usuall y decreases 0.5C t o 1.5C during the f i rst hour (5,6,7) as
vasodi l atati on causes redi st ri but i on of body heat f rom the core to the peri phery.
Warmi ng peri pheral t i ssues bef ore i nduct ion of anesthesi a (prewarmi ng) decreases
t he cent ral -to-peri pheral temperature gradi ent , thereby mi ni mi zi ng the redi st ri but i on
of heat f rom the core to t he periphery and reduci ng the ini t i al decrease in core
t emperat ure (8,9,10,11,12,13, 14,15,16, 17, 18, 19). Thi s redi stri but ion cannot be
prevented by int raoperat ive ski n surface warmi ng (14).
Af ter the f i rst hour, core temperature typi cal l y decreases at a sl ower rat e as the
body' s heat l oss exceeds t he metabol ic heat product ion. Thi s is f ol l owed by a
t hermal pl ateau duri ng whi ch core temperature no longer signi f i cantl y decreases. At
t his t i me, heat l oss equi l i brat es wi th heat producti on and vasoconstricti on
const rai ns metabol i c heat to t he core compart ment whi l e all owi ng peri pheral t i ssues
t o cont inue to cool . Pat ients wi th neuropat hi es have more severe hypot hermi a than
ot her pati ents, possibly because the onset of vasoconst ri ct ion i s del ayed (20). A
pl at eau may never be reached when regi onal anesthesi a bl ocks vasoconstricti on
(1).
I n postanestheti c pati ents, vasoconst ri ct i on decreases rewarmi ng rates. For thi s
reason, pat i ents should be warmed duri ng surgery rat her t han al l owed t o cool and
t hen be postoperati vely rescued. Warming may be accel erat ed by usi ng cert ai n
drugs (21, 22) or wi t h a sympatheti c bl ock (23).
Etiologies of Heat Loss
Most heat is l ost via t he ski n surface. This l oss i s roughl y proport ional t o the skin-
t o-envi ronment t emperat ure gradient and t he body surface area i n contact wi th a
l ower t emperature envi ronment . Pediat ric pati ents have a hi gh surf ace area to body
mass rat io and t hus tend t o cool more quickl y t han adul ts but al so rewarm more
quickly (24).
Radiati on
Radiat i on is t he maj or heat l oss mechani sm, accounti ng f or 65% to 70% of the
body' s heat l oss (6). Thi s i s t he l oss of el ect romagnet ic energy through i nf rared
rays f rom the warm body t o col der obj ects in t he room that do not contact the body.
Radiant heat l oss is a f unct i on of the di ff erence i n temperature bet ween t he pati ent
and objects i n the operat ing room (OR) and thei r heat emissivit y (3). I t i s
unaff ect ed by ai r t emperature, ai r movement , or t he di stance bet ween the surf aces.
Convection
The second major mechanism of heat l oss is convecti on. Thi s is the transfer of heat
t o an ai r current . The magni tude of convecti ve heat exchange is determined by the
t emperat ure gradi ent bet ween t he body and the ai r as wel l as the veloci ty of t he ai r.
Surgi cal drapes prevent convecti ve heat l oss during surgery. Most of t he heat lost
by t hi s mechanism occurs when body surf aces are exposed prior to surgi cal
drapi ng.
Conduction
The t hi rd heat l oss mechani sm is conducti on. Heat i s lost t hrough di rect contact
bet ween t he pati ent and col der obj ects such as the operati ng table, l i nens, surgical
i nst ruments and ski n preparat ion, i rri gati on, and intravenous (IV) f l ui ds (25,26).
The heat f l ow i s proporti onal to the temperature di ff erence between the t wo bodies.
Thermal insul ati on between the surf aces wi l l reduce heat t ransf er. Wetness
i ncreases conduct ive heat l oss (6). Rel at ivel y l i tt le heat i s lost to objects such as
t he OR t abl e pad, but heat l ost when col d preparat ory and i rri gat i on sol uti ons and
I V f luids are used can reduce body t emperat ure si gnif icant l y.
Evaporati on
The f ourth heat l oss mechani sm is evaporati on. Evaporat ion l osses occur f rom the
ski n, respi rat ory tract , open surgical wounds, pneumoperi t oneum, or wet towel s and
drapes that are i n di rect contact wi t h the pat i ent' s body.
Other Factors
A number of f act ors determi ne the severi ty of hypothermi a. The l onger t he surgi cal
procedure, the greater the drop i n temperature. The si t e of surgery i s anot her
consi derat ion, si nce l arge cavi ti es are subject t o considerable heat l oss f rom
evaporat ion, whet her open or l aparoscopic techni ques are used
(27,28,29, 30, 31,32,33, 34,35,36). Admi ni st eri ng l arge quanti t ies of cool IV or
i rri gati on f l uids wi l l furt her chi l l t he pat i ent . Ext remes of age, cachexia, femal e sex,
and l ow body mass are associated wi t h i nadvertent hypot hermia.
Problems Associated with Hypothermia
Hypothermi a is a potenti al cause of adverse pati ent outcomes and may be
associ ated wi th l if e-threat ening compl icati ons (37, 38). Most compl i cat ions are
i ni ti ated int raoperat i vel y, al though t hey are generall y mani fest ed
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or detected in t he recovery peri od. The consequences of hypothermi a wi l l depend
on the si ze and condi ti on of t he pati ent . Smal l pati ents or t hose i n weakened
condi ti ons wi l l be more suscept ibl e to the negative eff ects. Mai nt ai ni ng pati ent' s
t emperat ure decreases postoperat ive mort al i t y and i mproves outcome
(39,40,41, 42, 43).
Metabolic Changes
Adverse metabol ic changes include a lef t ward shif t of the oxyhemogl obi n
di ssoci ati on curve, accumul at ion of metabol i c products, and exacerbati on of l acti c
acidosi s (44,45,46). Hemogl obi n sat urati on may be hi gher wi th warmi ng (47).
Babi es of mothers act ively warmed duri ng cesarean del ivery have a hi gher
umbi l ical vein pH (48).
Shiveri ng and Thermal Discomfort
Hypothermi a is associated wi t h post operat ive shi veri ng, whi ch i s of ten i ntense and
uncont roll abl e. I t causes pati ent di scomf ort; i ncreased met abol i c demand and
cardi orespi ratory work; i ncreased i ntraocul ar and i nt racranial pressures; and
i nterf eres wi t h moni tori ng, especial l y pul se oximet ry. Wound pain may be
aggravated by shiveri ng. Many pat ients recal l ed shi veri ng and a f eel ing of i ntense
cold as t he most distressing memory of thei r anest het ic management, even af ter
rel ativel y short procedures. Some pat ients report t he di scomfort f rom shi veri ng and
t he col d sensat i on worse t han the surgi cal pai n (49,50). Ski n temperature i s of
equal i mportance wi th core temperature i n determi ni ng thermal comf ort (51).
Increased Recovery Ti me and Length of Stay
Most studi es have shown t hat i nt raoperat ive hypothermi a causes slower awakeni ng
and l onger t i me i n the recovery room (even when t emperature i s not a discharge
cri teri on). Hypothermi a may cause post operat ive conf usi on (52). Hi gher
postanest hesi a scores, earl i er extubati on, and short er PACU t imes are associ ated
wi th normothermia (53, 54,55,56, 57,58,59,60,61,62,63,64,65). Mi l d hypothermi a
does not prol ong recovery i n pedi atric pati ents having peri pheral surgery (66).
Mai ntai ning normothermi a may shorten hospi tal i zati on (45).
Impaired Drug Tolerance
Drug di stri but ion i s al tered, drug metabol ism i s decreased, and the behavi or of
anesthet ic drugs i s al tered. Thi s of ten resul t s i n hi gher bl ood concent rati ons and
prol onged durati on of acti on (44, 67,68,69).
Hypovolemi a
Hypothermi a can l ead to f l ui d shi f ts f rom the vascular t o the ext racel lul ar space and
a relat i ve hypovol emi a. For every degree cent igrade of hypothermi a, 2. 5% of the
i ntravascular vol ume may be l ost (6). Col d-i nduced di uresi s can occur, adding t o
t he probl em. As the pat ient rewarms, vasodi l atat i on may occur and more fl ui ds wi l l
need to be gi ven to accommodat e the l oss. Pat i ents wi t h hypothermi a have
si gni f icant l y greater f l uid and transf usion requi rements (41,43,52).
Peri pheral vasoconst ricti on can make i t more di f f icul t to i nsert peri pheral venous
catheters. Active l ocal warmi ng f aci l i tat es IV catheter i nsert i on (70).
Cardiovascular System Effects
Hypothermi a enhances sympatheti c act ivi ty. Catechol ami ne concent rati ons may ri se
(71). Peri pheral vasoconst ri cti on, whi ch refl ects t he body's ef f ort to conserve heat,
can resul t i n i ncreased blood pressure and cardi ac workl oad and
el ect rocardi ographi c changes (65, 72, 73). Ri sks i nclude cardiac dysrhyt hmi as, de-
creased cont racti l i ty, myocardi al i schemi a and i nfarct i on, and cardi ac arrest
(74,75,76). Hypothermi a can resul t i n increased adverse hemodynami c events and
i ncreased requi rements f or vasoacti ve drugs (41,77). Normothermi a is associated
wi th a reduct i on i n the i nci dence of postoperati ve morbi d cardiac events i n pati ents
wi th known ri sk f act ors f or coronary art ery disease (46,65, 74,76,78). However, t he
ef fects are modest i n rel at ivel y young, general l y heal thy pati ents (55).
Rapidl y rewarmi ng pati ents wi t h profound hypot hermi a can resul t i n shock due to
redi st ri but i on of bl ood t o the peri phery as ti ssues vasodi l at e.
Effects on Coagulation
Hypothermi a i nhi bi ts pl atelet f unct ion and act ivat ion of the coagulati on cascade
(79). It may be associ ated wi t h i ncreased bl ood l oss and hi gher t ransf usi on
requi rements (41,53,58,80,81,82,83,84,85, 86, 87).
Reduced Resistance to Infection
Even mi l d hypothermi a may del ay heali ng and predi spose pati ents to wound and
ot her i nf ect i ons (45, 88,89,90, 91,92). Warmi ng may prevent postoperat ive wound
i nfect ion (93). Mai nt aining normothermi a may attenuate prot ei n breakdown af ter
surgery (94).
Interference with Monitori ng
Thermoregulatory vasoconstri ct ion decreases cut aneous bl ood f l ow and may
i nterf ere wi t h pul se oxi met ry and other forms of moni tori ng (95, 96).
Increased Costs
Hypothermi c pat i ents have prol onged stays i n the i ntensi ve care uni t and heal th
care faci li ty (41, 87). Heart surgery pati ents have shorter durati ons of venti l atory
support wi th normot hermia. A reducti on i n costs may resul t f rom act i ve warmi ng
(53,97).
Other
Col d aggl ut i ni ns may be found in associati on wi th i nfecti on. Vascul ar obstruct i on
and even gangrene may resul t (98). Cool ing may cause a decrease i n uri ne out put
(99). The agreement of cent ral and peri pheral venous
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pressures det eri orates at l ower t emperat ures (100). Increased pain and anxi et y
may be associat ed wi th hypothermia (101).
Warming Devices
Standards
Two U. S. st andards on warmi ng devices were publ ished i n 2002: one f or ci rculati ng
l i quid and forced-ai r pati ent t emperature management devi ces (102) and one f or
f lui d warmers (103).
The f ol lowi ng are i n t he st andard f or ci rcul at i ng l iqui d and forced ai r devi ces:
For forced-ai r devi ces, the maxi mum contact surf ace t emperature shal l not
exceed 48C, and the average contact surf ace t emperature shal l not exceed
46C duri ng normal condi t i ons.
For ci rcul ati ng l i qui d devices, t he contact surf ace t emperature shal l not
exceed 43C, and the average contact surf ace temperature shall not exceed
42C duri ng normal condi t i ons.
The f luid warmi ng standard requi res t hat t he devi ce does not heat the f l ui d above
44C under normal condi ti ons.
Warming Methods
I t i s general l y accepted t hat no single t echni que al one i s superi or i n combat i ng
hypothermia. The best resul ts are l i kel y t o be achi eved by combi ni ng methods. The
costs, ri sks, and benef i ts of warmi ng shoul d be specif ical l y consi dered for each
pati ent , f actori ng i n preexi sti ng medical condi ti ons and the surgical procedure.
Forced-air Warming Devi ces
Forced-ai r warmi ng devi ces (convecti ve warming devi ces, warm ai r bl owers) ent rai n
ambi ent ai r through a mi crobi al f i l ter. The ai r i s warmed usi ng an electri c heater
t hermostati call y control led, and then bl own t hrough a hose t hat is connected t o an
i nf l atabl e pat i ent cover (Fi g. 31.1). Some devi ces moni t or t he temperature set ti ng
wi thi n t he warmi ng uni t . Some newer uni ts moni tor t he t emperature at t he end of
t he ai r del ivery hose (104). Most off er a selecti on of temperat ures (Fi g. 31. 2).
A variety of covers, both disposabl e and reusabl e, are avai l able. They have a
seri es of hol es that al low t he warm, f i l t ered ai r to pass through. Another design
uses a fabri c that al lows the heated ai r t o fi l ter through the enti re pati ent side.
The shape of the cover vari es (Figs. 31.1, 31. 3,31. 4,31.5). A number of pedi at ri c
bl ankets are avai l able. A U-shaped tubul ar bl anket that enci rcles the pati ent may
be useful i n si tuati ons such as cardi ac surgery, where much of the body cannot be
covered. However, i t i s l ess eff ect i ve than a blanket placed over the body
(13,22,105,106). I t i s possi bl e to cut some covers and seal the edges of t he cut t o
f i t the pat i ent (107,108). Pati ent and heal th care provi der gowns that can be
connected
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t o a f orced-ai r uni t are avai l abl e. Sl eeves for warmi ng an arm to f aci l i tate I V
catheter i nsert i on are avai labl e.

View Figure

Figure 31.1 Forced air-warming device with low body
blanket. (Picture courtesy of Arizant Healthcare, Eden
Prairie, MN.)


View Figure

Figure 31.2 Control unit on a forced air device. A selection
of temperatures is provided.


View Figure

Figure 31.3 Warming blanket for a small patient. Note the
plastic cover over the child. (Picture courtesy of Arizant
Healthcare, Eden Prairie, MN.)

Pl aci ng a bl anket or sheet over t he warmi ng blanket wi l l resul t i n i ncreased heat
t ransfer (109). Lower body warmi ng is sl i ghtl y more ef fective than upper body
warmi ng (110,111, 112). Underbody bl ankets al l ow easy access to t he pat ient (113).
However, they are probabl y onl y usef ul f or very small pat ients.
A number of i nst i tut ions have used these uni t s wi thout t he warmi ng bl anket by
pl aci ng t he hose ei ther under t he surgi cal drapes or bet ween cot ton bl ankets (f ree
hosing) (114,115,116). Free hosi ng may resul t i n heat ed ai r bl owi ng di rect l y onto
onl y a smal l area of t he pat i ent ' s ski n and cause burns (117, 118). Theref ore, t hi s
pract i ce is not recommended.

View Figure

Figure 31.4 Over-the-body warming blanket with an area in
center removed to allow surgical access. (Picture courtesy
of Arizant Healthcare, Eden Prairie, MN.)

Numerous studies have shown that f orced-ai r warmi ng i s ef f ecti ve i n mai nt ai ni ng or
i ncreasi ng the pat i ent 's (i ncl udi ng both maternal and baby) t emperature, decreasi ng
t he i nci dence of shiveri ng and i ncreasi ng thermal comfort
(31,48,55, 58, 59,62,105,110, 119, 120,121,122, 123, 124,125, 126, 127,128,129,130,13
1, 132,133,134, 135, 136,137,138,139). I t
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works wel l even when the avail abl e ski n surf ace area to be warmed i s rest ricted, as
occurs duri ng ort hopedic, maj or vascul ar, or abdomi nal operat ions (9,109). Forced-
ai r warmi ng i s of ten used i n conj uncti on wi t h other warmi ng methods (140).

View Figure

Figure 31.5 Cardiac access blanket. This provided localized
warming to the legs while allowing access to both legs.

Al though f orced-ai r warmi ng i s of ten ef f ective i n raisi ng peri pheral temperature,
core temperature may not ri se (47, 141, 142,143,144,145,146,147). Thi s may be
because of l i mi ted heat t ransf er bet ween t hermal compartments i n vasoconstri cted
pati ents. In the pati ent wi t h a neuraxi al block, the vasodi l ati on may ai d in heat
t ransfer f rom the peri pheral to the core t i ssues.
Most studi es have f ound f orced-ai r warmi ng superi or t o ol der-st yl e l i qui d-ci rculat i ng
mat tresses, warmed or unwarmed bl ankets, radiant heat l amps, i nhalati on
rewarmi ng, passi ve insul at ion, el ect ri c bl ankets, negati ve-pressure warmi ng
devices, or warmi ng I V f l ui ds
(14,19,22, 46, 47,57,109,127, 128, 139,144,145, 147, 148,149, 150, 151,152,153,154,15
5, 156,157,158, 159, 160,161,162,163,164,165, 166,167, 168, 169,170,171,172,173,174
, 175,176,177,178,179,180,181,182). Newer l i quid-ci rcul ati ng devi ces and resi st i ve
heati ng devices may be as or more ef f i ci ent than f orced-ai r warmi ng devi ces
(85,137,138,183,184,185,186,187,188). Some studies have f ound t hat warmi ng IV
f lui ds was as eff ecti ve as f orced-ai r warmi ng i n maint ai ni ng normothermia
(189, 190).
Forced-ai r warmers are usual l y saf e when properl y used. There are a f ew reports of
burns (191,192,193,194,195,196,197,198,199). Care shoul d be exerci sed t hat the
hose does not come i n contact wi t h the pati ent' s ski n and that t he exi t vents are
posi t i oned away f rom t he pati ent and the surgical f ield. Speci al care shoul d be
t aken to avoi d contact wi th i schemic areas (i . e. , di st al t o a vascular cl amp).
Forced-ai r warmi ng is si mpl e, saf e, ef f ecti ve, and i nexpensi ve. The vari et y of
pati ent covers makes i t adaptabl e to many dif ferent si tuati ons. Most nursi ng
personnel and fami l y members pref er thi s met hod t o radi ant heat . Forced-ai r
warmi ng provides more calori es/cost t han ot her modal i t ies
(47,97,200,201,202,203). Fi beropt ic l aryngoscopes can be warmed before use wi t h
a forced-ai r warmi ng device (204). Warming these devi ces wi l l prevent f oggi ng
when t he device is i nsert ed i nto the mouth f or i ntubat i on. I t can be used to warm
t he operat i ng tabl e bef ore the pati ent is t ransf erred to i t by pl acing t he hose under
a sheet. It can al so be used f or cool ing (205,206). Another use is t o rel i eve
cl austrophobi a (207). A coi l ed t ubi ng can be pl aced insi de the hose f rom a f orced-
ai r heati ng device to heat IV f luid (Fig. 31. 14). However, thi s i s eff ect ive onl y at l ow
f lui d f l ow.
A di sadvantage i s that i ts el ect ri c power requi rements make i t unsui tabl e for f i el d
use (208). I t i s somewhat cumbersome to t ransf er or set up i n a computed
t omography (CT) scanner (190). It must be removed f rom t he pat i ent t o expose
covered areas. Another di sadvantage is t hat many systems do not permi t t he
concurrent use of mul ti pl e blankets (i .e., upper and l ower body) wi t hout usi ng two
separate f orced-ai r uni ts.

View Figure

Figure 31.6 Liquid-circulating device. The patient contact
part can be wrapped around various parts of the body.
(Picture courtesy of Gaymar Industries, Inc.)

Liqui d-circulati ng Devices
A l i qui d-ci rcul ati ng device consists of a heat i ng/cool i ng uni t and pat i ent contact
device (mat tress, pad, bl anket, or wrap) that i s connected to the heati ng/cooler uni t
by hoses (Fig. 31.6). Heated/cooled l i qui d ci rculates through the pat ient contact
device and then back to the heat ing/cool i ng element . Some machi nes can suppl y
more than one pat ient contact devi ce.
Ot her devi ces may be at t ached t o the l i qui d-ci rcul ati ng uni t (209). IV f luids can be
heated by usi ng a water mat tress pad appl ied to the tubi ng cl ose to the pat ient
(210).
A pad can be pl aced ei ther over or under t he pat i ent but is safer and more eff ecti ve
when pl aced over the
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pati ent (154,211) (Fi g. 31.7). Di rect pat ient contact wi th t he pad surf ace shoul d be
avoided. Folds and creases in the pad shoul d be avoi ded. These uni ts may
predi spose pat i ents to burns, so ski n i ntegri ty must be assessed f requent l y
(212, 213,214).

View Figure

Figure 31.7 The pad from a liquid-circulating device may
be placed over the patient. (Picture courtesy of Augustine
Biomedical.)


View Figure

Figure 31.8 Liquid-circulating device. The patient contact
part adheres to the body surface. (Picture courtesy of
Kimberly-Clark.)

Some newer l i quid-ci rcul at ing systems use a di sposable t hi n pad that adheres
di rectl y t o the skin and i s made of a materi al t hat f aci l i tat es heat conducti on toward
t he pat ient. Dif f erent shapes and si zes are avai lable, al lowi ng attachment t o
vari ous body surf aces (183,186,215) (Fi gs. 31.8, 31.9). Most i ncorporate a
mi croprocessor t hat cont rol s t he f l ow and temperature and a pati ent temperature
sensor so that the l i qui d temperature can be adjusted to mai ntain t he desi red
pati ent t emperat ure. One system operates under negati ve pressure so that i f the
pad i s cut or punctured, ai r wi l l be pul led i nt o t he system rat her t han wat er spi l l ing
out (104).
Ol der-st yl e li quid-ci rcul ati ng uni ts are l ess ef f ecti ve than f orced-ai r heati ng
(14,154,163,164,165,166,167,181,216,217,218). The newer-st yl e uni ts may be more
ef fective than f orced-ai r heat i ng, because they can cover a l arger surf ace area
(65,78,85, 104, 183,184, 185, 219,220, 221, 222).

View Figure

Figure 31.9 Close-up of liquid-circulating device. The
backing is removed, revealing the sticky side of the pad that
is attached to the patient.

The ol der-st yl e mat t resses are heavy and cumbersome. I t i s dif f i cul t t o mai ntain
good contact wi t h the sti ff matt ress and to cover a large surf ace area (15). Thei r
use can lead to burns, especi al l y over pressure poi nts where the pat ient contacts
t he bl anket (109,212,213,214,223,224,225). Placing t hem above the pat ient may
decrease the l i kel i hood of burns. Care shoul d be taken that the tubing does not
come i nto contact wi t h the pati ent.
Passive Coverings
Appl ying passi ve i nsul at i on can decrease heat l oss f rom convect i on, radi at ion,
conducti on, and evaporati on. Cot ton bl anket s, surgi cal drapes, towel s and sheets,
pl ast i c sheeti ng, plasti c bags, and special l y desi gned ref l ect ive composi tes
(thermal drapes, space blankets, ref lecti ve bl ankets, met al l i zed pl asti c sheets or
sheets, head coveri ngs, bl ankets, socks, l eggi ngs, etc. ) are among the mat eri al s
t hat have been used (226, 227,228,229,230,231,232) (Fi g. 31. 10). There are
mi nimal cl inical di f ferences among the vari ous coverings
(228, 233,234,235, 236, 237). Warmi ng the covers or adding addi ti onal l ayers of
i nsul at i on further reduces heat loss onl y sl ightl y and has not been found to be of
benef i t i n preventi ng shi veri ng (238, 239). These covers provide a t ransi ent sense of
warmth. Coveri ng as much surf ace area as possi bl e is more i mport ant t han the type
of coveri ng or speci fi c area covered. Cost and convenience shoul d be major factors
when choosing among covers. The costs of l aunderi ng and repl aci ng cott on
bl ankets must be t aken i nto account . There are no publ ished reports of pat ient
i nj ury caused by warmed hospi t al bl ankets (240).
Passi ve insul at ion wi l l reduce cutaneous heat l oss but wi l l not mai nt ai n
normothermia
(6,22,127, 158, 159,177, 218, 230,231, 241, 242,243,244, 245,246,247, 248,249).
Appl ying warmed cott on bl ankets to the pati ent has been a t radi t i onal ri tual i n the
PACU, but i s ineff ecti ve (250). However, placi ng a cot ton
P. 891

bl anket over the pat ient as soon as possi ble af ter t he pat ient has entered t he OR
wi l l reduce i ni t i al heat l oss and resul t i n a hi gher body temperat ure when the
pati ent enters t he PACU (231).

View Figure

Figure 31.10 Thermal head covering.

I nsul at ed coverings have been f ound to be l ess ef f ecti ve than forced-ai r warmi ng
f or conservi ng body temperat ure
(22,47,57, 127, 128,149, 150, 151,152, 153, 155,158,159, 160,161,172, 251). Warmed
bl ankets were f ound to be inf eri or to radi ant heat i n preventi ng shi veri ng (248).
Passi ve covers are conveni ent, easy t o use, l i ght wei ght , and not subj ect to
el ect rical or mechani cal f ai l ures. There i s no burn hazard. However, they may
i nhi bi t access to t he pati ent . Most of them are combust i bl e and shoul d be used wi th
cauti on when a source of i gni ti on i s present (252) (see Fi res i n Chapter 32).
Resistive Heating
Resisti ve el ect ri cal heati ng devices generate heat by passi ng low-vol t age current
t hrough semi conducti ve wi res or carbon-f i ber fabri c. No danger resul ts f rom
penet rat i ng the f abric. The system cont inues to operate normal l y because the
current si mpl y f l ows t hrough adjacent f abri c.
The warmi ng bl anket or mat tress i s thermostati cal l y cont roll ed by a computer to
mai ntai n t he contact surf ace at t he set temperature. Thi s system can heat several
f iel ds i ndependent l y. Blankets and mat t resses are avai l abl e in a l arge number of
confi gurati ons that can be used i n various combi nat i ons to i ncrease the heat ing
surf ace. They can be cl eaned and di si nfected af ter use.
Resisti ve heati ng has been f ound to be as or more eff ect ive than most other
t echnol ogi es, i ncluding f orced-ai r warmi ng
(9,57,85,101, 109, 137,138,208,253,254,255,256,257). A report ed advantage i s cost
savi ng compared wi th f orced-ai r warmi ng (57, 254, 255). I t i s al so qui eter t han
f orced ai r. Resi sti ve heati ng devi ces may be especi al l y hel pful for f i el d treat ment of
hypothermia (101,208). However, severe t hermal i nj uri es have been report ed wi th
an el ect rical warmi ng matt ress (258). A f i re may resul t i f an el ect ri c bl anket is
f olded and wi res are broken.
Radiant Heaters
Radiant warmers use special i ncandescent bul bs or heat ed surf aces t o generate
i nf rared energy. The radi ant heater can be a si mpl e l amp on a port abl e st and or a
more elaborate panel (145). The lat t er comes as a port abl e uni t or may be cei l i ng
mounted on t racks (6,259,260).
The radi ant devi ce i s most ef f ect ive when i t heats areas hi gh i n art eri ovenous
anastomoses such as t he f orehead, nose, ears, hands, and f eet (261). These can
di l ate i n response to l ocal heat i ng and anest hesi a and al l ow appl i ed heat energy to
be t ransf erred di rectl y to the core.
Radiant warmi ng can be used on exposed areas of t he pat i ent ' s skin duri ng
catheter placement, ski n preparati on, and duri ng t he surgi cal procedure, when
f easi bl e (6). I t may be especi al ly usef ul i n the PACU (260). The heat shoul d shi ne
on the pat ient' s bare ski n or at most t hrough a thin sheet . If pl aced t oo cl ose t o the
ski n, burns can resul t . The ski n surf ace must be assessed f requentl y to detect earl y
si gns of burns. Skin exposure may resul t i n cool i ng by convecti on currents, so i t i s
i mportant to el i mi nate draf ts i n the envi ronment .
Radiant heat can provi de f aster rewarmi ng and reduced shiveri ng
(6,248,259,262,263,264,265,266). It i s more eff ect ive in smal l i nf ants because of
t hei r rel at ivel y large body surface area. Radiant heati ng has been f ound t o be l ess
ef fective than f orced-ai r warmi ng but superi or t o el ect ri c, warmed, or ref l ect i ve
bl ankets (145,149,154,178,180,248,260,267,268). It decreases heat l oss bef ore
ski n washi ng but i ncreases i t duri ng washi ng (269).
Radiant heat l amps enable t he medi cal and nursi ng st af f to have an unobst ructed
vi ew of and access to t he pat i ent . There are no disposabl es and no pati ent contact .
However, the equi pment is bulky and somewhat cumbersome. Exposure of the adul t
pati ent may be unacceptabl e to the pat i ent and f ami l y members (145). I t may cause
burns or hypert hermi a i f used f or l ong peri ods of ti me, i f the radi ant heat source i s
cl ose to the pati ent' s ski n, or if t here is a probl em wi t h the ski n-t emperature
measurement sensor (214,270). Because radi ant warmers i ncrease evaporat ive
heat l oss, they may increase f l ui d requi rements (271). Pat i ents wi t h poor peri pheral
ci rcul ati on may be more di ff icul t to heat. It i s necessary to adj ust t he heater-ski n
di stance i f t he operat i ng table
P. 892

i s rai sed or lowered. Radi ant warmers may i nt erf ere wi t h i maging i f used in an MRI
uni t (272).
Heating and Humi difyi ng I nspired or Insufflated Gases
Evaporative heat l oss f rom the ai rway can be prevented by using warm, humidif ied
gases (i nhal ati on rewarmi ng). Devices for heati ng and humidi f yi ng inspi red gases
are discussed i n Chapter 11. Minimal heat transf er occurs wi t h this method, whi ch
carri es the ri sk of thermal injuri es.
Some studi es have found that heati ng i nspi red gases is of mini mal val ue in
rewarmi ng, even when used i n conj uncti on wi t h other warmi ng modal i t ies
(14,163,259,273,274). Other studi es f ound that heated humi di f i cati on systems can
reduce t he i nci dence of shiveri ng and resul t i n a more rapi d ret urn to normothermia
(263, 275). Ai rway heat i ng and humi di f i cati on may be more eff ect i ve in i nf ants and
chil dren than in adul ts (276,277,278), but cutaneous warmi ng is f ar more eff ect ive
(279).
Heati ng and humidi f yi ng gases used f or peri toneal i nsuff l ati on can prevent the heat
l oss associ ated wi th t hi s procedure (280).
Heat and Moi sture Exchangers
Heat and moi sture exchangers (HMEs) are discussed in Chapter 11. They provi de
ef fi ci ent humi di f i cat i on and work almost as wel l as heat ed humi di f i ers to prevent
respi ratory heat loss but cost l ess and provide fi l trat ion. However, the amount of
heat preserved by t hi s met hod is smal l (281, 282). Heat conservat ion by al l
avai l able HMEs i s comparabl e (38).
Low Fresh Gas Fl ows
Usi ng l ow f resh gas f l ows reduces heat l oss t hrough t he ai rways (282). However,
studi es i ndi cat e that using l ow-f l ow anesthesi a is i nef fect ive i n mai ntaining
i ntraoperati ve normot hermia (158).
Flui d Warmi ng
Fl ui d warmers are used t o warm bl ood products, IV sol uti ons, i rri gat i on sol uti ons,
and i nsuff l ati ng gases (283,284). Si nce these f l ui ds are usual l y wel l bel ow body
t emperat ure, exposure to them can be a si gni f i cant source of heat loss when l arge
volumes are used. Most fl ui d warmers have a temperature di spl ay and an al arm to
al ert the operator if the heater temperature or t emperature of the f l ui d i s too hi gh.
Some al arm i f t he heater t emperat ure f al l s bel ow a t hreshold.
Manuf acturers wi l l provide i nf ormati on about t he maxi mum f l ow rat e that i s possi bl e
f or the parti cul ar system. Thi s f l ow rate wi l l not necessari l y provi de f l ui d at body
t emperat ure. If there is a di screpancy, the manuf acturer wi l l also provide t he f low
rate t hat wi l l provi de f l ui d warmed to body temperature.
Most uni ts are desi gned for use wi th dedi cat ed di sposabl e sets. Some of these sets
are used i n conj uncti on wi th a standard bl ood or IV admi ni st rati on set and
extensi on tubi ng, whi l e others i ncl ude a Y-set as wel l as a pat ient l ine. Some of fer
a number of di f f erent disposabl e sets desi gned for specif ic appl icati ons.
Di ff erences among t hese sets i ncl ude the gauge and l ength of the tubi ng, t he
number of bag spi kes, and t he presence of a bl ood f i l ter and/or degassi ng
mechani sm.
Fl ui d warmi ng can prevent the heat loss caused by i nf usi on of cold f luids but
generall y cannot t ransf er enough heat t o prevent hypothermi a or restore
normothermia expedi t iousl y unl ess extracorporeal rewarmi ng i s used
(14,27,30, 156, 157,162, 189, 210,274, 285, 286,287,288, 289,290,291, 292,293,294,295
, 296). Warmi ng l iqui ds improves the f low t hrough the admi ni st rat i on set by loweri ng
t he vi scosi t y (297, 298).
No cl ear gui del ines about when t hese devi ces shoul d be used exi st. Drawbacks
i ncl ude t he expense and the t ime needed t o assemble the apparatus. It is general l y
agreed that warmi ng shoul d be performed duri ng massi ve and/or rapid t ransf usi on,
i n pati ents wi th cold aggl uti ni ns, and for exchange t ransf usi ons i n the neonate, but
i ts use f or rout i ne procedures i s controversi al . Vari abl es that shoul d be considered
i ncl ude t he rate of i nf usi on, the t otal volume t o be used, the t emperat ure of t he
f lui d to be i nf used, and other pat i ent warming techni ques that are i n use (283,299).
Factors Determining the Fluid Temperature at the Patient
Temperature Controller Set Point
I ncreasi ng t he set t emperature of the warmer resul ts i n a higher outl et and distal
f lui d temperature. The f l ui d may or may not reach t he set point, depending on the
ef fi ci ency wi t h whi ch heat is t ransf erred by t he warmer and t he speed that the f l ui d
t ransi ts the warmer.
Starting Fluid Temperature
Fl ui ds mai ntai ned at cold temperatures such as blood wi l l requi re more heat to
warm t hem than f l ui ds stored at room temperature or i n warmi ng cabi nets.
Fluid Flow Rate
Fl ui ds l ose heat whi le hangi ng and whi l e f l owi ng to t he pat ient. The heat loss
usual l y i ncreases as t he rate of i nf usi on sl ows
(300, 301,302,303, 304, 305,306, 307, 308,309, 310,311,312). Thi s is especi al l y
i mportant in pedi atri c pati ents where f low rates are usual ly rel ati vel y l ow. However,
i f the f l ow i s very rapi d, i t may exceed t he abi li t y of the f l ui d warmer t o heat i t
adequatel y.
Length of Tubing between the Warmer and Patient
Keepi ng the t ubi ng bet ween t he warmer and t he pat i ent as short as possi bl e wi l l
reduce heat l oss (200,279,302,306,313,314, 315,316,317). Heat ing t he tubi ng may
prevent heat l oss. Pl aci ng the tubi ng under a warmi ng bl anket wi l l hel p to mai ntai n
f lui d temperature.
Methods of Fluid Warming
Preuse Warming
Fl ui ds other t han bl ood products can be warmed in an OR cabinet (316,318). A
maxi mum temperature of 43C is recommended (319); some manuf acturers
recommend l ower temperatures. Thi s method
P. 893

can be used to heat sal ine that i s subsequent l y mi xed wi t h red bl ood cel l s
(320, 321). Dextrose-containing sol uti ons shoul d not be heated because the
dextrose wi l l be al tered by heat . Contai ners shoul d be marked wi th t he dat e that
t hey were pl aced i n the warmer.
A uni t of blood or bag of IV f l ui d may be immersed i n a bowl of warm wat er before
admi ni st rati on (44,322). However, thi s i s slow and associ ated wi t h techni cal
probl ems (323). The bath wat er must not enter the blood or IV soluti on. Pl aci ng the
uni t between two hot packs may resul t i n overheati ng (324).
Whol e bags of bl ood and bl ood components have been warmed by pl aci ng them i n a
mi crowave oven. This pract i ce was abandoned because the nonuni form distri buti on
of energy and the f i ni te depth of penetrat ion resul ted i n hot spots and overheat i ng
(325, 326,327,328, 329). More recent ly, a microwave devi ce speci f ical l y designed for
t hawi ng f resh f rozen pl asma and warmi ng packed red bl ood cel l s has become
avai l able (330). Duri ng heat ing, t he products are rotat ed wi t hi n the devi ce.
Syri nges that cont ai n f l ui d can be warmed by usi ng a ci rculati ng wat er mat tress or
f orced-ai r warmer (323). Small er syringes warm more rapidl y t han l arge ones. A
ci rcl e system may be created to al low t he f lui d in t he heated tubi ng to act as a
reservoi r f rom whi ch f lui d can be wi t hdrawn i nto syri nges (331).
Prewarmi ng blood or f l ui ds i s inexpensi ve and convenient. It i s most eff ect i ve wi t h
rapi d t ransf usi on. At sl ower f l ow rat es or i f transf usi on i s del ayed, the f l uid cool s
rapi dl y (301). I nsulati ng the f l ui d contai ner or tubi ng wi l l reduce heat l oss (300).
Warmed IV fl ui d bags or pl astic containers of i rri gat i on sol ut ions should not be
appli ed to t he pati ent ' s ski n ei t her as warmi ng or posi ti oning devi ces, because thi s
has been associ ated wi th burns and i s i nef fecti ve (38, 214, 332).
In-line Warming
I n-l i ne warmi ng devi ces heat f l ui d as i t passes f rom the source (a sol uti on bag or
i nfusi on device) to the pat i ent . The warmer may be mounted on a standard i nf usi on
pol e, att ached to a dedicated pol e system, or f reestanding. A speci al di sposabl e
admi ni st rati on set is usual l y used, but at l east one uni t warms t he f l ui d in
conventi onal IV t ubi ng. Some devi ces have a means f or cont rol l ing i nf usi on rate
and may displ ay the i nf used volume i n real t i me. Some al low t he operator t o set the
t emperat ure. Some have a means to admi ni ster a bolus of f l ui d.
Desi rabl e qual i ti es i ncl ude a l ow pri ming vol ume, l arge heat transf er area, l ow
pressure drop, and the abi l i ty to heat eff i ci ent l y at al l f l ow rat es (323,333).
Advantages of In-line Warmers
They can general l y be used wi t h red bl ood cel ls, whol e bl ood, or IV or
i rri gati on f l uids.
Once t he warmer i s set up, new f l ui d bags can be connected at once.
Ent ry ports must be punctured bef ore warmi ng, so warmed bl ood cannot be
mi stakenl y returned to the bl ood bank f or i ssue t o ot her pati ents (44).
St udi es show t hat plast ici zer does not l each i nto heat ed IV t ubi ng (210). One
drawback is that most devi ces can be used f or onl y one l i ne at a ti me (44). Loss of
body heat can be mi nimi zed by warmi ng the f l ui d f l owi ng to one IV si te whi l e
keepi ng vei ns open at other avai labl e si t es. Mul t i pl e heat i ng devi ces coul d be used
f or mul ti pl e IV i nfusi ons.
Types of In-line Warmers
Dry Heat
I n a dry heat exchanger, the f l ui d passes t hrough a t ubi ng, cassett e, or bag that i s
pl aced around or wi thi n a heated bl ock or pl at e(s) (308,334) (Fi g. 31.11). I t may
al so be heated by a magneti c i nduct ion heat er (335, 336) (Fi g. 31.12). Inf rared
l amps can also be used to heat t he IV f l ui d (284). Some can be pl aced i n an x-ray
casset t e on certai n OR t abl es.
St udi es di ff er on t he ef fecti veness of dry heat warmers at hi gh f low rates
(284, 312,334,337, 338, 339,340, 341). Newer model s may perf orm bet ter than older
ones. Because the f lui d i s usual l y forced through l ong, const ri ct ed plast ic tubes or
channels, hi gh resistance may l i mi t the f l ow rat e (297,340). Current leakage has
been report ed wi th some uni ts (342, 343, 344,345). Overheat i ng wi t h burni ng of the
pl ast i c disposabl e tubing has been reported (336).
Microwave
Al though bulk mi crowave warmi ng devi ces were abandoned some t i me ago, recent
studi es show that in-l ine mi crowave blood warmi ng i s not associated wi t h
si gni f icant damage to blood (298,326,346,347,348,349,350,351, 352, 353).
One i n-l i ne microwave warmer empl oys a di sposabl e cart ri dge that contai ns a short
l ength of I V tubi ng coil ed around a pl asti c bobbin. Temperature moni tori ng i s
carri ed out by mi crowave radi omet ry, whi ch measures the temperature wi thi n the
l umen of t he tubi ng wi t hout di rect contact wi th t he f l ui d (350,436). The amount of
mi crowave power i s t hen automati call y adj usted unti l the measured temperature
matches t he target t emperature.
Mi crowave warming uni ts provi de rapi d heat i ng and accurate temperature cont rol
(298, 346).
Water Immersion
Water bat h uni ts warm a f l ui d as i t passes through a bag or coi l s of t ubi ng
i mmersed i n heated water (354). One or more I V extension sets can be used i n
pl ace of the coil or bag (355). Most wat er bath warmers moni tor and displ ay onl y
t he wat er bat h temperature (44). Some uni ts agi t ate the wat er t o improve heat
t ransfer. I f t hi s i s done, i t is i mportant that i nj ect i on ports not become cont ami nat ed
and that the connecti ons are secure.
St udi es show t hat these devices are i nef f i ci ent at hi gh f low rates (312,334, 356).
Some uni ts take a l ong t i me to warm t he wat er, so they must be t urned ON
someti me pri or t o use.
P. 894



View Figure

Figure 31.11 A: Dry heat warmer. A disposable cassette
through which fluid flows is placed inside the device. B:
Disposable cassette.

Hazards associ ated wi t h water baths i ncl ude l eaki ng coil s, bl ockage, hemol ysi s
resul ti ng f rom overheat ing, l eakage currents, and septi cemi a secondary t o
contaminati on of t he wat er t hat may enter the IV tubi ng
(357, 358,359,360, 361, 362,363, 364, 365). The long tubi ng may off er a hi gh
resi st ance that coul d l i mi t f l ow. A l arge pri mi ng vol ume may be needed.
Thi s t ype of devi ce is i mpractical f or f ield or ambul ance use. I t may requi re more
mai ntenance than other t ypes of f l ui d warmers (299). Bl ood or I V f l ui d can l eak i nto
t he wat er bat h sol ut ion.
Countercurrent Heat Exchangers
Countercurrent heat exchangers use a count ercurrent f l ow of heated water wi t h a
t ube contai ni ng t he IV f lui d i nsi de (44,283,284,334,339,366, 367,368). Single-
channel and mul ti channel countercurrent heat exchangers are avai l abl e (353) (Fi g.
31.13).

View Figure

Figure 31.12 Disposable set from a magnetic induction
heater.

Most f l ui d warmers that use countercurrent t echnol ogy heat more eff ectivel y than
ot her f l ui d warmers (284,305,307,308,309, 333,334,339,366, 369), so t hey may be
appropri at e for si t uat i ons where rapi d vol ume resusci tati on i s necessary (335).
However, thei r eff ecti veness may decrease as f low rat e i ncreases (306). Cont i nual
countercurrent warmi ng of f l uids in t he tubing l eading to the pat i ent decreases the
l oss of heat distal to the warmer. The resistance to f low may be l ower than wi t h
wat er bath warmers (305).
Other
I V t ubi ng can be placed i nsi de the tubing bet ween the pati ent and a convect i ve
warmi ng devi ce (156,299,370,371). One forced-ai r uni t manuf acturer of f ers a
speci al di sposabl e coil wi t h IV tubi ng to be pl aced i nsi de the hose that goes f rom
t he warmi ng uni t t o the blanket (Fi g. 31.14). A f ol ded wat er mat tress pad can be
appli ed to t he t ubi ng cl ose t o the pati ent (210). The use of i nsul ati on sl ows heat
l oss f rom tubi ng but i s of l i mi ted eff ecti veness (210, 315,369). All of these warmi ng
methods resul t i n reduced access to the tubi ng f or drug i nj ecti on.
Negative-pressure Warming Devi ces
Thi s device (Fi g. 31.15) consi sts of a thermal exchange chamber t hat provi des
negat ive pressure when ai r is exhausted f rom t he chamber (175,372). A seal
around where the wri st ent ers t he chamber ensures negati ve
P. 895

pressure. Heat i s suppl ied by an elect ri cal warmi ng device.

View Figure

Figure 31.13 Countercurrent heat exchangers. Different
arrangements can be used for IV fluid and warming fluid
flow.

The t heory behi nd thi s device i s that peri pheral vasoconstricti on can hi nder t he
ef fectiveness of warmi ng t herapi es appli ed t o t he skin. If t he subcutaneous
vascul ar struct ure of the hand of a hypothermic i ndi vi dual can be di l at ed by usi ng
subatmospheri c pressure appli ed t o the skin, a thermal l i nk bet ween t he ski n and
t he body core woul d be created, al lowi ng t ransf er of appl ied heat to the core.
Some studi es i ndi cate t hat thi s may be a usef ul t echni que for rewarmi ng
hypothermic i ndi vi duals (373, 374,375). Other studi es have f ai l ed to f ind any
si gni f icant benef i ts (175,176, 377,378, 379).
Esophageal Warmi ng Devices
Thi s device consists of a di sposable doubl e-l umen esophageal tube and a base uni t
wi th wat er heat er, ci rcul ati ng pump, and moni tor/ al arm modul e (380,381). Steri l e
di st il l ed wat er i s heated and then ci rcul ated through t he esophageal tube.
Thi s device is expensive and somewhat i nvasi ve. Most studi es have found i t t o be
of l i mi ted ef f ecti veness (131,266,382,383).
Cryogen Packs
Hot -col d cryogen packs have been used to t reat l ocal i zed areas of the body. Many
burns have occurred wi th t hei r use.
Hot-water Containers
Pl ast i c contai ners of i rri gati on or I V f l ui d are f requent l y kept i n warmers or ovens
near ORs, somet imes at qui te el evated temperatures (211). It may be tempti ng to
t ry t o warm pati ents by posi ti oni ng these cont ai ners in areas of hi gh blood f l ow
such as the axi ll a. This practi ce, however, i s both inef f ecti ve and dangerous. The
l ack of eff i cacy resul ts because t he surface area i nvol ved i s smal l (38). The danger
i s that burns may resul t f rom hi gh local t i ssue temperatures (214).

View Figure

Figure 31.14 Disposable fluid-warming coil that fits inside
the hose of a forced-air warmer.

P. 896



View Figure

Figure 31.15 Negative-pressure warming device. The seal
around the wrist is not shown. (Picture courtesy of
Dynatherm Medical, Inc.)

Increased Operating Room Temperature
I ncreasi ng ambient temperature i n t he OR, especial l y whi le t he pati ent i s bei ng
prepped and draped f or surgery, wi l l decrease t he loss of body heat by reduci ng the
radi ati on and convect ion gradi ents (384). The room can be cool ed af ter t he pati ent
i s draped, and other means of temperat ure cont rol are i ni ti ated. The t emperat ure
can be rai sed agai n duri ng emergence f rom anesthesi a when the surgery is f ini shed
(385). Systems are avai l abl e that wi l l keep surgical personnel cool regardl ess of
t he temperature of the room.
Endovascular Devices
Conti nuous art eri ovenous rewarmi ng uses percutaneousl y pl aced f emoral art eri al
and venous catheters and the pati ent ' s own bl ood pressure to create an
arteri ovenous f istul a that diverts a port i on of t he cardi ac out put t hrough a hepari n-
bonded heat exchanger (43). The heat exchanger consi sts of an i nner chamber
t hrough whi ch hot water i s pumped and an outer chamber t hrough whi ch t he
pati ent 's bl ood f l ows i n a countercurrent di recti on. These devi ces can i ncrease core
t emperat ure by 1.5C t o 2. 5C per hour (386).
Central venous heat exchange cat heters are di scussed under the Cool i ng Devices
secti on. These cat heters can al so be used f or heat ing. Whi l e they are hi ghl y
ef fective, they are highl y i nvasive and expensive.
Lavage
Peri toneal , bl adder, or gast ric l avage wi t h warmed l i qui ds can be perf ormed.
Cost-effectiveness
The i nf luence of warmi ng on peri operat ive costs depends on t he pat i ent 's condi ti on,
surgi cal procedure, and i nst i tut ional f actors rel ated to cost accounti ng (59).
Avoiding t he negati ve ef f ects associ ated wi t h the cold pati ent may reduce
expenses. Bl ood l oss and transfusion requi rements, ti me to extubati on, the need f or
drugs, and t he number of bl ankets and the l ength of stay i n t he PACU may be
reduced (53,59,155,387,388). The normothermi c pat ient i s more hemodynamicall y
stabl e, requi ring l ess int ensive nursi ng care.
I n l ooki ng at the dif f erent methods of provi di ng warmt h to pati ents, i t was
determined that the old styl e of water matt ress and i nsul at i ng covers have the
l owest return on a cost basi s; I V fl ui d warmers were more ef fective but not as
economi cal as f orced-ai r warmers (47,200, 201,202). El ectric bl ankets may be more
cost-ef fecti ve t han f orced-ai r devices (57). I f t he blankets are reusabl e, t he
reprocessi ng costs must be consi dered.
Hazards
Softened Tracheal Tubes
Heat suppli ed by a convecti ve warmi ng device has been shown to sof ten a pol yvi nyl
chlori de tracheal t ube (389,390). This may make the tube more l i kel y t o ki nk and
possi bl y obst ruct (391).
Infection
The possi bi l i t y of bacteri al di ssemi nat ion f rom f orced-ai r devi ces has caused some
t o be uncomf ortable wi t h t hei r use. Envi ronmental contami nati on of t he intensive
care uni t (ICU) i s wel l known. However, studi es i ndi cate that t here is no i ncreased
ri sk associated wi t h f orced-ai r warmi ng devi ces (392). Al l f orced-ai r uni ts i ncl ude
f il ters t hat remove bact eri a f rom the heat ed ai r. Recommendati ons to avoid thi s
probl em incl ude usi ng a f i l ter i n the hose, changi ng the f i l ter regul arl y, usi ng onl y
manuf acturer-recommended blankets, steri l i zi ng the detachabl e hose, and not
reusi ng coverlets (393, 394,395).
A wat er bath can act as a source of inf ecti on (358,396,397,398). IV i nj ecti on ports
and tubi ng connecti ons shoul d be kept out of the water (44). The water should be
di scarded af ter use and t he reservoi r cl eaned and di si nfected.
I f a l eak devel ops i n a countercurrent f l ui d warmi ng system, unsteri l e wat er may be
i nfused i nto t he pati ent (399). To avoi d thi s probl em, a leak check should al ways be
perf ormed before connecti ng the l i ne of t he warmi ng set t o the pat i ent . Si nce t he
pressure i n the IV l i ne may
P. 897

be hi gher than that in t he wat er chamber, bl ood or f l ui d may ent er the water bat h.
Sedati on
Pat i ents under regi onal anesthesia have al tered thermal percepti on and behavioral
responses that may counter t he acti on of sedati ve drugs. Warming may reverse thi s
ef fect wi th resul t ant sedat i on (155,299,400).
Burns
A report f rom the American Associ at ion of Anesthesi ol ogi sts (ASA) closed-cl ai ms
database showed 54 pati ent burns out of 3000 total cl ai ms (214). Ei ghteen burns
were caused by bags or bot t les t hat had been heated and pl aced next or cl ose to
t he pat ient' s ski n. Other cases of thi s t ype have been report ed (401, 402). Of the
ei ght burns f rom el ectri cal l y-powered warmi ng equipment , f ive resul t ed f rom
ci rcul ati ng-wat er mat t resses. Other burns resul ted f rom a warming l i ght and a
heated humi dif i er tubi ng. I n onl y one case was the heat ing devi ce f ound t o be
defective. There are reports of burns wi th forced-ai r warmi ng
(191, 192,193,194, 195, 196,197), radiant war mers i n inf ants (403), and resi st i ve
warmi ng matt resses (258,404). Unfort unatel y, burns are not usuall y recognized
unti l af ter surgery has been compl eted.
A common pati ent factor in many burns i s poor cut aneous bl ood f low. Inj uri es are
usual l y most severe i n areas overl yi ng bony promi nences. The ri sk of ti ssue inj ury
i s further i ncreased when heat or pressure i s combi ned wi t h chemi cal i rri t ati on such
as t hat produced by many ski n-cl eani ng solut i ons, especi al l y t hose containing
i odi ne (38). Age is another f act or. The el derl y of ten have thi n, del i cate skin t hat i s
especi al l y suscept ible t o i nj ury. The ski n on newborn pat i ents has a reduced
t hickness compared wi t h adul ts. Thi s di mi ni shes protecti on agai nst external
noxious events (402). Pati ents wi t h i schemi c t issue or t hose who undergo
procedures invol vi ng cardi opul monary bypass are l ikel y to be at i ncreased ri sk of
t hermal i nj ury. Heat ing devi ces shoul d not be used di stal t o a tourni quet or arteri al
cl amp or duri ng cardi opulmonary bypass.
When a warmi ng devi ce i s used f or a pat i ent wi th compromised ci rculat i on, the
pati ent 's ski n condi t ion shoul d be moni tored f requentl y and the uni t' s maxi mum
sett ing not used (192,211,405). Const ant vi gi l ance must be exercised to ensure
t hat port i ons of heati ng devi ces not meant f or di rect pat ient contact, such as t ubi ng
f or a wat er bl anket or t he hose of a forced-ai r matt ress, do not come i n contact wi t h
t he pat ient (211). Sol ut i on and bl anket-warmi ng cabi net t emperature shoul d be
l i mi ted t o 43C (319,406).
When a burn occurs, the pat tern of t he lesi on can hel p to i denti f y t he cause (407).
I f a warmi ng device has been used and the l esi on conforms to t hat devi ce' s edges
but no other area of the skin i s invol ved, then i t i s l i kel y t hat t he warmi ng devi ce
caused the l esi on.
Increased Transcutaneous Medication Uptake
An i ncrease i n transdermal drug upt ake may occur when the ski n i s heated
(408, 409). For this reason, t ransdermal medicati on shoul d be appl i ed in a l ocat i on
t hat wi l l not be warmed or should be di scont i nued duri ng heat i ng (410).
Hemol ysis
Bl ood may hemol yze i f overheated (44,324,336,345,359). Al t erati ons i n red cel l
i ntegri t y do not occur bel ow a t emperature of 46C, and f rank hemol ysis does not
occur unti l 48C (411,412). Packed red blood cel l s remai ni ng stat ionary wi t hi n
mi crowave or count ercurrent heati ng cart ri dges may show evi dence of hemol ysi s
(353). I f wat er f rom a f l ui d-warmi ng system l eaks i nto bl ood, hemol ysi s may resul t
(399).
Current Leakage
Li qui d bat h and dry heat exchangers must be wel l grounded. They can l eak
el ect rical current i nt o the f l ui d pat h (44).
Air Embolism
A hazard wi th f l ui d warmers i s the possibil i ty of i nf usi ng ai r i nto the pat i ent ei ther
as a resul t of bubbl es created as the f l ui d is warmed (outgassing), ai r ent rai ned
t hrough an i nfusi on system, or by del i veri ng ai r cont ai ned i n t he f lui d source
(283, 299,413,414, 415, 416,417, 418, 419,420, 421,422,423,424,425,426,427,428,429)
. The danger is greatest wi t h the use of pressure i nf users; when f lui ds are i nfused
by a pump; and when rapi d, high-vol ume f l ui d administrat ion i s necessary.
Sol ut ion manuf act urers t ypi call y put 50 to 75 mL of ai r i nto each sol uti on cont ai ner
(299, 421). This shoul d be removed f rom the contai ner and the t ubi ng checked f or
bubbl es bef ore the start of an i nf usi on. Part i all y empt i ed fl ui d bags shoul d not be
reat tached t o the IV system (427,428).
Many systems provi de a warning f eat ure to al ert the operator to ai r i n the I V l i ne,
and t raps that coll ect bubbl es i n the f l ui d are incorporat ed int o many di sposable
sets. If t he t rap i s instal l ed upside down, ai r may be t ransmi tted t o the pati ent
(430). Many of these traps cannot be easil y vented; once t he t rap becomes f ul l , ai r
may be deli vered t o the pati ent . Some gas-el i minati ng devi ces use a mi croporous
membrane that all ows t he gas t o escape wi t hout any user i ntervent ion (431).
Another design uses a mechani sm that stops the f l ui d f l ow when ai r is detect ed
(432, 433,434). Some systems al l ow f l ui d cont ai ni ng ai r to be reci rcul ated t o the
reservoi r chamber (310). However, no gas-el i mi nat ing devi ce can rel iabl y remove
l arge amounts of ai r. Aut omat ic ai r detecti on devices may f ai l
(335, 413,421,435, 436).
P. 898


Interference with Bispectral Index Monitoring
Fal sel y el evated bispect ral i ndex values have been reported i n pat i ents receiving
f orced-ai r warmi ng around the head (437). Temporary i nt errupti on of t he warm ai r
f low may be requi red to get accurate readi ngs.
Pressuri zed I nfiltration
The use of a f l ui d-warmi ng system that pressuri zes t he f l ui d can resul t i n
extravasat ion of f l ui d. A compart ment syndrome could occur (438).
Cooling Devices
Pat i ents may requi re cooli ng for a variety of reasons, i ncl udi ng treat ment of
mal i gnant hypert hermia and possibl e cerebral prot ecti ve ef fects duri ng neurol ogic
or cardiac surgery or f ol l owi ng head t rauma or cardi ac arrest.
Chilled Intravenous Fluids
Hypothermi a can be i nduced by rapi d inf usion of chi ll ed f luids or IV f lui ds at room
t emperat ure (440,441,442,443). One l i ter of cryst al l oi d at ambi ent temperature or
one uni t of ref rigerated blood admi nistered t hrough a peri pheral si t e reduces mean
body temperature by approximat el y 0.25C i n adul ts (444). Administ ering the f l uid
central l y wi l l decrease core temperature more rapi dl y (442). Thi s method i s
rest ri cted by the vol ume that can be administered wi thout overl oading the
cardi ovascular system but may hel p to compensate f or ant i ci pated di uresi s and hel p
t o maint ai n cerebral perf usi on pressure. It i s l ess ef fect ive t han i mmersion i n i ce
wat er (206).
Circulating Water Units
Newer ci rculati ng wat er uni ts have been found to be eff ecti ve for cont roll i ng fever
i n neurol ogi c pat ients (445,446). Ol der uni ts were l ess ef fecti ve (447).
Forced-air Cooling
Cooli ng can be perf ormed by usi ng a forced-ai r uni t. This needs t o be combi ned
wi th ot her methods to achi eve ef fective cool i ng (206,448). Also, most uni ts have no
f eedback control . Personal ai r-condi ti oni ng systems that at tach to the medi cal ai r
l i ne are avai l abl e.
Immersion in Ice Water
Cooli ng by conducti on may be l ess ef f i ci ent than usi ng forced ai r and is more li kel y
t o i nt erf ere wi t h pat i ent care (449,450).
Central Venous Heat Exchange Catheters
Devices are avai l able that have heat t ransfer el ements that can be i nsert ed i nto t he
central venous system (451,452,453,454). Pat ient temperature i s regulated t hrough
a cl osed-l oop cont rol l er. These devi ces can l ower core temperature rapi dl y (455).
Thei r i nvasi veness i s a drawback i n terms of ease of appl i cati on and risk of
compl i cati ons. The t ime l ag bef ore cool ing can be ini t i ated i s a pot ent i al drawback.
Lavage
Peri toneal , bl adder, or gast ric l avage wi t h iced sol uti ons can be perf ormed.
Peri toneal l avage is i nvasive, and bl adder lavage provi des mi ni mal cool i ng.
References
1. Schwartz AJ. Anestheti c i ssues rel ated to body temperature (ASA Ref resher
Course #222). New Orl eans: ASA, 2001.
2. Stewart S, Luj an E, Ruf f C. I nnovat ions and excel l ence: t he i nci dence of adul t
hypothermia i n t he postanesthesi a care uni t. Peri op Nurs Q 1987;3:5762.
3. Sessl er DI . Peri operat ive heat balance. Anesthesi ology 2000;92:578596.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
4. Schwartz AJ. Anestheti c i ssues rel ated to body temperature (ASA Ref resher
Course). Park Ri dge, IL: ASA, 2000.
5. Carl i F, Macdonald IA. Peri operative i nadvertent hypot hermia: what do we need
t o prevent? Br J Anaesth 1996;76: 601603.
6. Li l l y RB. Si gni f i cance and recovery room management of postanesthesia
hypothermia and shi veri ng. Anesth Cl in Nort h Am 1990; 8:365374.
7. Matsukawa T, Sessl er DI , Chri stensen R, et al . Heat f l ow and di st ri buti on during
epi dural anesthesi a. Anest hesi ol ogy 1995; 83: 961967.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
8. Hynson JM, Sessler DI, Moayeri A, et al . The ef fects of prei nducti on warmi ng on
t emperat ure and bl ood pressure during propof ol / ni trous oxi de anesthesi a.
Anesthesi ol ogy 1993; 79:219228.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
9. Just B, Trevi en V, Delva E, et al . Preventi on of i ntraoperati ve hypot hermi a by
preoperat ive ski n-surface warmi ng. Anesthesi ol ogy 1993; 79:214218.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
10. Gl osten B, Hynson J, Sessl er DI , et al . Preanesthet ic ski n surf ace warmi ng
reduces redistri buti on hypothermi a caused by epi dural bl ock. Anesth Analg
1993; 77:488493.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
11. Moayeri A, Hynson JM, Sessl er DI, et al . Pre-i nduct ion ski n-surf ace warmi ng
prevents redi st ri but i on hypothermi a. Anesthesiol ogy 1991; 75:A1004.
[Full text Li nk]
[CrossRef ]
12. Motsch J, Bach A, Mul ler J, et al . Preinduction warmi ng at tenuates hypothermia
i n maj or abdomi nal surgery. Anest hesi ol ogy 1996; 85:A996.
13. McGui re JP, Giesbrecht GG. A comparison of t hree forced-ai r pati ent warmi ng
systems. Anesth Anal g 1993; 76:S256.
14. Hynson JM, Sessl er DI . Intraoperat i ve warmi ng t herapi es: a comparison of
t hree devi ces. J Cl i n Anesth 1992; 4:194199.
[CrossRef ]
[Medli ne Li nk]
15. Forstot RM. The eti ol ogy and management of i nadvertent peri operat ive
hypothermia. J Cl i n Anesth 1995;7:657674.
[CrossRef ]
[Medli ne Li nk]
16. Camus Y, Delva E, Sessl er DI, et al . Pre-i nducti on skin-surf ace warmi ng
mi nimi zes i nt raoperative core hypot hermi a. J Cl i n Anesth 1995; 7:384388.
[CrossRef ]
[Medli ne Li nk]
17. Sessler D, Schroeder M, Merri f i el d B, et al . Opti mal durati on and temperature of
prewarmi ng. Anesthesi ol ogy 1995;82: 674681.
[Full text Li nk]
[Medli ne Li nk]
18. Vanni SMD, Braz JRC, Modol o NSP, et al . Preoperative combi ned wi t h
i ntraoperati ve skin-surf ace warmi ng avoi ds hypothermia caused by general
anesthesi a and surgery. J Cl i n Anesth 2003; 15:119125.
[CrossRef ]
[Medli ne Li nk]
19. Fossum S, Hays J, Henson MM. A comparison study on t he eff ects of
prewarmi ng pati ents i n the outpati ent surgery set ti ng. J Peri Anesth Nurs
2001; 16:187194.
[CrossRef ]
[Medli ne Li nk]
20. Ki tamura A, Hoshino T, Kon T, et al . Pat i ents wi t h diabet ic neuropathy are at
ri sk of a greater intraoperat ive reduct ion in core temperature. Anest hesi ol ogy
2000; 92:13111318.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
21. It tner KP, Bucher M, Bachfi scher M, et al . The 1-adrenergi c antagonist/ 5-HT
1A agoni st urapi di l accel erates f orced ai r rewarmi ng of pat ients wi t h mi l d
hypothermia. Anesthesi ology 1998;89:A1332.
22. Harri son SJ, Font e J. Convect i ve warming combi ned wi th vasodi l ator therapy
accel erates core rewarmi ng af ter coronary art ery bypass surgery. Br J Anaesth
1996; 76:511514.
[Medli ne Li nk]
23. Szmuk P, Ezri T, Sessler DI, et al . Spi nal anesthesi a speeds act ive
postoperati ve rewarmi ng. Anesthesi ol ogy 1997;87:10501054.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
24. Szmuk P, Sessl er DI , Rabb M, et al . Intra-operat ive f orced-ai r rewarmi ng rate i s
i nversel y proport i onal to body si ze. Anesthesi ol ogy 1998; 89:A917.
25. Sanders BJ, D' Al essi o JG, Jerni gan JR. Intraoperat i ve hypothermi a associ at ed
wi th l ower extremi ty t ourni quet def lat i on. J Cl i n Anesth 1996;8:504507.
[CrossRef ]
[Medli ne Li nk]
26. Duterque D, Grousset D, Rouge P, et al . Eval uat ion of the decrease of core
t emperat ure caused by i mmedi ate post -operat ive ski n cleani ng. Anesthesiology
2003; 99:B25.
27. Moore SS, Green CR, Wang FL, et al . The rol e of i rri gat i on in t he devel opment
of hypot hermi a duri ng l aparoscopi c surgery. Am J Obstet Gynecol 1997;176:598
602.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
28. Maki nen M-T. Compari son of body t emperature changes duri ng l aparoscopic
and open chol ecystectomy. Acta Anaesthesi ol Scand 1997; 41:736740.
[Medli ne Li nk]
P. 899


29. Ott DE. Correcti on of l aparoscopi c i nsuf f lat i on hypothermi a. J Laparoendosc
Surg 1991;1:183.
[Medli ne Li nk]
30. Sei tzinger MR, Dudgeon LS. Decreasi ng t he degree of hypothermi a duri ng
prol onged l aparoscopic procedures. J Reprod Med 1993;38:511513.
[Medli ne Li nk]
31. Luck AJ, Moyes D, Maddern G, et al . Core t emperature changes duri ng open
and l aparoscopic colorectal surgery. Surg Endoscop 1999; 13:480483.
32. Matsukawa T, Imamura M, Ozaki M, et al . Warmed gas prevents hypothermi a
duri ng laparoscopi c surgery. Anesthesi ol ogy 2001;95:A1119.
33. Danel l i G, Berti M, Perott i V, et al . Temperat ure cont rol and recovery of bowel
f uncti on af t er l aparoscopic or l aparotomi c col orectal surgery i n pat ients receiving
combi ned epi dural /general anest hesi a and postoperat ive epi dural anal gesi a. Anest h
Anal g 2002;95:467471.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
34. Berber E, St ri ng A, Garl and A, et al . Intraoperat i ve thermal regul ati on i n
pati ents undergoing l aparoscopic vs open surgi cal procedures. Surg Endosc
2001; 15:281285.
[CrossRef ]
[Medli ne Li nk]
35. Saad S, Mi nor I , Mohri T, et al . The cli ni cal i mpact of warmed i nsuff lati on
carbon dioxi de gas for l aparoscopi c chol ecystectomy. Surg Endosc 2000; 14:787
790.
[CrossRef ]
[Medli ne Li nk]
36. Hazebroek E, Schreve MA, Visser P, et al . I mpact of temperature and humidi t y
of carbon di oxi de pneumoperi toneum on body t emperat ure and peri t oneal
morphol ogy. J Laparoendosc Adv Surg Tech 2002;12: 355364.
37. Sessler D. Consequences and treatment of peri operati ve hypothermia. Anesth
Cl in Nort h Am 1994;12:425456.
38. Sessler DI. Compli cati ons and treatment of mil d hypothermi a. Anesthesi ol ogy
2001; 95:531543.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
39. Uebel en R, Ruckol dt MH, Pi epenbrock S. Uni nt ended decreasi ng body
t emperat ure: a stepchi l d of peri operat ive care and outcome consequences. Br J
Anaesth 1998;80:8.
40. Tryba M, Leben J, Heuer L. Does active warmi ng of severel y injured t rauma
pati ents inf l uence peri operati ve morbi di t y. Anesthesiology 1996;85:A283.
41. Bush HL, Hydo LJ, Fi scher E, et al . Hypot hermia duri ng el ecti ve abdominal
aort ic aneurysm repai r: t he hi gh price of avoidabl e morbi di ty. J Vasc Surg
1995; 21:392402.
[Medli ne Li nk]
42. Cheney FW. Shoul d normot hermia be mai nt ai ned duri ng major surgery? JAMA
1997; 277: 11651166.
[CrossRef ]
[Medli ne Li nk]
43. Gent i l el l o LM, Jurkovich GI , Stark MS, et al . Is hypot hermi a i n the victi m of
maj or t rauma prot ecti ve or harmf ul ? A randomi zed, prospect ive study. Ann Surg
1997; 226: 439449.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
44. Iserson KV, Huesti s DW. Bl ood warmi ng: current appl icati ons and techni ques.
Transfusion 1991; 31:558571.
[CrossRef ]
[Medli ne Li nk]
45. Kurz A, Sessler DI, Lenhardt R. Peri operati ve normothermia t o reduce the
i nci dence of surgi cal - wound i nf ect i on and shorten hospi tal i zat ion. New Engl J Med
1996; 334: 12091215.
[CrossRef ]
[Medli ne Li nk]
46. Elmore J, Frankli n D, Youkey J, et al . Normot hermi a i s protecti ve duri ng
i nf rarenal aorti c surgery. J Vasc Surg 1998;28:982984.
47. Summers S, Dudgeon N, Bram K, et al . The eff ects of t wo warmi ng met hods on
core and surf ace t emperat ures, hemogl obi n oxygen sat urat ion, bl ood pressure, and
perceived comf ort of hypot hermi c postanesthesia pati ents. J Post Anesth Nurs
1990; 5:354363.
[Medli ne Li nk]
48. Horn E-P, Schroeder F, Got tschal k A, et al . Acti ve warmi ng during Cesarean
del i very. Anest h Anal g 2002;94:409414.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
49. Sessler D. Mi l d perioperative hypothermi a. New Engl J Med 1997; 336:1730
1737.
[CrossRef ]
[Medli ne Li nk]
50. Vogelsang J. Pati ents talk about t hei r post anesthesi a shaking experi ences. J
Post Anesth Nurs 1994;9:214218.
[Medli ne Li nk]
51. Frank SM, Raj a SN, Bul aco C, et al . Rel at ive cont ri buti ons of core and
cutaneous temperature to thermal comf ort and aut onomic responses i n humans. J
Appl Physi ol 1999;93: 15881593.
[Medli ne Li nk]
52. Nesher N, Pi zov R, Kushni r I , et al . Ut i l i zat i on of a uni que thermoregul at ion
system i mproved hemodynamic f uncti on peri operat ivel y i n pati ents undergoi ng
CABG surgery. Anest hesi ol ogy 2001;93:A308.
53. Bock M, Mul l er J, Bach A, et al . Eff ects of prei nduct ion and int raoperat ive
warmi ng duri ng maj or l aparot omy. Br J Anaesth 1998;80: 159163.
[Medli ne Li nk]
54. Cohen AM, Li ban JB. Convecti ve warming af ter hypothermic cardi opul monary
bypass. Br J Anaesth 1995;75: 504.
[Medli ne Li nk]
55. Kurz A, Sessler DI, Narzt E, et al . Post operat ive hemodynami c and
t hermoregul atory consequences of i nt raoperat ive core hypothermia. J Cl i n Anesth
1995; 7:359366.
[CrossRef ]
[Medli ne Li nk]
56. Lenhardt R, Marker E, Gol l V, et al . Mi ld i nt raoperat ive hypothermia prol ongs
postanest het i c recovery. Anesthesiology 1997;87:13181323.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
57. Pat hi V, Berg GA, Morri son J, et al . The benef i ts of active rewarmi ng af ter
cardi ac operati ons: a randomi zed prospect ive t ri al . J Thorac Cardi ovasc Surg
1996; 111: 637641.
[CrossRef ]
[Medli ne Li nk]
58. Mason DS, Sapal a JA, Wood MH, et al . I nfl uence of a f orced warmi ng syst em
on morbi dl y obese pati ents undergoi ng Roux-en-Y gast ri c bypass. Obes Surg
1998; 8:453460.
[CrossRef ]
[Medli ne Li nk]
59. Fleisher LA, Metzger SE, Lam J, et al . Peri operati ve cost-f i nding anal ysi s of the
rout ine use of i ntraoperati ve f orced-ai r warmi ng duri ng general anesthesi a.
Anesthesi ol ogy 1998; 88:13571364.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
60. Conover M, Lennon D, Rose S. Evaluati on of a f orced-ai r pati ent warmi ng
system f or hypot hermic postsurgi cal pati ents. Anesth Anal g 1989;68:S59.
61. Lenhardt R, Kurz A, Sessl er DI , et al . I ntraoperati ve hypot hermia prol ongs
durat ion of postoperati ve recovery. Anesthesi ol ogy 1995; 83:A1114.
62. Def i na J, Li ncol n J. Preval ence of i nadvertent hypot hermi a duri ng the
peri operat ive peri od: a qual i ty assurance and performance i mprovement study. J
Peri anesth Nurs 1998;13:229235.
[CrossRef ]
[Medli ne Li nk]
63. Hamza MA, Whi te PF, Recart A, et al . Ef f ect of humidi f i ed and warmed CO
2

i nsuf f lat i on gas on recovery af ter l aparoscopi c gastric bypass surgery f or morbi d
obesi ty. Anesthesi ol ogy 2003;99:A618.
64. Panagioti s K, Maria P, Argi ri P, et al . I s postanest hesi a care uni t l ength of stay
i ncreased in hypot hermic pati ents? AORN J 2005;81:379392.
65. Nesher N, Wol f T, Kushni r I , et al . Novel t hermoregul at ion system for enhanci ng
cardi ac f unct i on and hemodynamics duri ng coronary art ery bypass graf t surgery.
Ann Thorac Surg 2001; 72:10691076.
66. Bissonnet te B, Sessl er D. Mi l d hypothermi a does not impai r postanestheti c
recovery i n i nfants and chi ldren. Anesth Analg 1993; 76: 168172.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
67. Lesl i e K, Sessler DI, Bjorksten AR, et al . Mi l d hypothermi a al ters propof ol
pharmacoki net i cs and i ncreases the durati on of acti on of atracuri um. Anesth Anal g
1995; 80:10071014.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
68. Hei er T, Caldwel l JE, Sessl er DI , et al . Mi l d i nt raoperati ve hypot hermia
i ncreases durati on of action and spontaneous recovery of vecuroni um blockade
duri ng ni trous oxi dei sof lurane anest hesi a i n humans. Anesthesi ol ogy
1991; 74:815819.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
69. Hei er T, Caldwel l JE. I mpact of hypothermi a on the response to neuromuscul ar
bl ocking drugs. Anest hesi ol ogy 2006;104:10701080.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
70. Lanhardt R, Ki mberger O, Sessl er DI . Local warmi ng f aci l i tates i nt ravenous
catheter i nsert i on. Anesthesiol ogy 2001; 95:A4.
71. Motamed S, Kl ubi en K, Edwardes M, et al . Metaboli c changes duri ng recovery
i n normothermi c versus hypot hermic pati ents undergoing surgery and recei vi ng
general anesthesi a and epi dural local anestheti c agents. Anest hesi ol ogy
1998; 88:12111218.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
72. Papadimos TJ, Fowl er E. Hypothermi a and rapi d, col d peri toneal crystal l oi d
i nfusi on. Anaesthesia 2001; 56:805806.
[Full text Li nk]
[Medli ne Li nk]
73. Frank S, Hi ggi ns M, Bresl ow M, et al . The catechol ami ne, corti sol and
hemodynamic responses t o mi l d perioperati ve hypothermia. A randomi zed cl i nical
t ri al . Anesthesi ol ogy 1995;82:8393.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
74. Frank SM, Fl ei sher LA, Bresl ow MJ, et al . Peri operat i ve mai ntenance of normo-
t hermi a reduces the i nci dence of morbi d cardi ac events. A randomi zed cl i nical t ri al .
JAMA 1997;277:11271134.
[CrossRef ]
[Medli ne Li nk]
75. Frank SM, Beat t ie C, Chri stopherson R, et al . Uni ntent i onal hypot hermi a i s
associ ated wi th postoperative myocardi al i schemi a. Anesthesi ol ogy 1993; 78:468
476.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
76. Nesher N, Zi sman F, Wol f T, et al . St ri ct t hermoregul at i on att enuates
myocardial i njury duri ng coronary artery bypass graf t surgery as refl ect ed by
reduced level s of cardi ac-speci f i c troponi n I. Anesth Anal g 2003; 96:328335.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
77. El -Rahmany HK, Frank SM, Schnei der GM, et al . Forced-ai r warmi ng decreases
vasodi l ator requi rement af ter coronary artery bypass surgery. Anesth Analg
2000; 90:286291.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
78. Nesher N, I nsl er SR, Shei nberg N, et al . A new t hermoregul at ion system f or
mai ntai ning peri operative normothermia and att enuati ng myocardi al injury i n off -
pump coronary art ery bypass surgery. Heart Surg Forum 2002;5:373380.
[Medli ne Li nk]
79. Ket tner SC, Kozak SA, Groet zner JP, et al . Eff ects of hypothermi a on
t hrombel astography i n pati ents undergoi ng cardi opul monary bypass. Br J Anaesth
1998; 80:313317.
[Medli ne Li nk]
80. Schmi ed H, Kurz A, Sessl er DI , et al . Mi l d hypothermia i ncreases bl ood l oss
and t ransf usi on requi rements duri ng tot al hi p arthropl asty. Lancet 1996;347:289
292.
[CrossRef ]
[Medli ne Li nk]
81. Schmi ed H, Schi f erer A, Sessl er DI , et al . The ef fects of red-cel l scavengi ng,
hemodi lut i on, and act ive warmi ng on al l ogeni c bl ood requi rements i n pati ents
undergoi ng hi p or knee art hropl ast y. Anesth Anal g 1998;86:387391.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
82. Hohn L, Schwei zer A, Kal angos A, et al . Benef i ts of i nt raoperat ive ski n surf ace
warmi ng i n cardi ac surgi cal pat ients. Br J Anaesth 1998; 80:318323.
[Medli ne Li nk]
83. Johannson T, Li sander B, Ivarsson I. Mi l d hypothermi a does not increase bl ood
l oss duri ng total hi p art hropl ast y. Acta Anaesth Scand 1999; 43:10051010.
[CrossRef ]
[Medli ne Li nk]
84. Wi nkler M, Akca O, Bi rkenberg B, et al . Aggressive warmi ng reduces bl ood l oss
duri ng hi p art hropl ast y. Anesth Anal g 2000;91:978984.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
85. Hof er CK, Worn M, Tavakol i R, et al . Inf l uence of body core temperat ure on
bl ood l oss and transf usion requi rements duri ng off -pump coronary artery bypass
graf ti ng: a comparison of 3 warmi ng systems. J Thorac Cardi ovasc Surg
2005; 129: 838843.
[CrossRef ]
[Medli ne Li nk]
86. Insler SR, O' Connor MS, Leventhal MJ, et al . Associ ati on bet ween
postoperati ve hypothermia and adverse outcome af t er coronary artery bypass
surgery. Ann Thorac Surg 2000;70:175181.
[CrossRef ]
[Medli ne Li nk]
87. Woo YJ, At luri P, Grand TJ, et al . Acti ve t hermoregul ati on i mproves outcome of
of f -pump coronary art ery bypass. Asi an Cardi ovasc Thorac Ann 2005;13:157160.
[Medli ne Li nk]
88. Bei li n B, Shavi t Y, Razumovsky J, et al . Eff ects of mi l d peri operat ive
hypothermia on cel l ul ar i mmune responses. Anesthesi ol ogy 1998;89:11331140.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
89. Shef fi el d C, Sessl er DI, Hunt TK. Mi l d hypothermi a during i sof l urane anesthesi a
decreases resi stance t o E col i dermal i nf ecti on in gui nea pigs. Acta Anaest hesi ol
Scand 1994;38:201205.
[Medli ne Li nk]
90. Shef fi el d C, Sessl er DI, Hunt TK, et al . Mi l d hypothermia duri ng hal ot hane-
i nduced anesthesi a decreases resi stance to Staphyl ococcus aureus dermal
i nfect ion i n gui nea pi gs. Wound Repai r Regen 1994;2: 4856.
[CrossRef ]
91. Alf onsi P, Coggi a M, Lef lon-Gui bout V, et al . Peri operati ve warmi ng reduces
bacteri al prol if erat ion on endovascular graf ts in dogs. Anesthesiology
1999; 91:A1191.
92. Pat erson DL, Stapl ef el dt WH, Wagener MM, et al . Int raoperative hypothermi a i s
an i ndependent risk f actor f or earl y cytomegal ovi rus i nf ect i on in l iver t ranspl ant
reci pi ents. Transplant ati on 1999; 67:11511155.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
93. Mel l i ng AC, Al i B, Scot t EM, et al . Ef f ect s of preoperat i ve warmi ng on t he
i nci dence of wound infecti on af ter cl ean surgery: a randomi zed cont roll ed t ri al .
Lancet 2001; 358:882886.
94. Carl i F, Emery PW. Ef f ect of peroperat ive normothermi a on postoperati ve
protein met abol i sm in elderl y pat ients undergoi ng hi p arthropl ast y. Br J Anaesth
1989; 63:276282.
[CrossRef ]
[Medli ne Li nk]
95. Keegan MT, Sharbrough FW, Lani er WL. Shiveri ng compli cati ng the t reat ment
of neurol ogi cal ly i mpai red surgi cal and intensi ve care uni t pat ients. Anesthesi ol ogy
1999; 91:874876.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
96. Kober A, Scheck T, Lieba F, et al . The i nf l uence of act ive warmi ng on si gnal
quali t y of pul se oximet ry i n prehospi tal trauma care. Anesth Anal g 2002;95:961
966.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
97. Mahoney CB, Odom J. Maint ai ni ng i ntraoperati ve normot hermia: a meta-
analysi s of outcomes wi t h costs. AANA J 1999;67: 155164.
[Medli ne Li nk]
98. Tal isman R, Li n JT, Sorof f HS, et al . Gangrene of the back, but tocks, f i ngers,
and toes caused by transi ent col d aggl ut i nemi a i nduced by a cool ing bl anket i n a
pati ent wi t h sepsis. Surgery 1998;123:592595.
[CrossRef ]
[Medli ne Li nk]
99. Backlund M, Kel lokumpu I , Scheinin T, et al . Eff ect of temperature of insuf f l at ed
CO
2
duri ng and af ter prol onged l aparoscopi c surgery. Surg Endosc 1998;12:1126
1130.
[CrossRef ]
[Medli ne Li nk]
100. Sahi n A, Sal man A, Salman AE, et al . Ef f ect of body temperat ure on peri pheral
venous pressure measurements and i ts agreement wi t h cent ral venous pressure i n
neurosurgical pati ents. J Neurosurg Anesthesiol 2005;17:9196.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
101. Kober A, Scheck T, Ful esdi B, et al . Ef f ect iveness of resi sti ve heat ing
compared wi t h passive warmi ng i n t reati ng hypothermia associated wi th mi nor
t rauma: a randomi zed t ri al . Mayo Cl in Proc 2001; 76:369375.
[Medli ne Li nk]
102. American Soci et y for Testi ng and Materi al s. St andard speci f icati on f or
ci rcul ati ng l iqui d and forced ai r pati ent temperature management devi ces (ASTM F-
219602). West Conshohocken, PA: Author, 2002.
103. American Soci et y for Testi ng and Materi al s. St andard speci f icati on f or
bl ood/i nt ravenous f l ui d/i rri gat ion f l ui d warmers (ASTM F-217202). West
Conshohocken, PA: Author, 2002.
P. 900


104. Akri dge J. Turni ng up the heat on temperature and pressure management .
Heal thcare Purchasi ng News 2004;28.
105. Gi esbrecht GG, Ducharme MB, McGui re JP. Comparison of f orced-ai r pati ent
warmi ng systems f or peri operat ive use. Anesthesiol ogy 1994;80:671679.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
106. Komatsu H, Chuj o K, Ogli K. Forced-ai r warmi ng syst em f or perioperati ve use
i n neonates. Paediatr Anaesth 1996;6:427428.
[Medli ne Li nk]
107. Tuckey J. Forced-ai r warmi ng bl anket and surgical access. Anaesthesia
1999; 54:9798.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
108. Robi nson D, Ani s S. Warming pati ents i n the l i t hotomy posi ti on. Anaesthesi a
2004; 59:12491250.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
109. Camus Y, Delva E, Just B, et al . Leg warming mi ni mizes core hypothermi a
duri ng abdominal surgery. Anest h Anal g 1993;77:995999.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
110. Motamed C, Labai l l e T, Leon O, et al . Core and thenar ski n temperature
vari ati on duri ng prol onged abdomi nal surgery: comparison of t wo si t es of active
f orced ai r warmi ng. Act a Anaesth Scand 2000;44:249254.
[CrossRef ]
[Medli ne Li nk]
111. Brauer A, Engl ish MJM, Lorenz, N, et al . Comparison of f orced-ai r warmi ng
systems wi t h l ower body blankets usi ng a copper manikin of the human body. Act a
Anaesthesiol Scand 2003; 47:5864.
[CrossRef ]
[Medli ne Li nk]
112. Brauer A, Engl ish MJM, Steinmetz N, et al . Compari son of forced-ai r warmi ng
systems wi t h upper body bl ankets usi ng a copper maniki n of the human body. Act a
Anaesthesiol Scand 2002; 965972.
113. Kongsayreepong S, Gunnal eka P, Suraserani vongse S, et al . A reusabl e,
custom-made warmi ng bl anket prevents core hypothermi a duri ng major neonatal
surgery. Can J Anesth 2002;49:605609.
114. Kempen PM. Ful l body forced ai r warmi ng; commercial bl anket vs. ai r del ivery
beneat h bed sheets. Can J Anaesth 1996;43:11681174.
[Medli ne Li nk]
115. Vu H, Kempen PM. Upper body f orced-ai r warmi ng via bedsheets. Anesth
Anal g 1997;84:S31.
116. Kabbara A, Goldlust SA, Smi th CE, et al . Randomi zed prospect ive compari son
of f orced ai r warmi ng usi ng hospi t al blankets versus commercial bl ankets i n
surgi cal pat ients. Anesthesi ol ogy 2002;97:338344.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
117. Anonymous. Misusi ng f orced-ai r hypert hermia uni ts can burn pat i ents. Heal th
Devices 1999;28:229230.
[Medli ne Li nk]
118. Anonymous. Burns f rom misuse of f orced-ai r warmi ng devi ces. Bi omed Saf e
St and 2003; 33:31.
119. Murat I , Berniere J, Const ant I. Eval uat i on of the eff icacy of a f orced-ai r
warmer (Bai r Hugger) duri ng spinal surgery i n chi l dren. J Cl i n Anesth 1994;6:425
429.
[CrossRef ]
[Medli ne Li nk]
120. Gauthi er RL. Use of f orced ai r warmi ng system f or i nt raoperat ive warmi ng.
Anesthesi ol ogy 1990; 73:A462.
121. Grange C, Cl ery G, Purcel l G, et al . Eval uati on of the Bai r Hugger warmi ng
device. Anaest h Intens Care 1992;20: 122.
[Medli ne Li nk]
122. Mathi eu A, Vogelsang J. The rel ati ve eff i cacy of various warmi ng devi ces
(WDs) i n prevent ing i nt raoperat ive (IO) hypot hermi a. A meta-anal ysi s (MA). Can J
Anaesth 1995;42:A12.
123. Mathi eu A, Vogelsang J. A met a-anal ysis (MA) est abl i sher t he rel ative ef f i cacy
of vari ous warmi ng devices (WDs) in preventi ng i ntraoperati ve (IO) hypothermi a.
Anesthesi ol ogy 1996; 85:A418.
124. Karayan J, Thomas D, Lacoste L, et al . Delayed forced ai r warmi ng prevents
hypothermia duri ng abdominal aort ic surgery. Br J Anaesth 1996; 76:459460.
[Medli ne Li nk]
125. Szmuk P, Ezri T, Sessl er DI , et al . Spinal anesthesi a onl y minimal l y i ncreases
t he eff i cacy of postoperati ve f orced-ai r rewarmi ng. Anest hesi ol ogy 1996;85:A408.
126. Frank SM, Fl ei sher LA, Ol son KF, et al . Mul ti vari ate determi nates of earl y
postoperati ve oxygen consumpti on: the eff ects of shiveri ng, core temperature, and
gender. Anesthesi ol ogy 1995;83: 241249.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
127. Lennon RL, Hoski ng MP, Conover MA, et al . Eval uat ion of a f orced-ai r system
f or warmi ng hypothermi c postoperat ive pat ients. Anesth Analg 1990;70: 424427.
[CrossRef ]
[Medli ne Li nk]
128. Krenzi schek DA, Frank SM, Kel l y S. Forced-ai r warmi ng versus rout i ne thermal
care and core temperat ure measurement si tes. J Post Anest h Nurs 1995; 10:69
78.
[Medli ne Li nk]
129. Negi shi C, Ozaki M, Sessl er DI , et al . Forced-ai r warmi ng prevents shiveri ng
duri ng cesarean sect i on del ivery wi t h epi dural anest hesi a. Anesth Anal g
1997; 84:S398.
130. Gi esbrecht GC, Schroeder M, Bri stow G. Treatment of mi ld i mmersion
hypothermia by f orced ai r warmi ng. Avi at Space Envi ron Med 1994;65:803808.
[Medli ne Li nk]
131. Rasmussen Y, Lei kersf el dt G, Frenck N. Forced-ai r surface warmi ng versus
oesophageal heat exchanger in t he preventi on of peroperati ve hypothermia. Acta
Anaesthesiol Scand 1998; 42:348352.
[Medli ne Li nk]
132. Casati A, Baronci ni S, Pat tono R, et al . Ef fects of sympathetic bl ockade on the
ef fi ci ency of f orced-ai r warmi ng duri ng combi ned spi nal -epidural anesthesi a f or
t otal hi p art hropl ast y. J Cl i n Anesth 1999;11:360363.
[CrossRef ]
[Medli ne Li nk]
133. Oni k GM, Chambers N, Chernus SA, et al . Hepatic cryosurgery wi t h and
wi thout t he Bai r Hugger. J Cl i n Oncol 1993;52:185187.
134. Iai zzo PA, Jeon YM, Si gg DC. Facial warming i ncreases the threshol d f or
shiveri ng. J Neurosurg Anesth 1999;11:231239.
135. Raj el A, Lenhardt R, Sessl er DI, et al . Ef f i cacy of t wo methods for reduci ng
postbypass af t erdrop. Anesthesi ol ogy 2000;92:447456.
[Ful l text Li nk]
[CrossRef ]
[Medli ne Li nk]
136. Nguyen NT, Furdui G, Fl emi ng NW, et al . Ef fect of heat ed and humi di f i ed
carbon dioxi de gas on core temperature and postoperative pai n: a randomi zed t ri al .
Surg Endosc 2002;16:10501054.
[CrossRef ]
[Medli ne Li nk]
137. Matsuzaki Y, Matsukawa T, Ohki K, et al . Warmi ng by resi st ive heat i ng
mai ntai ns perioperati ve normot hermi a as wel l as forced ai r heat ing. Br J Anaesth
2003; 90:689691.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
138. Negi shi C, Hasegawa K, Mukai S, et al . Resisti ve-heati ng and f orced-ai r
warmi ng are comparabl y eff ect ive. Anest h Anal g 2003;96:16831687.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
139. Al fonsi P, Nourredine KEA, Adam F, et al . Eff ect of postoperati ve skin-surf ace
warmi ng on oxygen consumpt ion and the shi vering threshold. Anaesthesi a
2003; 58:12281234.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
140. Schlunzen L, Vestergaard A, Mul ler-Niel sen I , et al . Convective warmi ng
bl ankets i mprove peroperative heat preservat i on i n congeni tal heart surgery.
Paedi atr Anaesth 1998;8:397401.
[CrossRef ]
[Medli ne Li nk]
141. Vi ll amari a F, Bai sden C, Hi l l i s A, et al . Forced-ai r warmi ng i s no more
ef fective than conventi onal methods f or rai si ng postoperati ve core temperature
af ter cardi ac surgery. J Cardi othorac Vasc Anesth 1997;11:708711.
[CrossRef ]
[Medli ne Li nk]
142. Moors A, Pi ckett J, Bet hune D, et al . Convective warmi ng f oll owi ng
hypothermic cardi opulmonary bypass. J Cardi ot horac Vasc Anesth 1994;8: 79.
[CrossRef ]
143. Jaul t P, Lahot J, Durand P, et al . Heati ng ef f i cacy of convecti ve warming
t herapy af ter coronary surgery wi th hypothermi a. J Cardi othorac Vasc Anesth
1994; 8:78.
[CrossRef ]
144. Ereth M, Lennon R, Sessl er D. Li mi t ed heat transf er between thermal
compart ments duri ng rewarmi ng in vasoconst ricted pati ents. Aviat Space Envi ron
Med 1992; 63:10651069.
[Medli ne Li nk]
145. Gi uff re M, Hei denreich T, Prui t t L. Rewarmi ng cardi ac surgery pati ents: radi ant
heat versus f orced warm ai r. Nurs Res 1994;43:174178.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
146. Moors A, Pi ckett J, Wool man P, et al . Convecti ve warmi ng af ter hypot hermic
cardi opul monary bypass. Br J Anaesth 1994;73:782785.
[CrossRef ]
[Medli ne Li nk]
147. Pl att ner O, Ikeda T, Sessl er DI , et al . Post anestheti c vasoconst ri ct ion slows
peri pheral -t o-core transf er of cut aneous heat, t hereby i sol at i ng the core t hermal
compart ment . Anesth Anal g 1997;85:899906.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
148. Russel l SH, Freeman JW. Preventi on of hypothermia duri ng ort hotopic l iver
t ranspl antat ion: compari son of three di f ferent int raoperat ive warmi ng methods. Br J
Anaesth 1995;74:415418.
[CrossRef ]
[Medli ne Li nk]
149. Gi uff re M, Fi nni e J, Lynam DA, et al . Rewarmi ng postoperati ve pat ients: l ights,
bl ankets or forced warm ai r. J Post Anesth Nurs 1991;6:387393.
[Medli ne Li nk]
150. Borms SF, Engel en SLE, Hi mpe DGA, et al . Bai r Hugger forced-ai r warmi ng
mai ntai ns normothermi a more eff ectivel y t han Thermo-Li te i nsul ati on. J Cl i n Anesth
1994; 6:303307.
[CrossRef ]
[Medli ne Li nk]
151. Pl att ner O, Ikeda T, Sessl er DI , et al . Does postoperati ve f orced-ai r warmi ng
speed core temperature rewarmi ng? Anest h Anal g 1994;84:S262.
152. Smi th I , Newson CD, Whi te PF. Use of f orced-ai r warmi ng duri ng and af ter
outpati ent art hroscopic surgery. Anesth Anal g 1994; 78:836841.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
153. Wongprasart suk P, Konstantatos A, McRae R. The eff ect of forced ai r warmi ng
on postoperative oxygen consumpt ion and temperature in el ecti ve orthopaedic
surgery. Anaesth I ntens Care 1998;26:267271.
[Medli ne Li nk]
154. Sessl er DI, Moayeri A. Ski n surf ace warmi ng: heat f l ux and central
t emperat ure. Anesthesi ol ogy 1990;73:218224.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
155. Mort TC, Ri nt el TD, Al tman F. The eff ects of f orced-ai r warmi ng on postbypass
central and ski n temperatures and shi vering act ivi ty. J Cl in Anesth 1996;8: 361
370.
[CrossRef ]
[Medli ne Li nk]
156. Smi th C, Hol brook C, Radesi c B, et al . Compari son of peri operati ve heat i ng
modal i ti es i n anestheti zed adul t pati ents: a prospect ive, randomi zed study. Am J
Anesthesi ol 1998;25:6268.
157. Smi th CE, Desai R, Gl ori oso V, et al . Prevent ing hypothermi a: convecti ve and
i ntravenous f l uid warmi ng versus convecti ve warmi ng al one. J Cl i n Anest h
1997; 10:380385.
[CrossRef ]
[Medli ne Li nk]
158. Berti M, Casat i A, Torri G, et al . Active warmi ng, not passi ve heat retenti on,
mai ntai ns normothermi a during combi ned epidural -general anesthesi a f or hip and
knee art hropl ast y. J Cl i n Anesth 1997;9:482486.
[CrossRef ]
[Medli ne Li nk]
159. Bennet t J, Ramachandra V, Webst er J, et al . Prevent i on of hypothermia duri ng
hi p surgery: ef f ect of passive compared wi th acti ve skin surf ace warmi ng. Br J
Anaesth 1994;73:180183.
[CrossRef ]
[Medli ne Li nk]
160. Pat el N, Smi th CE, Knapke D, et al . Heat conservati on vs convecti ve warming
i n adul ts undergoi ng el ect i ve surgery. Can J Anaesth 1997;44:669673.
[Medli ne Li nk]
161. Berti M, Fael l i G, Al degheri G, et al . Central t emperat ure reducti on duri ng
maj or orthopaedi c surgery: how t o prevent i t . Br J Anaesth 1997;78: 13.
162. Borms SF, Engel en SLE, Hi mpe DGA, et al . Bai r Hugger forced-ai r warmi ng
mai ntai ns normothermi a more eff ectivel y t han Thermo-Li te i nsul ati on. J Cl i n Anesth
1994; 6:303307.
[CrossRef ]
[Medli ne Li nk]
163. Hardy E, Ci ri l lo B, Gut zei t N. Rewarming pati ents i n the PACU: can we make a
di ff erence? J Post Anesth Nurs 1988;3: 313316.
164. Kurz A, Kurz M, Poeschl G, et al . Forced-ai r warmi ng maintai ns i nt raoperati ve
normothermia bett er t han ci rcul ati ng-wat er mat t resses. Anesth Analg 1993;77: 89
95.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
165. Weyl and W, Fri t z U, Landmann H, et al . Ef fecti vi ty of i ntraoperat i ve warmi ng
t echni ques. Can J Anaesth 1996;43:A21.
166. Ci ufo D, Di ce S, Coles C. Rewarmi ng hypothermi c post anesthesi a pat ients: a
compari son bet ween a wat er coi l warmi ng bl anket and a f orced-ai r warmi ng bl anket.
J Postanesth Nurs 1995;10:155158.
[Medli ne Li nk]
167. Badgwel l JM, Durham NL, Lacey S, et al . Forced ai r warmi ng bl ankets
mai ntai n normothermi a i n i nfants duri ng anest hesi a. Anest hesiol ogy
1995; 83:A1174.
168. Guvakov DV, Shunkin AV, Wei ss SJ, et al . Ef f ect iveness of f orced ai r warmi ng
af ter pedi at ri c cardi ac surgery empl oyi ng hypothermic ci rcul atory arrest wi t hout
cardi opul monary bypass. Anesthesi ol ogy 1999;91:A1250.
169. Cross M, Davies J, Shah M. Post-operati ve warmi ng i n the cardiac pati ent:
evaluati on of the Bai r Hugger convect ive warmi ng system. J Cardi othorac Vasc
Anesth 1994; 8:80.
[CrossRef ]
170. Ouel l ett e RG. Compari son of four i ntraoperati ve warming devi ces. AANA J
1993; 61:394396.
[Medli ne Li nk]
171. Horn E-P, Schroeder F, Sessl er DI , et al . Postanest het i c shi vering i n
normothermic or hypothermi c pat ients af t er i sof lurane anesthesi a. Anesth Analg
1998; 86:S33.
172. St eel e MT, Nel son MJ, Sessl er DI , et al . Forced ai r speeds rewarmi ng i n
acci dent al hypot hermia. Ann Emerg Med 1996;27:479484.
[CrossRef ]
[Medli ne Li nk]
173. Smi th CE, Patel N. Hypothermi a i n adul t trauma pat i ents: anesthet ic
consi derat ions. Part I I. Preventi on and treatment . Am J Anesth 1997;24:2936.
174. Kol l er R, Schni der T, Nei dhart P. Deep acci dental hypothermi a and cardi ac
arrestrewarmi ng wi t h f orced ai r. Acta Anaesthesi ol Scand 1997;41:13591364.
[Medli ne Li nk]
175. Taguchi A, Arki l i c CF, Ahl uwal i a A, et al . Negative pressure rewarmi ng vs.
f orced ai r warmi ng i n hypothermi c postanest hetic volunteers. Anesth Anal g
2001; 92: 261266.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
176. Taguchi A, Arki l i c CF, Ahl uwal i a A, et al . Ef fi cacy of vi t al -heat warming i n
post-anesthet ic volunteers. Anesthesi ol ogy 2001; 93:A316.
177. Ng S-F, Oo C-S, Loh K-H, et al . A comparat i ve study of t hree warmi ng
i ntervent ions to determine t he most ef f ecti ve i n maint ai ni ng peri operat ive
normothermia. Anesth Analg 2003;96: 171176.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
178. Guvakov D, Cheung AT, Weiss SJ, et al . Ef f ecti veness of f orced ai r warmi ng
af ter pedi at ri c cardi ac surgery empl oyi ng hypothermic ci rcul atory arrest wi t hout
cardi opul monary bypass. J Cl i n Anest h 2000;12:519524.
[CrossRef ]
[Medli ne Li nk]
179. Goheen MS, Duchrame MB, Kenny GP, et al . Eff i cacy of f orced-ai r and
i nhal at i on rewarmi ng by usi ng a human model f or severe hypothermi a. J Appl
Physi ol 1997;83:16351640.
[Medli ne Li nk]
180. Lee L, Lesl i e K, Kayak E, et al . I nt raoperati ve pati ent warmi ng usi ng radi ant
warmi ng or forced-ai r warmi ng duri ng l ong operati ons. Anaesth Intens Care
2004; 32: 358361.
[Medli ne Li nk]
P. 901


181. Brauer A, Pachol i k L, Perl T, et al . Conducti ve heat exchange wi t h a gel -
coated ci rcul at i ng water mat tress. Anesth Anal g 2004;99: 17421746.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
182. Janke EL, Pi l ki ngton SN, Smi th DC. Eval uati on of two warmi ng systems af t er
cardi opul monary bypass. Br J Anaesth 1996;77:268270.
[Medli ne Li nk]
183. Grocot t HP, Mathew JP, Carver EH, et al . A randomi zed control l ed t ri al of the
Arct ic Sun t emperat ure management syst em versus convent i onal methods f or
preventi ng hypothermia duri ng of f -pump cardi ac surgery. Anesth Anal g
2004; 98:298302.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
184. St anl ey TO. Prel imi nary evaluati on of the Arcti c Sun temperature-cont rol l ing
system duri ng of f -pump coronary art ery bypass surgery. Ann Thorac Surg
2003; 75:11401144.
[CrossRef ]
[Medli ne Li nk]
185. Taguchi A, Ratnaraj J, Kabon B, et al . Ef f ects of a ci rcul ati ng-water garment
and f orced-ai r warmi ng on body heat content and core t emperat ure. Anesthesi ol ogy
2004; 100: 10581064.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
186. Janicki PK, Hi ggins MS, Janssen J, et al . Compari son of two di f f erent
t emperat ure mai nt enance st rat egies duri ng open abdomi nal surgery.
Anesthesi ol ogy 2001; 95:868874.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
187. Janicki PK, Stoi ca C, Chapman WC, et al . Water warmi ng garment versus
f orced ai r warmi ng system i n preventi on of i nt raoperative hypothermia duri ng l iver
t ranspl antat ion: a randomi zed cont rol l ed tri al . Anesthesiology 2002;2:15.
188. Komatsu R, Orhan-Surgur M, In J, et al . Ci rcul at i ng-wat er garments rewarm
f ast er t han f orced-ai r. Anesthesi ol ogy 2005;103:A853.
189. Smi th CE, Hol l brook C, Raghupathy A, et al . Compari son of peri operati ve
heati ng modal i t ies. Anesthesi ol ogy 1996; 85: A417.
190. O' Nei l l KA, Bernardo LM, Gardner MJ, et al . The ef f ects of core and peripheral
warmi ng methods on temperature and physi ol ogi c vari abl es i n i nj ured chi ldren.
Pedi at r Emerg Care 2001;17:138142.
[Full text Li nk]
[Medli ne Li nk]
191. ECRI . Augusti ne Medical Bai r Hugger pati ent warmi ng systems model s 200
and 250. Technol Anesth 1990;11: 12.
192. Anonymous. Misusi ng f orced-ai r hypert hermia uni ts can burn pat i ents. Technol
Anesth 1999; 20:12.
193. Truel l KD, Bakerman PR, Teodori MF, et al . Thi rd-degree burns due to
i ntraoperati ve use of a Bai r Hugger warmi ng devi ce. Ann Thorac Surg
2000; 69:19331934.
[CrossRef ]
[Medli ne Li nk]
194. Anonymous. Burns f rom misuse of f orced-ai r warmi ng devi ces. FDA Pat ient
Saf et y News, 2002; Broadcast #9.
195. Marders J. FDA encourages t he reporti ng of medical devi ce adverse events:
f ree-hosi ng hazards. APSF Newslet t 2002;17: 41.
196. Azzam FJ, Krock JL. Thermal burns i n t wo i nf ants associ ated wi t h a forced ai r
warmi ng system. Anest h Anal g 1995;81:661.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
197. Anonymous. Mal l i nckrodtWarmTouch pati ent warmers: overheati ng relays
could cause pati ent burns or surgi cal f i res. Heal th Devi ces Al erts 2004;28: 12.
198. Anonymous. Pat i ent f orced-ai r warmi ng uni ts. Technol Anesth 2005; 25:16
17.
199. Gol den S, Bachman C. Forced ai r war mer burn can occur wi th poor ci rcul ati on.
APSF Newslett er 20052006;20:87.
200. Badgwel l JM, Ol son SJ, Moore BL, et al . Forced ai r warmi ng modali t i es are
more cost eff ect i ve than other hypothermia preventi on techni ques. Anesthesi ology
1995; 83:A406.
201. Carrel l S. Forced-ai r warmi ng devi ces most ef f ecti ve f or preventi ng cut aneous
heat l oss duri ng surgery. Anesthesi ol ogy News, October 1996.
202. Mathi eu A, Gaf ni A. A comparative cost -ef fect iveness anal ysi s (CEA) of three
current warmi ng devi ces used i nt ra-operat i vel y. Anesthesi ol ogy 1997; 87:A493.
203. Senn GF. Some col d, hard f acts about warmed cot ton bl ankets. SSM
2002; 8:1925.
204. Dunn SM, Pul ai I. Forced ai r warmi ng can faci l i tate fi beropti c intubati ons.
Anesthesi ol ogy 1998; 88:282.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
205. Isert P, Stewart A, Sekhon L, et al . Changes i n brai n temperature duri ng
f orced-ai r convect ion cool i ng of pri mates. J Neurosurg Anesth 1996; 8:331.
206. Pl att ner O, Kurz A, Sessler DI, et al . Ef f i cacy of i ntraoperative cool i ng
methods. Anesthesi ol ogy 1997;87:10891095.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
207. Gerstner M, Ecki nger P, Tew P, et al . Another use of the Bai r Hugger. Can J
Anaesth 1999;46:200.
[Medli ne Li nk]
208. Greif R, Raj ek A, Laciny S, et al . Resistive heati ng i s a more ef f ecti ve
t reatment for acci dental hypothermi a than metall i c foi l i nsulat i on. Ann Emerg Med
2000; 35:337345.
[CrossRef ]
[Medli ne Li nk]
209. Radel R, Fall ocaro M, Si evenpi per T. The ef fects of a warmi ng vest and cap
duri ng lower extremi t y orthopedi c surgi cal procedures under general anesthesia. J
Am Assoc Nurse Anesth 1986;65:486489.
210. Bostek C. Eff ect i ve methods of i n-l i ne i ntravenous f l ui d warmi ng at l ow to
moderate i nfusi on rates. J Am Assoc Nurs Anesth 1992;60:561566.
211. Eat on M, Lusti k S. Pat i ent warmi ng systems. In: Atl ee J, ed. Compl i cati ons i n
Anesthesi a. Phi l adelphia: WB Saunders Company, 1991: 570573.
212. Scott SM. Thermal bl anket i nj ury i n the operati ng room. Arch Surg
1967; 94:181.
[Medli ne Li nk]
213. Cri no MH, Nagel EL. Thermal burns caused by warmi ng bl ankets in the
operati ng room. Anesthesi ol ogy 1968; 29:149150.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
214. Cheney FW, Posner KL, Capl an RA, et al . Burns f rom warmi ng devices in
anesthesi a. A cl osed cl ai ms anal ysi s. Anesthesiology 1994;80:806810.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
215. Nesher N, Wol f T, Uretsky G, et al . A novel thermoregulatory system mai nt ai ns
peri operat ive hypothermi a i n chi l dren undergoi ng el ecti ve surgery. Paed Anaesth
2001; 1:555560.
216. Col l i s M, Stei nman AM, Chaney RD. Acci dent al hypothermi a: an experi mental
study of pract ical rewarmi ng met hods. Avi at Space Envi ron Med 1977; 48:625
632.
[Medli ne Li nk]
217. Goudsouzian NG, Morris RH, Ryan JF. The ef fects of a warmi ng bl anket on the
mai ntenance of body temperatures i n anestheti zed i nf ants and chi l dren.
Anesthesi ol ogy 1973; 39:351353.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
218. Morri s R, Kumar A. The ef fect of warmi ng bl ankets on mai ntenance of body
t emperat ure of the anesthet i zed, paralysed adul t pat ient. Anesthesiology
1972; 36:408411.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
219. Hasegawa K, Negi shi C, Nakagawa F, et al . Compari son of a ci rcul ati ng-wat er
garment wi t h forced-ai r convecti on duri ng maj or abdomi nal surgery. Anesthesi ol ogy
2002; 96:A505.
220. Kat z J, Stei nberg R, Kachl o L, et al . Novel f eedback cont rol l ed ci rcular wat er
warmi ng system (Al l on 2001) is superi or to f orced warmed ai r devi ce i n maintai ni ng
normothermia i n inf ants undergoi ng major surgery. Anesthesiol ogy 2002; 96: A591.
221. Berry JM, Daoud R, Talukder ZH, et al . I nt raoperati ve pati ent warmi ng: a
cl i nical comparison of ai r- and wat er-based systems. Anesthesi ol ogy
2002; 96:A589.
222. Mot ta P, Mossad E, Toscana D, et al . Eff ectiveness of a ci rcul ati ng-wat er
warmi ng garment i n rewarmi ng af ter pedi atri c cardi ac surgery usi ng hypothermi c
cardi opul monary bypass. J Cardi othorac Vasc Anest h 2004;18:148151.
[CrossRef ]
[Medli ne Li nk]
223. Anonymous. Recommended practi ces f or safe care t hrough i dent i f i cat i on of
potenti al hazards i n the surgi cal envi ronment. AORN J 1996;63:802806.
[CrossRef ]
[Medli ne Li nk]
224. Anonymous. Def ect i ve hypo/hyperthermi a machine and blanket bl amed for
burns on bypass surgery pati ent. Medical Mal pract ice Verdict Set tl ements
1995; 11:15.
225. Internati onal Elect rot echni cal Commi ssion. Medi cal el ect ri cal equi pment
part icular requi rements f or t he saf et y of bl ankets, pads and mat tresses intended for
heati ng i n medi cal use (I EC 606102-35). Ann Arbor, MI: Author, 1996.
226. Bi ddl e C, Bi ddl e W. A pl asti c head cover t o reduce surgi cal heat l oss. Geri at r
Nurs 1985;6:3941.
[Medli ne Li nk]
227. Caruso LJ, Mnookin S, Layon AJ. Ef f ectiveness of a plasti c bag i n prevent i ng
heat l oss: a bench model . Anesth Analg 2000; 90:S194.
228. Deacock S, Holdcrof t A. Heat retent ion usi ng passive syst ems duri ng
anaesthesia: compari son of two pl ast i c wraps, one wi t h ref lective propert i es. Br J
Anaesth 1997;79:766769.
[Medli ne Li nk]
229. Kami tani K, Hi guchi A, Takebayashi T, et al . Coveri ng the head and face
mai ntai ns intraoperat i ve core temperature. Can J Anaesth 1999;46:649652.
[Medli ne Li nk]
230. Howel l RD, MacRae LD, Sanj i nes S, et al . Eff ects of t wo types of head
coveri ngs in the rewarmi ng of pati ents af ter coronary artery bypass graf t surgery.
Heart Lung 1992;21:15.
[Medli ne Li nk]
231. Erickson R, Yount S. Eff ect of al umi ni zed covers on body temperature i n
pati ents havi ng abdomi nal surgery. Heart Lung 1991;20:255264.
[Medli ne Li nk]
232. Parry NS, Ni ghti ngale A. A si mpl e way to reduce heat l oss f rom t he head.
Anaesthesia 2002;57: 1043.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
233. Sessl er DI, McGui re J, Sessl er AM. Peri operative thermal i nsul ati on.
Anesthesi ol ogy 1991; 74:875879.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
234. Si mmons M, Phi l l i ps P, Doctor U, et al . The eff ect of t wo i nt raoperat ive heat -
conservi ng methods on ort hopedic pati ents receivi ng regi onal and general
anesthesi a. J Postanesth Nurs 1992;7:170175.
[Medli ne Li nk]
235. Whi tney AM. The ef fi ci ency of a ref l ecti ve heat i ng bl anket in preventi ng
hypothermia i n pat ients undergoi ng intra-abdomi nal procedures. AANA J
1990; 58:212215.
[Medli ne Li nk]
236. Brauer A, Perl T, Uyanik Z, et al . Peri operat ive t hermal i nsulati on: mi ni mal
cl i nical ly i mportant di ff erences? Br J Anaest h 2004;92:836840.
237. Magl i nger PE, Sessler DI, Lenhardt R. Cutaneous heat loss wi t h three surgical
drapes, one i mpervi ous to moisture. Anesth Anal g 2005;100:738742.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
238. Sessl er D, Schroeder M. Heat l oss i n humans covered wi th cott on hospi tal
bl ankets. Anesth Anal g 1993;77: 7377.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
239. Feroe D, August ine S. Hypothermi a in t he PACU. Cri t Care Nurs Cli n North Am
1991; 3:135144.
[Medli ne Li nk]
240. Wicks TC. Take our pati ent warmi ng qui z. Outpat ient Surgery Magazi ne
2006; 7: 3643.
241. Bourke DL, Wurm H, Rosenberg M, et al . I nt raoperati ve heat conservati on
using a refl ecti ve bl anket. Anesthesi ol ogy 1984;60:151154.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
242. Bl ansett MT. The ef fects of rewarmi ng hypothermi c postanaesthesi a pati ents
using Thermadrape coveri ng, heat l amps, and warmed cott on bl ankets. J
Postanesth Nurs 1990;5: 8084.
[Medli ne Li nk]
243. Hi ndshol m K, Bredahl P, Herl evsen P, et al . Refl ecti ve bl ankets used for
reducti on of heat l oss duri ng regi onal anaesthesi a. Br J Anaest h 1992;68:531
533.
[CrossRef ]
[Medli ne Li nk]
244. Thomas L, Engl i sh S, Cork R. The eff ect of ref l ect i ve hats and j ackets on
i ntraoperati ve temperature decrease. Anesthesi ology 1997;87:A29.
245. Buggy D, Hughes N. Pre-empti ve use of the space blanket reduces shiveri ng
af ter general anaest hesi a. Br J Anaesth 1994;72: 393396.
[CrossRef ]
[Medli ne Li nk]
246. Radf ord P, Thurl ow A. Met al l i zed pl asti c sheeti ng i n the preventi on of
hypothermia duri ng neurosurgery. Br J Anaesth 1979;51: 237240.
[CrossRef ]
[Medli ne Li nk]
247. Daanen HAM, Van De Li nde FJG. Compari son of f our noni nvasive rewarmi ng
methods f or mi l d hypot hermia. Avi at Space Envi ron Med 1992;63:10701076.
[Medli ne Li nk]
248. Sharkey A, Li pton JM, Murphy MT, et al . Inhi bi t ion of postanest het ic shivering
wi th radi ant heat . Anesthesi ol ogy 1987;66: 249252.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
249. Buggy D, Gardiner J. The space bl anket and shiveri ng duri ng ext radural
analgesi a in l abour. Acta Anaesthesiol Scand 1995;39:551553.
[Medli ne Li nk]
250. August ine DS. Hypot hermi a therapy i n the post anesthesi a care uni t: a revi ew.
J Post Anesth Nurs 1990;5: 254263.
[Medli ne Li nk]
251. Pat el N, Smi th CE, Knapke D, et al . Convecti ve warmi ng alone is superi or to
t hermal i nsul ati on wi t h f l ui d warmi ng. Anesthesiology 1996;85:A413.
252. Crooke JW, McCann T. Saf et y of space bl ankets. Anaesthesia 1994;49: 547.
[CrossRef ]
[Medli ne Li nk]
253. Chandon M, Paugam C, Cohen S, et al . Ef fi cacy of el ectric warmi ng bl ankets
t o prevent hypothermi a duri ng hi p surgery. Anesthesiol ogy 1995; 83:A398.
254. Camus Y, Bossard AE, Cohen S, et al . Hypothermi a prevent i on duri ng
abdomi nal surgery by el ectric warmi ng bl ankets wi th t hermostat ic cont rol . Br J
Anaesth 1996;76:27.
255. Camus Y, Bossard AE, Cohen S, et al . Hypothermi a prevent i on duri ng
abdomi nal surgery by el ectric blankets wi t h thermostati c control . Anesthesi ology
1996; 85:A412.
256. Camus Y, Delva E, Bossard AE, et al . Preventi on of hypothermi a by cutaneous
warmi ng wi t h new el ect ri c bl ankets duri ng abdominal surgery. Br J Anaesth
1997; 79:796797.
[Medli ne Li nk]
257. Camus Y, Delva E, Li enhart A. Hypot hermi a prevent ion by cutaneous warmi ng.
A cost compari son between forced ai r warmi ng and el ect ric warming blankets.
Anesthesi ol ogy 1997; 87:A494.
258. Dewar DJ, Fraser JF, Chon KL, et al . Thermal i nj uri es i n three chi l dren caused
by an el ectrical warmi ng matt ress. Br J Anaesth 2004;93: 586589.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
259. Joachi msson P-O, Nystrom S-O, Tyden H. Heat ing eff icacy of external heat
suppl y during and af t er open-heart surgery wi th hypot hermia. Act a Anaesthesi ol
Scand 1987;31:7380.
[Medli ne Li nk]
260. Bredahl C, Lambert -Jensen P, Freundl i ch M. Ef fect of radi ant heat er on post -
operati ve hypothermi a: compari son wi th a ref l ect ive bl anket. Eur J Anaesthesi ol
1995; 12:565569.
[Medli ne Li nk]
261. Wong A, Wal ker S, Bradl ey M. Compari son of a radi ant pat ient warmi ng devi ce
wi th f orced ai r warmi ng duri ng l aparoscopi c chol ecystect omy. Anaesth I ntens Care
2004; 32:9399.
[Medli ne Li nk]
P. 902


262. Cushing EV, Mi l l s KR. Does radi ant heat on t he bl ush area i nhi bi t shiveri ng
and decrease rewarmi ng t i me t hrough peri pheral vasodi lat i on? A proposed new
method f or rewarmi ng postoperat ive cardi ac and surgi cal pati ents. Can J Anaesth
1997; 44:A60.
263. Joachi msson P, Nyst rom S, Tyden H. Post operat ive venti lat ory and ci rcul atory
ef fects of heati ng af ter aortocoronary bypass surgery: post operat ive external heat
suppl y. Acta Anaesthesi ol Scand 1987;31:532542.
[Medli ne Li nk]
264. Sharkey A, Gul den RH, Li pt on JM, et al . Eff ect of radi ant heat on t he
metabol i c cost of postoperative shiveri ng. Br J Anaesth 1993;70:449450.
[CrossRef ]
[Medli ne Li nk]
265. Henneberg S, Ekl und A, Joachi msson PO, et al . Ef f ects of a t hermal cei l i ng on
postoperati ve hypothermia. Acta Anaesth Scand 1985;29:602606.
[Medli ne Li nk]
266. Imri e MM, Ward M, Hal l GM. A compari son of pati ent rewarmi ng devices af ter
cardi ac surgery. Anaesthesi a 1991;46:4448.
[CrossRef ]
[Medli ne Li nk]
267. Weyl and W, Weyl and A, Hel l i ge G, et al . Ef f iciency of a new radi ant heater f or
postoperati ve rewarmi ng. Act a Anaesthesi ol Scand 1994; 38:601606.
[Medli ne Li nk]
268. Torri e JJ, Yip P, Robi nson E. Compari son of f orced-ai r warmi ng and radi ant
heati ng duri ng transurethral prostat i c resecti on under spi nal anaesthesi a. Anaesth
I ntens Care 2005;33:733738.
[Medli ne Li nk]
269. Sessl er DI, Sessl er AM, Hudson S, et al . Heat l oss duri ng surgi cal ski n
preparat i on. Anesthesi ol ogy 1993; 78:10551064.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
270. Anonymous. DraegerBabytherm Model 8004 and 8010 warmi ng uni ts: ri sk of
i naccurate t emperature measurements. Heal th Devices Al erts 2004;28:3.
271. Si menauer R, Spencer T. Dynamic thermal responses of fi ve commercial l y
avai l able i nf ant radi ant warmer systems. Biomed InstrumTechnol 2000;34:203
211.
272. Shel l ey K, Shel l ey S, Bel l C. Moni tori ng i n unusual envi ronments. In: Lake CL,
Hi nes RL, Bli tt CD, eds. Cli ni cal Moni tori ng. Practi cal Appl icat ions for Anesthesia
and Cri t i cal Care. Phi ladel phi a: WB Saunders Company, 2001:524538.
273. Morton GH, Flewel l en EH. Preventi on of intraoperat i ve hypothermi a in geri at ri c
pati ents. Anesth Anal g 1989;68:S204.
274. Gi nsberg S, Soli na A, Papp D, et al . A prospect ive comparison of three heat
preservati on methods f or pati ents undergoing hypothermi c cardiopul monary bypass.
J Cardi othorac Vasc Anesth 2000; 14:501505.
[Medli ne Li nk]
275. McEvoy MT, Carey TJ. Shi vering and rewarmi ng af ter cardi ac surgery:
compari son of venti l ator ci rcui ts wi t h humi di f i er and heated wi res t o heat and
moi st ure exchangers. Am J Cri t Care 1995;4:293299.
[Medli ne Li nk]
276. Bi ssonnet te B, Sessl er DI . Passi ve or acti ve i nspi red gas humi di f icati on
i ncreases thermal steady-state temperatures i n anestheti zed i nf ants. Anesth Anal g
1989; 69:783787.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
277. Bi ssonnet te B, Sessl er KI, LaFl amme P. Passive and acti ve inspi red gas
humi di f icati on i n i nf ants and chi l dren. Anesthesiology 1989;71:350354.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
278. Baden JM, Fuj i naga M. Ef f ects of ni trous oxide on day 9 rat embryos grown i n
cul ture. Br J Anaesth 1991;66:500503.
[CrossRef ]
[Medli ne Li nk]
279. Mi l l er G, Badgwel l JM, Hei nri ch R, et al . Cutaneous heat l oss exceeds
respi ratory heat loss in anestheti zed chil dren. Anesthesi ol ogy 1993;79:A1170.
280. Guran C, Schi ot terbeck H, Schaef f er R, et al . Prevent ion of central
t emperat ure drop duri ng peri t oneal i nsuf f l ati on: comparison of t wo CO
2

humi di f icati on devices. Anesthesiology 2005;103:A859.
281. Eckerbom B, Li ndhol m CE. Heat and moi sture exchangers and the body
t emperat ure: a peroperat ive study. Acta Anaesthesiol Scand 1990;34: 538542.
[Medli ne Li nk]
282. Gregori ni P, Cangini D. Control of body t emperat ure duri ng abdomi nal aort ic
surgery. Acta Anaesthesi ol Scand 1996;40:187190.
[Medli ne Li nk]
283. Anonymous. A cl i ni cal and t echnical overview of i n-l i ne blood/sol ut ion
warmers. Technol Anesth 1997;17(9): 16.
284. Turner MWH, Hodzovic I , Mapl eson WW. Si mul ated cl inical evaluat ion of f our
f lui d warmi ng devi ces. Anaest hesi a 2006;61:571575.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
285. Camus Y, Cohen M, Del va E, et al . Ef fect of warmi ng i .v. f l uids on
i ntraoperati ve hypot hermia and post operat ive shi veri ng. Br J Anaesth
1995; 74:A52.
286. El li s-Stoll C, Anderson C, Cant u L, et al . Ef f ect of cont i nuousl y warmed I V
f lui ds on i nt raoperat ive hypothermi a. AORN J 1996;63:599606.
[CrossRef ]
[Medli ne Li nk]
287. Leben J, Trybga M. Preventi on of hypothermi a duri ng surgery: contri but ion of
convecti ve heati ng syst em and warm i nfusi on. Anesthesi ol ogy 1996;85:A416.
288. Smi th C, Gerdes E, Sweda S, et al . Warmi ng i ntravenous f luids reduces
peri operat ive hypothermi a i n women undergoi ng ambulatory gynecol ogi cal surgery.
Anesth Anal g 1998;87:3741.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
289. Pat el N, Smi th CE, Pi nchak AC, et al . Prospect ive, randomi zed compari son of
t he Flotem I Ie and hotl i ne fl ui d warmers i n anestheti zed adul ts. J Cl i n Moni t
1996; 8:307316.
290. Smi th CE, Fi sgus JR, Kan M, et al . Ef f i cacy of IV f lui d warmi ng i n Cesarean
secti on pati ents undergoi ng regi onal anesthesi a. Anesthesiology 1999;91:A1071.
291. Camus Y, Delva E, Cohen S, et al . The eff ects of warmi ng int ravenous f l ui ds
on i nt raoperati ve hypothermia and postoperat ive shi veri ng during prol onged
abdomi nal surgery. Act a Anaesthesi ol Scand 1996;40: 779782.
[Medli ne Li nk]
292. Workhoven M. Int ravenous f lui d temperature, shi veri ng, and the part uri ent .
Anesth Anal g 1986;65:496498.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
293. Dunham CM, Bel zberg H, Lyl es R, et al . The rapi d i nf usi on system: a superi or
method f or t he resusci tat ion of hypovol emi c trauma pati ents. Resusci t at ion
1991; 21:207227.
[CrossRef ]
[Medli ne Li nk]
294. Smi th CE, Fi sgus JR, Kan M, et al . Ef f i cacy of I V f lui d warmi ng in cesarean
secti on pati ents undergoi ng regi onal anesthesi a. Am J Anaesthesiol 2000;27:84
88.
295. Hurd WW, Togl ia MR, Smi th YR. Laparoscopi c i rri gati on usi ng a prewarmed
pressuri zed syst em. J Laparoendosc Surg 1993;3: 573575.
[Medli ne Li nk]
296. Muth CM. The use of countercurrent heat exchangers dimi ni shes acci dental
hypothermia duri ng abdominal aort ic aneurysm surgery. Acta Anaesthesi ol Scand
1996; 40:11971201.
[Medli ne Li nk]
297. Li nko K. In-l i ne bl ood warmi ng and mi crof i l t rati on devices II . I nf l uence of blood
t emperat ure on f low rat e and hemol ysis duri ng pressure t ransfusi on through
mi crofi l t ers and t ransfusi on sets. Acta Anaesth Scand 1979; 23:4650.
[Medli ne Li nk]
298. Herron D, Grabowy R, Connol l y R, et al . The l i mi ts of bloodwarmi ng:
maxi mal l y heat ing bl ood wi t h an i nl i ne mi crowave bl oodwarmer. J Trauma
1997; 43:219228.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
299. Anonymous. In-l i ne blood/sol ut ion warmers. Heal th Devices 1996;25:352
390.
[Medli ne Li nk]
300. Bowen D. Eff iciency of the Thermal Jacket on the del ivered temperature of
prewarmed crystal l oi d i ntravenous f l ui d. AANA J 1992;60:369373.
[Medli ne Li nk]
301. Bi ssonnet te B, Paul O. Acti ve warmi ng of sal i ne or bl ood i s i nef fective when
standard i nf usi on tubi ng is used: an experi mental study. Can J Anaesth
2002; 49:270275.
[Medli ne Li nk]
302. Fari es G, Johnst on C, Prui t t KM, et al . Rel ati onshi p to di stance and fl ow rate
of warmed IV f l ui ds. Ann Emerg Med 1991; 20: 11981200.
[CrossRef ]
[Medli ne Li nk]
303. Fari es G, Johnst on C, Prui t t K, et al . Temperature rel at ionshi p to di stance and
f low rate of warmed IV f l ui d. Ann Emerg Med 1991;20: 11981200.
[CrossRef ]
[Medli ne Li nk]
304. Schul t z J, Guest C, Bissonnett e B. Fl ui d temperature in IV t ubi ng wi th and
wi thout bl ood warmi ng. Are conventi onal f l ui d warmers ef fecti ve i n pedi at ri c
anesthesi a. Anesthesiology 1997;87:A1045.
305. Presson R Jr, Hasel by K, Bezruczko A, et al . Eval uati on of a new hi gh-
ef fi ci ency bl ood warmer for chi l dren. Anesthesi ol ogy 1990; 73:173176.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
306. Lee J-H, Mi ntz PD. A method of est i mati ng t he del ivery temperature of
i ntravenous f l uids. Anesth Anal g 1994;79:155159.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
307. Henker R, Bernardo LM, O' Connor K, et al . Eval uati on of f our methods of
warmi ng i nt ravenous f l ui ds. J Emerg Nurs 1995;21:385390.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
308. Pat el N, Smi th CE, Pi nchack AC. Compari son of f l ui d warmer performance
duri ng si mul ated cl i ni cal condi t ions. Can J Anaesth 1995; 42: 636642.
[Medli ne Li nk]
309. Pat el N, Knapke DM, Smi th CE, et al . Si mul at ed cl i nical eval uati on of
conventi onal and newer f lui d-warmi ng devi ces. Anesth Analg 1996; 82:517524.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
310. Smi th CE, Kabbara A, Kramer RP, et al . Eval uati on of a new I V f l ui d and bl ood
warmi ng system to prevent ai r embol i sm. Trauma Care 2001;11:7882.
311. Barcel ona SL, Vi l i ch F, Cote CJ. A comparison of f low rates and warmi ng
capabi l i t ies of t he Level I and Rapid I nf usi on System wi th vari ous-si ze i nt ravenous
catheters. Anest h Anal g 2003;97:358363.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
312. Sat oh J-I, Yamakage M, Wasaki SI, et al . Perf ormance of three systems f or
warmi ng i nt ravenous f l ui ds at dif ferent f l ow rates. Anaesth I ntens Care 2006;34:46
50.
[Medli ne Li nk]
313. Pat el N, Knapke D, Smi th C, et al . Si mul at ed cl i nical evaluati on of
conventi onal and newer f lui d warmi ng devi ces. Can J Anaesth 1998;42:A28.
314. Pat el l N, Knapke D, Smi t h C, et al . Heat i ng capabi l i t ies of Hot l i ne and Fl otem
I Ie warmers i n anestheti zed pat ients. Can J Anaesth 1998;42: A28.
315. Ski rvanek GD, Hei n HAT. Fl ui d warmi ng: eff ect iveness wi t h ext ensi on tubi ng.
Anesthesi ol ogy 1988; 65:A126.
316. Norman E, Ahmad I , Zei g N. Del i very temperature and heated and cooled
i ntravenous sol uti ons. Anesth Anal g 1986; 65: 693699.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
317. Pat el N, Smi th CE, Costel l o F, et al . Cl i nical comparison of two f l uid warmers
i n adul t pat i ents. Can J Anaesth 1994;41:A53.
318. Raphael DT, Gardea-Torresdey JL, Ti emann K. Volati le i mpuri t i es i n
normothermic and heated pl asti c i nt ravenous sol ut ion bags. Anesth Analg
1997; 84:S204.
319. Anonymous. Li mi t i ng temperature set ti ngs on blanket and sol ut i on warmi ng
cabinets can prevent pat i ent burns. Heal th Devi ces Al ert s 2005;29:13.
320. Wi l son E, Knauf M, Donohoe K, et al . Red blood cel l survi val fol l owi ng
admi xture wi t h heat ed sal i ne: eval uat i on of a new bl ood warmi ng method for rapi d
t ransfusi on. J Trauma 1988; 28:12741277.
[CrossRef ]
[Medli ne Li nk]
321. Nemesdy G, Tal avera J, Azar I , et al . Rapi d warmi ng of stored bl ood.
Anesthesi ol ogy 1996; 85:A280.
322. Marks R, Mi nty B, Whi te D. Warmi ng bl ood before transfusion. Does i mmersi on
warmi ng change bl ood composi ti on? Anaesthesia 1985;40: 541544.
323. Schul t z J-A, Si ms C, Bissonnet te B. Met hods f or warmi ng i ntravenous f l uid i n
smal l vol umes. Can J Anaesth 1998;45:11101115.
[Medli ne Li nk]
324. Rososhansky S, Szymanski I. Is bl ood warmi ng before t ransfusi on a saf e
procedure? Anesth Anal g 1994;79:197198.
325. Leaman P, Martyak G. Microwave warmi ng of resusci tati on f luids. Ann Emerg
Med 1985; 14:876879.
[CrossRef ]
[Medli ne Li nk]
326. Schwai tzberg SD, Al l en MJ, Connol l y RJ, et al . Rapi d i n-l i ne bl ood warmi ng
using mi crowave energy: prel i mi nary st udi es. J Invest Surg 1991;4:505510.
[Medli ne Li nk]
327. St apl es P, Gri ner P. Ext racorporeal hemol ysi s of blood in a microwave bl ood
warmer. N Engl J Med 1971;285:317319.
[Medli ne Li nk]
328. Luf f RD, Kessl er CM, Bel l WR. Microwave technol ogy for rapi d thawi ng of
f rozen bl ood components. Am J Cl in Pathol 1985;83:5964.
[Medli ne Li nk]
329. Arens JF. Danger of overwarmi ng bl ood by mi crowave. JAMA 1971;218: 1045.
[CrossRef ]
[Medli ne Li nk]
330. Hi rsch J, Bach R, Menzebach A, et al . Temperature course and distri buti on
duri ng pl asma heati ng wi th a microwave device. Anaesthesi a 2003; 58:444447.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
331. Weesner K, Wai sel D. A ci rcl e syst em: adaptat i on of t he hotl i ne f luid warmer
i s eff ect i ve f or smal l volumes. Anesth Anal g 1998; 86:S244.
332. Zuokumor P. An unusual postoperat ive burn. Anaesthesi a 2004;59:510.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
333. Fl ancbaum L, Trooski n SZ, Pedersen H. Eval uati on of bl ood-warmi ng devices
wi th t he apparent thermal cl earance. Ann Emerg Med 1989;18:355359.
[CrossRef ]
[Medli ne Li nk]
334. Uhl L, Paci ni D, Kruskal l MS. A comparat ive study of bl ood warmer
perf ormance. Anesthesiology 1992;77:10221028.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
335. Smi th CE, Pri nci pl es of f l ui d warming i n t rauma. Semi n Anesth 2001;20:51
59.
[CrossRef ]
336. Husser CS, Chambl ee B, Brown MJ, et al . Induct ive warmi ng of i nt ravenous
f lui ds: overheati ng of the toroid heati ng el ement during rapi d i nfusi on.
Anesthesi ol ogy 2004; 101: 10191021.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
337. Pat el N, Smi th CE, Pi nchak AC. Cl i ni cal compari son of bl ood warmer
perf ormance at maximum f low rates. Can J Anaesth 1994;41:A36.
338. Bl ock E, Cheatham M, Saf csak K, et al . Dry-wal l f l ui d warmers fail to heat
crystal l oid f luids at l ow t o moderate inf usion rat es. Cri t Care Med 1999;27: A172.
339. Browne DA, De Doeck R, Morgan M. As evaluati on of the Level I bl ood warmer
seri es. Anaesthesi a 1990; 45:960963.
[CrossRef ]
[Medli ne Li nk]
340. Li nko K. Testi ng of a new i n-l ine blood warmer. Anesthesi ol ogy 1980; 52:445
446.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
341. Wal ters S, Wood C, Morgan M. An eval uati on of the Sti hl er 1FT 200 blood
warmer. Anaesthesi a 1988;43:3032.
[CrossRef ]
[Medli ne Li nk]
342. Mant i a A. High l eakage current i n new i n-l ine bl ood warmer. Anesthesiology
1981; 54:257.
[Medli ne Li nk]
343. Paulsen A, Pri t chard D. ECG art i f act produced by cryst al loid admi ni st rati on
t hrough bl ood/f luid warmi ng sets. Anesthesi ol ogy 1988;69: 803804.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
344. Takehara Y, Uno T, Motomatsu K. Acci dent of bl ood warmer and i ts
compl i cati on. Masui 1981;30: 992995.
[Medli ne Li nk]
345. Vaughan R. Morbi di ty due to exchange transf usi on wi th heat -hemol yzed bl ood.
Am J Dis Chi l d 1982; 136:646648.
[Medli ne Li nk]
346. Carr K. Mi crowave heati ng of physiol ogic f luids. Microwave Journal
1994; 37:2432.
347. Gi bby GL, Lampot ang S, Gravenstei n N. Magnetron-based i nl i ne microwave
f lui d warmer. J Cl i n Moni t 1996;12:271276.
[CrossRef ]
[Medli ne Li nk]
348. Pappas CG, Paddock H, Goyet te P, et al . I n-l i ne microwave bl ood warmi ng of
i n-date human packed red bl ood cel l s. Cri t Care Med 1994;22:A216.
[CrossRef ]
P. 903


349. Connol l y RJ, Al l en MJ, Ramberg K, et al . I n vivo erythrocyte survival st udi es
af ter in-l i ne mi crowave warmi ng. Anesthesiology 1991;75:A1115.
[Full text Li nk]
[CrossRef ]
350. Hol zman S, Connol l y R, Schwai t zberg S. The eff ect of i n-l i ne microwave
energy on bl ood: a potenti al modal i t y for blood warmi ng. J Trauma 1992;33:89
94.
[CrossRef ]
[Medli ne Li nk]
351. Gi bby GL, Lampot ang S, Gravenstei n N. Magnetron-based i nl i ne microwave
f lui d warmer. J Cl i n Moni t 1996;12:271276.
[CrossRef ]
[Medli ne Li nk]
352. Hol zman S, Connol l y RJ, Schwai tzberg SD. The ef fect of i n-l i ne mi crowave
energy on bl ood: a potenti al modal i t y for blood warmi ng. J Trauma 1992;33:89
94.
[CrossRef ]
[Medli ne Li nk]
353. Pappas CG, Paddock H, Goyet te P, et al . In-l i ne microwave bl ood warmi ng of
i n-date human packed red bl ood cel l s. Cri t Care Med 1995;23:12431250.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
354. Russel l W. A review of blood warmers f or massive t ransf usion. Anaesth I ntens
Care 1974;2: 109130.
[Medli ne Li nk]
355. Vaghadi a H. Bl ood warmi ng wi t h t he Avon A60 extension set. Anaesthesi a
1984; 39:932933.
[CrossRef ]
[Medli ne Li nk]
356. Ward CF, Ozaki GT. Laboratory eval uati on of a hi gh ef f iciency I.V. f l ui d
warmer. Anesthesi ol ogy 1988;69:A287.
[Full text Li nk]
[CrossRef ]
357. Wu A, Oshi ma W, Dhandha S. Imperf orat e blood warmer coi ls. Anesthesi ol ogy
1979; 51:579.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
358. Casewel l MW, Sl ater NGP, Cooper JE. Operati ng theat re waterbat hs as a
cause of pseudomonas sept icaemi a. J Hosp I nf ect 1981;2: 237247.
[CrossRef ]
[Medli ne Li nk]
359. Oi ra K, Yasukawa K, Takahashi T. An acci dent i nvol vi ng the bl ood warmer.
Masui 1973;22: 259263.
[Medli ne Li nk]
360. Bj oraker D. Bl ood warmers as a source of sol ut ion-conducted leakage
currents. Anesthesi ol ogy 1978; 49:286288.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
361. Bray B. Ri sk of i nf ect ion f rom water bat h bl ood warmers. Anaesthesi a
1987; 42:778779.
[CrossRef ]
[Medli ne Li nk]
362. D' Angel o E. Fl ui d warmer l eakage i nto the bloodst ream: a case report . J Am
Assoc Nurse Anesth 1995;63: 525528.
363. Coroneos N. Hazard of blood warmi ng coi l s. Anaest h Intens Care 1978;6: 87.
[Medli ne Li nk]
364. Bray B. Ri sk of i nf ect ion f rom water bat h bl ood warmers. Anaesthesi a
1987; 42:778779.
[CrossRef ]
[Medli ne Li nk]
365. Hegart y M, Turner T, Yent is SM. FW-5371 f l ui d warmer. Anaesthesia
2000; 55:402403.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
366. Johnson ALM, Morgan M. An assessment of a bl ood warmer f or hi gh and low
f lows. Anaesthesi a 1994; 49:707709.
[CrossRef ]
[Medli ne Li nk]
367. Smal l man J, Morgan M. Evaluati on of the Level I Hotl i ne bl ood warmer.
Anaesthesia 1992;47: 869871.
[CrossRef ]
[Medli ne Li nk]
368. Fried SJ, Sat iani B, Zeeb P. Normothermic rapi d vol ume repl acement for
hypovolemi c shock: an i n vivo and i n vi tro st udy ut il i zi ng a new techni que. J
Trauma 1986;26: 183188.
[CrossRef ]
[Medli ne Li nk]
369. Presson RG, Bezruczko AP, Hi l l i er SC, et al . Eval uati on of a new f l uid warmer
ef fective at low t o moderat e f l ow rat es. Anesthesiology 1993;78:974980.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
370. Magui re D, Torjman M. Flui d warmi ng using a hot ai r warmi ng bl anket .
Anesthesi ol ogy 1998; 89:A560.
371. Magui re DP, Torjman M. Fluid warmi ng at l ow f l ow rat es usi ng a hot ai r
warmi ng blanket . J Cl in Moni t 1997; 13:422.
372. Anonymous. New device coul d reduce rewarmi ng t ime f rom anesthesi a
hypothermia. Anesthesi ology News, 1997.
373. Grahn D, Katol ic J, Brock-Utne J. The evoluti on of a technique f or treat ing
hypothermia: a port abl e device f or appl icati on of negati ve pressure and heat t o
speci f i c heat exchange surf aces. Anesth Anal g 1998;86:S206.
374. Mathus A, Grahn D, Di l li ngham MF, et al . Treatment of mi l d hypothermi a usi ng
t he t hermostat f aci l i tates earl ier di scharge f rom t he post anesthesi a care uni t.
Anesthesi ol ogy 1999; 91:A1232.
375. Tran KM, Frank SM, El -Rahmany HK, et al . Treat ment of hypothermi a wi t h
sub-atmospheri c pressure warmi ng (SAPR) of t he upper extremi t y. Anesthesiology
1999; 91:A532.
376. Grahn D, Brock-Utne JG, Wat enpaugh D, et al . Recovery f rom mi ld
hypothermia can be accel erated by mechani cal l y distendi ng bl ood vessel s in t he
hand. J Appl Physiol 1998;85: 16431648.
[Medli ne Li nk]
377. Taguchi A, Arki l i c CF, Ahl uwal i a A, et al . Ef fi cacy of vi t al -heat warming i n
post-anesthet ic volunteers. Poster presentat i on, ASA Meet ing, San Francisco,
2000.
378. Smi th CE, Parand A, Pinchak AC, et. al . Fai lure of negat i ve pressure
rewarmi ng (thermostat) t o accelerate recovery f rom mi l d hypothermi a i n
postsurgical pati ents. Anesthesiol ogy 1999; 91:A1175.
379. Smi th CE, Parand A, Pinchak AC, et al . Fai l ure of negati ve pressure
rewarmi ng (thermostat) t o accelerate recovery f rom mi l d hypothermi a i n
postsurgical pati ents. Anesth Anal g 1999;89:15411545.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
380. Beck E, Langer M, Di Mauro P, et al . Eff i cacy of intraoperat ive heat
admi ni st rati on by venti l ati on wi th warm humi dif i ed gases and an oesophageal
warmi ng system. Br J Anaest h 1996;77:530533.
[Medli ne Li nk]
381. Krist ensen G, Drenck NE, Jordeni ng H. Si mpl e system f or cl i nical rewarmi ng
of hypot hermi c pat ients. Lancet 1986;2:14671468.
[CrossRef ]
[Medli ne Li nk]
382. St ei b A, Bel ler J, von Bandel M, et al . Oesophageal thermal t ube f or
i ntraoperati ve hypot hermia i n l i ver t ransplantati on. Acta Anaesthesiol Scand
1993; 37:199202.
[Medli ne Li nk]
383. Kul karni P, Matson A, Bri ght J, et al . Cl i ni cal eval uati on of the oesophageal
heat exchanger i n the preventi on of perioperati ve hypothermia. Br J Anaesth
1993; 70:216218.
[CrossRef ]
[Medli ne Li nk]
384. El -Gamal N, El -Kassabany N, Frank SM, et al . Age-related thermoregul at ory
di ff erences i n a warm operati ng room envi ronment (approxi matel y 26C). Anesth
Anal g 2000;90:694698.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
385. Choi JJ. A compassionat e view of pat ient warmi ng. Out pat i ent Surgery
Magazi ne 2004;5:88.
386. Smi th CE, Sorei de E. Hypothermia i n trauma vi ct ims. ASA Newsl et t
2005; 69:179, 30.
387. Met zger SE, Lam J, Harri s A, et al . Intraoperat i ve forced-ai r warmi ng
decreases emergence t ime and operati ng room costs. Anesth Anal g 1997;84:S44.
388. Mort TC, Ri nt el TD, Al tman F. Shi veri ng in t he cardi ac patent: eval uat ion of
t he Bai r hugger warmi ng syst em. Anesthesiol ogy 1990;72: A238.
389. Thompson N. Hot ai r warmi ng devi ces-a potenti al hazard. Anaesthesi a
1996; 51:287.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
390. Taylor IR. Bai r Hugger active pat ient warming system. Br J Anaesth
1998; 80:409.
[Medli ne Li nk]
391. Ayala JL, Coe A. Thermal sof tening of t racheal tubes: an unrecogni zed hazard
of t he Bai r Hugger acti ve pati ent warmi ng system. Br J Anaesth 1997;79:543545.
[Medli ne Li nk]
392. Zi nk RS, I ai zzo PA. Convecti ve warmi ng therapy does not i ncrease the ri sk of
wound cont ami nat i on i n the operat ing room. Anesth Anal g 1993;76:5053.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
393. Avi dan MS, Jones N, Khoosal M, et al . Convect ion warmersnot j ust hot ai r.
Anaesthesia 1997;52: 10731076.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
394. Si gg DC, Houl ton AJ, Iai zzo PA. The pot ent i al f or i ncreased i nf ecti on due to
t he reuse of convecti ve-ai r warmi ng/cool i ng coverl ets. Anesthesi ol ogy
1998; 89:A1207.
395. Si gg DC, Houl ton AJ, Iai zzo PA. The pot ent i al f or i ncreased ri sk of i nf ect ion
due to the reuse of convecti ve ai r warmi ng/cool ing coverl ets. Act a Anaesthesi ol
Scand 1999;43:173176.
[CrossRef ]
[Medli ne Li nk]
396. Oku S, Ohashi I, Yokoyama M, et al . Bacteri al contaminati on i n ci rcul at i ng
wat er of Hotl i ne bl ood warmi ng system. Anesthesi ol ogy 2002;96: A1158.
397. Rutal a WA, Weber DJ. Water as a reserv oi r of nosocomi al pathogens. I nf ect
Control Hosp Epi demi ol 1997;18:609616.
[Medli ne Li nk]
398. Burns S. An i nvesti gati on of surgi cal i nfecti ons reveal s a f l ui d warmer as a
reservoi r f or bacteri a. Am J Inf ect Cont rol 1999;27:216.
[Full text Li nk]
399. Anonymous. Greater vi gi lance urged i n use of SI MS Level 1 Hotl i ne f l ui d
warmers t o detect leaks in warmi ng set . Heal th Devi ces 2000;29:478480.
[Medli ne Li nk]
400. Ben-David B, Sol omon E, Levin H. Spinal anesthesi a, hypot hermi a, and
sedati on: a case of resedati on wi th f orced-ai r warmi ng. Anesth Anal g
1997; 85:13571358.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
401. Rosenf iel d L, Pi t lyk P. Intraoperati ve burns secondary t o warmed I V bags: a
warni ng. Anesthesiol ogy 1999; 90:616618.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
402. Mohrenschl ager M, Weigl LB, Haug S, et al . I at rogeni c burns by warmi ng
bot tl es i n the neonatal period. Report of two cases and review of the l i t erature. J
Burn Care Rehabi l 2003; 24:5255.
[Medli ne Li nk]
403. O' Dea TJ, Sal y G, Hol te J. Saf et y invest i gat ion: i nteracti on of i nf ant radi ant
warmers and bi l i rubin phototherapy li ghts i n t he regul at ion of temperature of
newborn i nf ants. Bi omed I nst rum Tech 1998;32:355369.
404. Anonymous. Improperl y connected cord l eads to pat ient burns on Advanced
Surfaces Cool / Heat matt resses. Heal t h Devi ces Al erts 2005;29:34.
405. Gal i B, Fi ndlay JY, Pl evak DJ. Ski n injury wi th t he use of a wat er warmi ng
device. Anesthesi ol ogy 2003;98: 15091510.
[Ful l text Li nk]
[CrossRef ]
[Medli ne Li nk]
406. Greenhalgh DG, Lawl ess MB, Chew BB, et al . Temperature threshol d for burn
i nj ury: an oxi meter safet y study. J Burn Care Rehabi l 2004;25:411415.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
407. Anonymous. Device rel ated burns. Technol Anesth 1993;14:16.
408. Roth JV. Warm ai r convecti on heati ng bl ankets may increase the absorpt ion of
t ransdermal ni t rogl yceri n. Anesthesi ol ogy 1997;86:12081209.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
409. Frol i ch MA, Gi annot ti A, Model l JH. Opi oid overdose i n a pati ent usi ng a
f entanyl patch duri ng treatment wi t h a warmi ng bl anket . Anesth Anal g 2001;93:647
648.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
410. Roth JV. Warming bl ankets shoul d not be pl aced over t ransdermal
medi cati ons. Anesth Analg 2002; 94:1043.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
411. Uhl L, Paci ni D, Kruskal l M. The eff ect of heat on i n vi t ro parameters of red
cell i ntegri t y. Transf usi on 1993;33:60S.
412. Li nko K, Hekal i R. Inf l uence of the Taurus radi owave bl ood warmer on human
red cel ls. Hemol ysis and eryt hrocyte ATP and 2,3 DPG concent rati ons f ol lowi ng
warmi ng by radiowaves, microwaves and water bath. Acta Anaesthesi ol Scand
1980; 24: 4652.
[Medli ne Li nk]
413. Schnorr J, Macko S, Weber I, et al . The ai r el imi nat i on capabi l i ti es of pressure
i nfusi on devices and fl ui d-warmers. Anaesthesi a 2004;59:817821.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
414. Comunal e ME. IV f l ui d warmers create ai r embol us danger. APSF Newslett
2000; 15:4142.
415. St evenson GW, Tobin M, Hal l SC. Fl uid warmer as a potenti al source of ai r
bubbl e embol i . Anesth Anal g 1995;80:1061.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
416. Wol in J, Vasdev GM. Potent ial for ai r embol ism usi ng Hotl i ne (Model HL90
f lui d warmer. J Cl i n Anesth 1996;8:8182.
[CrossRef ]
[Medli ne Li nk]
417. Mashimo T. Rapi d warmi ng of stored bl ood causes f ormati on of bubbl es i n the
i ntravenous tubi ng. Anesth Anal g 1980;59:512513.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
418. Woon S. Possi bl e ri sk of ai r embol i usi ng hot l ine HL-900 f l ui d warmer.
Anesthesi ol ogy 1998; 89:A1204.
419. Anonymous. Use of pressure inf usion wi t h Level 1 technol ogi es L-10 gas
el i mi nators and hotl ine f l ui d warmers. Technol Anesth 1996;16: 67.
420. Woehl ck HJ. Equi pment modi f i cati on to prevent ai r emboli sm wi th LEVEL 1
H-500 f l ui d warmer. Can J Anaesth 1995;42: 11781179.
[Medli ne Li nk]
421. Hartmannsgruber MWB, Gravenstei n N. Very l i mi ted ai r el i minati on capabi l i t y
of t he Level 1 f luid warmer. J Cl i n Anesth 1997;9:233235.
[CrossRef ]
[Medli ne Li nk]
422. Woon S, Talke P. Amount of ai r i nfused t o pati ent increases as f l ui d f l ow rat es
decrease when usi ng the Hot l ine HL-90 f l uid warmer. J Cl i n Moni t Comput
1999; 15:149152.
[CrossRef ]
[Medli ne Li nk]
423. Adhikary GS, Massey SR. Massi ve ai r embol i sm: a case report. J Cl i n Anesth
1998; 10:7072.
[CrossRef ]
[Medli ne Li nk]
424. Breen PH, Hong A. Beware of t he ai r in t he bl ood pump. Anesth Analg
2000; 91:1038.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
425. Kuzukawa A, Takenoshi t a M, Nosaka S. Ai r bubbles produced duri ng bl ood
warmi ng f or t ransf usi on at l ow rate; thei r composi t i on and a device (reservoi r wi th a
f il ter) t o el i mi nate them. J Cli n Anesth 2004; 16:148149.
426. Anonymous. Smi th Medi cal Level 1 hi gh-f l ow f l ui d warmers: possi bi l i ty of ai r
embol i sm. Heal th Devi ces Alerts 2005;29(18): 56.
427. Anonymous. Smi ths Medical Level 1 f l uid warmers: possi bi l i t y of ai r
embol i sm. Heal th Devi ces Alerts 2005;29:45.
428. Anonymous. Bl ood/sol ut i on warmi ng uni ts. Technol Anesth 2005;25: 89.
429. Al dri dge J. Potent i al ai r embol us f rom a Level 1 Rapi d I nfuser. Anaesthesi a
2005; 60:12501251.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
430. St evenson GW, Tobin M, Cote CJ. Potenti al ai r embol us wi t h the use of a
bl ood/f luid warmi ng set . Anesth Analg 1994; 79:610611.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
431. Avula RR, Smi th CE. Ai r vent ing and in-l ine int ravenous fl ui d warming f or
pediatrics. Anesthesi ol ogy 2005; 102:1290.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
432. Smi th CE, Kabbara A, Kramer RP. A new I V f l ui d and bl ood warmi ng system to
prevent ai r embol i sm and compart ment syndrome. Anesthesi ol ogy 2001;95:A549.
433. Comunal e ME. A l aboratory eval uat i on of the Level 1 rapid i nf user (H1025)
and the Bel mont Instrument Fluid Management System (FMS 2000) f or rapi d
t ransfusi on. Anest h Anal g 2003;97:10641069.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
434. Schechter L. Compari son bet ween Level 1 and other f ast f l ow f l ui d warmi ng
systems. Anesth Anal g 2004; 99:301.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
435. Eat on MP, Dhi l lon AK. Rel ative perf ormance of the Level 1 and Ranger
pressure i nf usi on devices. Anest h Anal g 2003;97:10741077.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
P. 904


436. Phi l ip JH. Perf ormance of Level I and mi crowave medical systems ai r
el i mi nators. Anesthesiology 1999;91:A513.
437. Hemmerl i ng TM, Fort i er JD. Falsel y i ncreased bi spect ral index val ues i n a
seri es of pati ents undergoing cardi ac surgery usi ng forced-ai r warmi ng therapy of
t he head. Anesth Analg 2002; 95:322323.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
438. Wi l l sey D, Peterf reund R. Compart ment syndrome of t he upper arm af ter
pressuri zed i nf i l t rat i on of i nt ravenous f l ui d. J Cl in Anesth 1997; 9:428430.
[CrossRef ]
[Medli ne Li nk]
439. Luscombe M, Andrzej owski JC. Cl i nical appl icati ons of induced hypothermi a.
Conti nui ng Educati on i n Anaesthesi a, Cri ti cal Care & Pai n 2006;6:2327.
[CrossRef ]
440. Baranov D, Bumgardner J, Smi th DS, et al . Rapi d i nfusi on of chi l led IV
solut i ons f or moderat e hypothermi a. Anesthesiol ogy 1998; 89:A316.
441. Bernard SA, Bui st MD, Montei ro O, et al . I nduced hypot hermi a usi ng l arge
volume, ice-col d i nt ravenous f l ui d in comatose survi vors of out-of -hospi tal cardi ac
arrest: a prel i minary report. Resusci tati on 2003;56:913.
[CrossRef ]
[Medli ne Li nk]
442. Raj ek A, Grei f R, Sessl er DI, et al . Core cool i ng by central venous i nf usi on of
i ce-col d (4 and 20C) f l ui d. Anesthesiol ogy 2000; 93:629637.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
443. Baumgardner JE, Baranov D, Smi th DS, et al . The eff ect i veness of rapi dl y
i nfused i nt ravenous f l ui ds for i nduci ng moderate hypothermi a in neurosurgi cal
pati ents. Anesth Anal g 1999;89:163169.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
444. Werl hof V. Hot li ne f luid warmi ng f ai l s to mai ntain normot hermia.
Anesthesi ol ogy 1996; 84:15201521.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
445. Mayer SA, Kowal ski RG, Presci utt i M, et al . Cl i ni cal tri al of a novel surf ace
cool i ng system f or f ever control i n neurocri ti cal care pati ents. Cri t Care Med
2004; 32:25082515.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
446. Carhuapoma JR, Gupta K, Copl i n WM, et al . Treat ment of ref ractory fever i n
t he neurosciences i nt ensive care uni t usi ng a novel , water-ci rculat i ng cool i ng
device. J Neurosurg Anesthesi ol 2003;15:313318.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
447. O' Donnell JM, Axel rod P, Fi sher C, et al . Use and ef f ecti veness of
hypothermia bl ankets f or f ebri l e pati ents in t he i ntensi ve care uni t. Cl i n Inf ect Dis
1997; 24:12081213.
[Medli ne Li nk]
448. Mayer SA, Commi chau C, Scarmeas N, et al . Cl i ni cal tri al of an ai r-ci rcul at ing
cool i ng bl anket f or f ever cont rol i n cri ti cal l y i l l neurologic pati ents. Neurol ogy
2001; 56:292298.
[Full text Li nk]
[Medli ne Li nk]
449. Creechan TA, Vol l man KM, Kravutske M. Comparison of cooli ng by convecti on
t o cool i ng by conduct ion for t he t reatment of f ever in t he cri t ical ly i ll medi cal pati ent
popul ati on. Cri t Care Med 1999;27:A32.
[Full text Li nk]
[CrossRef ]
450. Theard MA, Tempel hof f R, Crowder CM, et al . Convecti on versus conduct ion
cool i ng f or i nducti on of mi l d hypothermi a duri ng neurovascul ar procedures i n
adul ts. J Neuro Anest h 1997;9: 250255.
451. Schmutzhand E, Engel hardt K, Beer R, et al . Saf et y and ef f i cacy of a novel
i ntravascular cool i ng device t o cont rol body temperature i n neurologic i nt ensive
care pati ents: a prospect ive pil ot study. Cri t Care Med 2002;30:24812482.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
452. Al -Senani FM, Graf f agni no C, Grot ta JC, et al . A prospecti ve, mul ti center pi l ot
study t o eval uate t he feasi bi l i ty and saf ety of usi ng the Cool Gard syst em and Icy
catheter fol l owi ng cardi ac arrest . Resusci tat i on 2004;62: 143150.
[CrossRef ]
[Medli ne Li nk]
453. Lesl i e K, Wil l iams D, Irvi ne K, et al . Pethidi ne and ski n warmi ng t o prevent
shiveri ng duri ng endovascul ar cool i ng. Anaesth Intens Care 2004;32:362367.
[Medli ne Li nk]
454. Inderbi tzen B, Yon S, Lasheras J, et al . Saf et y and perf ormance of a novel
i ntravascular cathet er f or i nducti on and reversal of hypothermia i n a porcine model .
Neurosurgery 2002;50: 364370.
[Full text Li nk]
[CrossRef ]
[Medli ne Li nk]
455. Kel l er E, I mhof H-G, Gasser S, et al . Endovascul ar cooli ng wi th heat exchange
catheters: a new method t o i nduce and maintai n hypot hermi a. I ntensive Care Med
2003; 29:939943.
[Medli ne Li nk]
P. 905


Questions
For the f ol lowing quest ions, sel ect t he correct answer
1. What is the normal core body temperature?
A. 38C 0.2C
B. 38C 1C
C. 37C 0.6C
D. 37C 0.2C
E. 37C 0.6C
Vi ew Answer2. How much does core body temperature normal ly decrease
during the fi rst hour after the beginning of surgery wi thout usi ng measures to
reduce heat loss?
A. 0.5C t o 2C
B. 0.5C t o 1.5C
C. 0.5C t o 1C
D. 1C t o 1.5C
E. 1C to 2C
Vi ew Answer3. What is the major mechanism of heat loss duri ng
anesthesi a?
A. Evaporat ion
B. Conducti on
C. Convecti on
D. Radiati on
E. Si t e of surgery
Vi ew Answer4. What percent of the i ntravascular volume may be lost to
the extracellul ar space duri ng each degree of hypothermia?
A. 1.85%
B. 2%
C. 2.5%
D. 2.75%
E. 3%
Vi ew Answer5. What is the highest temperature above which alterati ons
i n red cel l i ntegri ty occur?
A. 44C
B. 45C
C. 46C
D. 47C
E. 48C
Vi ew Answer6. How much does a li ter of crystall oi d at ambient
temperature or one uni t of refri gerated blood i nfused through a peripheral si te
reduce the mean body temperature?
A. 1C
B. 15C
C. 0.2C
D. 0.25C
E. 0.3C
Vi ew Answer7. Which factors determi ne the temperature of a fluid as i t
enters the vei n?
A. The temperature set point on the warmi ng device
B. St arti ng temperature of the i nf usat e
C. Rate of f l ui d f low
D. Length of the tubing between the pati ent and the warmer
Vi ew AnswerFor the fol l owing quest i ons, answer
i f A, B, and C are correct
i f A and C are correct
i f B and D are correct
i f D i s correct
i f A, B, C, and D are correct .
8. Whi ch conditions prevent an equil ibration between heat l oss and heat
producti on duri ng surgery?
A. Thoraci c surgery
B. Peri pheral neuropathi es
C. I nt ra-abdominal surgery
D. Regional anestheti c bl ocks
Vi ew Answer9. Which factor(s) determi ne the severi ty of hypothermia?
A. Lengt h of t he surgi cal procedure
B. Amount of cool fl ui ds
C. Si te of surgery
D. Sex
Vi ew Answer10. Which metabolic changes occur as a resul t of
hypothermia?
A. Shi f t of t he oxyhemogl obi n dissoci ati on curve to t he ri ght
B. Lower umbi l ical pH i n babi es whose mothers were warmed
C. Hi gher hemoglobin saturati on
D. Accumul at i on of met abol i c products
Vi ew Answer11. Which probl ems are associ ated with shi vering i n the
postoperati ve peri od?
A. I ncreased metabol i c demand
B. I ncreased cardi ovascul ar work
C. I ncreased i ntraocular pressure
D. Decreased i nt racranial pressure
Vi ew Answer12. Which pati ent(s) are most suscepti ble to burns from
heati ng devi ces?
A. Those wi th poor cutaneous bl ood f l ow
B. Di abeti cs
C. The elderl y
D. I nf ants
Vi ew Answer13. What are the cardi ovascul ar effects of hypothermi a?
A. Decreased need for vasoact i ve drugs
B. Cardi ac dysrhyt hmias
C. I ncreased cont ract il i ty
D. I ncreased catechol amine product ion
Vi ew Answer14. The most effective way(s) to uti l ize a water heati ng pad
i ncl ude
A. Pl acing the heati ng pad over the pat ient
B. Pl acing the heati ng pad under t he pat i ent
C. Using a thi n pad attached to t he pat i ent
D. Heati ng af ter the pati ent is i n pl ace
Vi ew Answer15. Effective use of passi ve coverings includes
A. Covering as much of the body surf ace as possible
B. Appl yi ng in the PACU to rewarm t he pat ient
C. Pl aci ng a warm bl anket over t he pati ent as soon as he enters the operat ing room
D. Using ref lecti ve coverings
Vi ew AnswerP. 906


16. Advantages of radiant heat l amps i nclude
A. Decreased heat l oss f rom the ski n during washi ng
B. Unobst ruct ed access t o the pat i ent
C. Decreased f luid requi rements
D. Most ef fecti ve i n areas of arteri ovenous anastomoses such as t he f orehead,
hands, and f eet
Vi ew Answer17. Indicati on(s) for fl ui d warming i nclude
A. Pati ents wi t h col d agglut i ni ns
B. Exchange transfusion in neonates
C. Rapid i nf usi on
D. Restori ng normot hermi a af ter surgery
Vi ew Answer