normothermic during the entire case. It works for inpatient proce-
dures, outpatient procedures, trauma, small surgeries, big surgeries —
anything that requires general anesthesia. It even works with
Caesarean sections using spinals or epidurals. And when you combine
fluid warming with convective warming, you can practically guarantee
that patients won't get cold during surgery.
So why aren't more people taking advantage of this useful tech-
nique? From what I've seen, the mistake many make is waiting too
long. Oftentimes, people don't think of it, or they think of it after anes-
thesia induction. But once you've started induction, you're committed
to concentrating on airway management, patient positioning and get-
ting the patient ready for the surgical incision. So the best time to
think of it is before you put the patient to sleep. My rule of thumb is,
for any patient who's going to require at least a liter of fluid, I make
sure the fluid warmer is connected before induction of anesthesia,
and before any physiological changes start to take place.
That doesn't mean you should never start fluid warming after a case
has begun. Even if you wait until after you've given a liter of fluid and
then decide you'd better start the fluid warmer because the surgery is
lasting longer than expected, that's OK. But, by that time you've
missed a great opportunity to use it for the entire case.
Safe and effective
The fluid-warming technology available today is incredibly good.
When I started out in anesthesia, the warmers that were available
didn't warm adequately, so by the time the fluid got into the patient's
body, it was usually closer to room temperature than to the tempera-
ture of the patient.
By contrast, the generation we're using now warms fluids to 41
degrees (Celsius) in the heating element and lets you deliver it to the
patient at 36 to 37 degrees.
You should be aware that flow rates can affect the amount of cool-
1 0 3
A P R I L 2 0 1 5 | O U T P A T I E N T S U R G E R Y . N E T
