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involve a small amount of bleeding, but
excessive bleeding is never a positive
thing. Anemic patients don't heal as well,
and are likely to recover more slowly,
points out Dr. Sessler.
Meanwhile, in longer, more complex
surgeries, excessive blood loss may
necessitate transfusions, or greater num-
bers of transfusions. If those can be minimized or eliminated by pre-warming,
the cost-benefit ratio of pre-warming goes way up. Additionally, says Dr. Sessler,
"there's increasing evidence that transfusions are simply bad for you." As outpa-
tient facilities continue to expand the complexity of their offerings, minimizing
the need for transfusions is bound to become an increasingly significant con-
cern.
4. Monitor patients in post-op
While outpatient procedures typically involve limited blood loss, the flip side is
that the shorter the procedure, the greater the potential impact of hypothermia
post-operatively. In longer surgeries, patients typically reach normothermia by
procedure's end. "But it's much harder for patients to be normothermic at the
end of a short operation," says Dr. Sessler. "It's the 40-minute or 1-hour opera-
tion" that presents the biggest challenge."
Autonomic responses to cold, like tachycardia and hypertension, are con-
trolled when patients are under anesthesia, but not after they wake up.
Patients who remain hypothermic in the PACU are thus more likely to experi-
ence other consequences. The possibility that patients might have a "heart
attack or an infection would likely have more to do with how warm they are
at the end of surgery," says Dr. Sessler. "It's likely that the relative importance
of intra-operative temperature versus final temperature depends on which
outcome you're looking at."
Many patients arrive in the
chilly early-morning hours.
Makes you shiver just
thinking about it.