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Hypothermia

Dr. Paul Morgan

Consultant Intensivist
University Hospital of Wales
Cardiff
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Scenario

• A 73 year old man undergoes elective resection of a

carcinoma of the colon with a low anterior resection.
Surgery is more difficult than expected, with a 1.5
litre blood loss. During surgery, which lasted 4 hours,
he receives 2 litres of Hartmann’s solution and 3
units of blood. You are asked to review him in
Theatre recovery 30 minutes after completion of
surgery as he is hypothermic with a recorded core
temperature of 34 Celsius.
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Inadvertant Perioperative
Hypothermia
• NICE Guideline CG65 (2008)
• Risk factors - http://www.frca.co.uk/Documents/117%20-
%20perioperative%20hypothermia.pdf
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What is the definition of hypothermia?

• Core temperature of below 36.0°C

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Why do patients become hypothermic during

the perioperative period?

• Vasodilation from effects of anaesthetic drugs,

exposure (central effect on hypothalamus), inhibition
of shivering, dehydration from starvation, heat
conduction through cold operating table, unwarmed
fluids
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Temperature Regulation
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What are the risks of hypothermia?

• Increased energy expenditure from shivering, excess oxygen

consumption, risk of myocardial ischaemia, impairment of
coagulation, impairment of mentation, wound infection
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What measures can be taken during

surgery to prevent hypothermia?

• Warm IV fluids
• Warming blanket
• Bair Hugger (forced air warming)
• Increase theatre temperature
• Use of HME filter in anaesthetic circuit
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Describe your initial assessment of this

patient
• Model answer – CCrISP protocol
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Initial observations show:-

• Pulse 105/min, regular
• BP 110/40
• Temperature 34.2
• Urine output 25 ml since theatre
• GCS 15
• Pain score 1 – working epidural
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What steps can you now take to treat his

hypothermia?

• Forced air warming, extra blankets, warm IV fluids, warm

environment
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Thank you!