4 Warming Methods Combined to Prevent Hypothermia During Surgery

Using multiple warming measures, hypothermia was prevented in an adult man with severe cold agglutinin disease (CAD) undergoing surgery, a recent case study reports.

According to the investigators, the report is the first to describe the success of a combination of four specific warming strategies, including pre-surgery skin surface warming and intravenous (IV) infusion of pre-warmed fluids, and highlights the importance of hypothermia prevention in CAD patients before, during and after surgery.

“The most striking difference between the present case and previous reports is that warmed amino acid infusion and other preventive measures were simultaneously applied in our severe case,” they wrote.

The report, “Perioperative management of a patient with severe cold agglutinin disease by using multimodal warming measures, appeared in the Korean Journal of Anesthesiology.

CAD is a rare autoimmune disease in which exposure to cold temperatures triggers the body’s immune system to attack and rupture its own red blood cells in a process called hemolysis. The depletion of red blood cells results in anemia and complications like heart problems and kidney failure.

For patients with CAD, maintenance of core body temperature is vital to avoid triggering symptoms, particularly during surgery, when anesthetics and skin exposure can cause the body temperature to drop.

The case report describes a 63-year-old man with severe CAD who underwent back surgery for spinal stenosis (pressure on the spinal cord and nerves). The patient was on anti-inflammatory corticosteroid therapy, a previously common treatment for CAD symptoms, but still exhibited signs of anemia and discoloration in the hands and feet.

Because the patient’s normal body temperature was 36.5 C (97.7 F), efforts were made to maintain a body temperature of 37 C (98.6 F) before, during, and after surgery to avoid triggering CAD symptoms.

Conventional methods for preventing surgery-related hypothermia include warming the operating room with heating systems, warming the skin surface, and maintaining core temperature with infusions of pre-warmed IV fluids.

The researchers in this case combined several warming strategies to maintain the patient’s body temperature. Prior to the procedure, the operating room was heated with forced-air heating devices and the patient received an IV infusion of an amino acid solution pre-warmed to 41 C (105.8 F).

The early initiation of the infusions was based on previous research demonstrating that such infusions can maintain core body temperature, but fail to recover temperature after hypothermia onset. The patient also was warmed with an electric heating blanket before surgery.

During the procedure, the patient’s core temperature was monitored with a temperature probe in the esophagus and maintained with IV infusions of warmed amino acids administered throughout the operation. Body temperature was maintained using forced-air warming devices, a warmed circulating-water mattress, and gloves and socks for the extremities.

For 24 hours post-operation, the patient was warmed with an electric blanket and administered continuous amino acid infusions. No signs of hypothermia or hemolysis were observed following the surgery.

“We successfully maintained the core temperature and further avoided heat transfer from the core to the peripheries … by using these multimodal warming measures,” the research team wrote. 

“In conclusion, in the management of patients with severe CAD, multimodal warming measures from various viewpoints should be considered in maintaining the core temperature,” they added.