Session 1

Topic of Presentation: Normothermia: The Anesthesiologist's Viewpoint -- The KEY to achieving normothermia is to think of it!

Presenter: Scott Robinson, MD
Partner, Anesthesiology Consultants of Marin
Greenbrae, California

Presentation Summary

Dr. Robinson discusses the role of the anesthesiologist in maintaining normothermia in surgical patients, emphasizing that anesthesia is a main contributor to operating room (OR) hypothermia. He outlines how anesthesia regiments can interfere with the body’s natural defense mechanisms against cooling and the mechanisms of redistribution hypothermia.

Dr. Robinson then outlines the serious consequences of peri-operative hypothermia, as well as some of the keys to maintaining normothermia. Various methods for warming are also evaluated.

Viewing time: 29 minutes        

Session 2

Topic of Presentation: Active Thermoregulation in Off-Pump Coronary Artery Bypass (OPCAB) Grafting

Presenter: Y. Joseph Woo, MD
Assistant Professor of Surgery
Division of Cardiothoracic Surgery
University of Pennsylvania
Philadelphia, PA

Presentation Summary

Dr. Woo discusses a Case Study involving heart transplantation in a young male patient and the direct impacts of maintaining normothermia in cases like these and other cardio-thoracic procedures.

Dr. Woo then outlines the serious consequences of surgical hypothermia, including severe blood component dysfunction, peripheral vasoconstriction, delayed emergence from anesthesia, longer dependence on mechanical ventilation and longer Intensive Care Unit (ICU) stays. The challenges and short-comings of using various conventional patient warming methods in these highly complex procedures are discussed. Dr. Woo also reviews a study which discusses the impacts of the use of the Kimberly-Clark* Patient Warming System in off-pump CABG procedures.

Viewing time: 30 minutes        

Session 3

Topic of Presentation: Damage Control & Thermoregulation in the Trauma Patient

Presenter: Scott G. Sagraves, MD, FACS
Trauma Director
University Health Systems of Eastern Carolina

Presentation Summary

Dr. Sagraves describes the physiology of exsanguination, featuring three (3) key risk factors for the patient with traumatic injuries: acidosis, coagulopathy, and hypothermia. He states that hypothermia is a particular danger in the trauma patient because of the amount of blood loss, the wide exposure of the injured area, and the travel time often elapsed between the injury site and the Emergency Department (ED), allowing the body to cool further.

The warming strategies for the transit of the patient, in the ED, the operating room (OR), and finally the post-operative Intensive Care Unit (ICU) are discussed. Because of the increased risk and danger of hypothermia for the trauma patient, both before treatment and in the OR, warming strategies are crucial at every stage of treatment. Dr. Sagraves explains how the Kimberly-Clark* Patient Warming System has been utilized in the facility's emergency and peri-operative warming strategies.

Viewing time: 31 minutes        

Session 4

Topic of Presentation: Thermal Management in Cardiac Surgery: Outcomes and Cost Implications

Presenter: Kushagra Katariya, MD, FACS
Associate Professor of Cardiothoracic Surgery
Miller School of Medicine
University of Miami
Miami, FL

Presentation Summary

Dr. Katariya cites an increasing awareness among cardiac surgeons that hypothermia has significant adverse effects on post-operative cardiac patients. Dr. Katariya states that hypothermia complicates almost every point in the coagulation cascade leading to increased blood loss and, by reducing tissue oxygenation, also is a primary cause of infection. Dr. Katariya cites hypothermia as “the most frequent, preventable perioperative complication of surgery.” Dr. Kataryia mentions the preliminary results of a blinded, prospective, randomized study of 50 off-pump cardiac surgery patients.

Viewing time: 25 minutes        

*These presentations were developed from presentations given at the Kimberly-Clark Knowledge Network* Symposium, Roswell, GA Thermal Regulations: Implications for the Complex Surgical Patient on November 16, 2005. Kimberly-Clark* compensated each of the presenters for their services. Statements made by the clinicians in these presentations are the statements of the clinicians and not Kimberly-Clark.