my name is Max Feinstein and I'm an anesthesiology resident at the Mount Sinai Hospital in New York
City. you may have thought that operating rooms are kept cold to prevent infection.
I'm here to tell you that not only is that wrong,
but cold temperatures are actually associated with an increased rate of surgical site infections.
the real reason operating rooms are kept cold is actually just to keep the surgeons and nurses
comfortable. seriously. but in addition to just being annoying for anesthesiologists,
the cold temperature can actually have really serious implications for patient safety. in
this video I explore the heated debate around temperatures in the operating room.
if you find this video interesting or helpful I'd really appreciate it
if you liked it and subscribed to the channel. let's dive in!
contrary to what some people may have you believe, the most important person in the
operating room at all times is the patient, which is a great place to start this video. in
terms of the patient's core body temperature, anesthesia actually causes a very significant
redistribution of warm blood from the center of the body to the periphery of the body,
which in turn leads to a rapid heat loss. of course, this is not helped by being in an already
cold operating room. the effects of hypothermia have actually been studied extensively and are
something that anesthesiologists are trained to think about a lot.
one study demonstrated that a decrease of core body temperature of 1.9 degrees Celsius is
associated with a three-fold increase in surgical site infection. moreover,
hypothermia can lead to cardiac issues like arrhythmias and also ischemia. in the worst
case we worry about a cold temperature actually precipitating a myocardial infarction. cold
temperatures are also associated with increased rates of bleeding in the operating room,
so this of course can be a problem for the patient, and it makes it more difficult for
the surgeon to just do surgery if the surgical field is filled with blood. and there are also
studies that show that decreased core body temperature in the operating room
is associated with longer stays than the Post Anesthesia Care Unit, or the PACU for short.
a lot of these complications can be explained by the fact that many of
the proteins present throughout our body are optimized to work at a specific temperature,
and so when a core body temperature drops below that optimal range,
then these proteins/enzymes don't function as well as they normally do,
which can then lead to dysfunction of a number of different organ systems.
the question of how anesthesiologists keep patients warm during surgery is actually
something that receives a lot of attention during our training. one of the mainstays of
our ability to keep patients warm is a forced air warming device. one that you'll commonly hear is
the Bair Hugger, which - pro tip - it's actually spelled b-a-i-r not b-e-a-r. a forced air warming
device is essentially a fancy blow dryer that delivers very warm air through a blanket that
surrounds the patient, and interestingly there are a number of different blankets
that we can apply to the patient including one that goes on the top half of the body,
one that goes on the bottom half of the body, and then one that goes underneath the patient's
body. the blanket that we choose is really based on where the surgery is expected to take place,
so there's often a conversation between the anesthesiologist and the surgeon
about where the most appropriate place to apply a Bair hugger is.
another very effective method for keeping patients warm is delivering warm IV fluids.
and that might mean warm crystalloid or it might mean warm blood products. and it's
actually routine for us to transfuse blood products through warmers simply because most
blood products are kept in a refrigerator, so at baseline they're already quite cold.
it's also worth pointing out that monitoring a patient's temperature during surgery is actually
a standard of care during general anesthesia. for that reason, we actually have a variety
of different temperature probes that we can apply to a patient during surgery that can
be inserted it into a patient's nostril or esophagus or bladder, for example.
I should also just mention that the more invasive temperature
probes are placed after a patient has gone under general anesthesia.
so going back to why the operating room is actually kept at a cold temperature,
it's summarized perfectly in this article. and I'll just quote here
because it's better than anything I could come up with on my own:
"typically surgeons prefer a cool, dry climate to accommodate for the hats,
masks, gloves, and gowns they wear, and the fact that they work under bright,
hot lights. Anesthesia personnel, on the other hand, are typically not as physically
active or heavily clothed as surgeons, and desire a warmer, less breezy climate."
couldn't have said it better myself. and to be honest I don't blame surgeons. I remember when
I was an intern and I was rotating through a surgical service and I scrubbed into the OR,
and I do recall it is actually uncomfortably hot when you have a gown on and you're underneath the
surgical lights. and that's to say nothing of having lead on as well, which is very commonly
used in many different types of procedures where there is ionizing radiation that's used
in the operating room. in these situations I actually put lead on as well, but again,
I don't have a gown on top of that and I'm not sitting underneath a couple of bright, hot lights.
Believe it or not, measures of performance of the surgical team and the anesthesia
team has actually been studied under different environmental temperatures in the operating room.
unsurprisingly, people feel like their performance is not as good when they're uncomfortably hot,
and they also just feel frustrated. but on objective measures of performance,
there's actually no difference in terms of feeling uncomfortably hot versus just comfortable.
and just for the sake of being thorough, it was actually found found that surgeons
have an optimal operating room temperature of 19 degrees Celsius
while anesthesiologists prefer 21.5 degrees Celsius. sounds perfect to me.
it's very easy to change the temperature in the operating room. in addition to the
fact that there are thermostats that are located in the OR, the air actually turns
over very frequently in an operating room. it's recommended that the air in the room
is changed 20 times per hour. it's actually so noticeable that when I edit these videos that
I post on YouTube I actually have to use voice isolation so that I can get rid of
the background noise from the ventilation in the operating room. this is what the
current operating room sounds like without any voice isolation to remove the background noise
ah, feels like about 19 degrees Celsius, a couple degrees too cold for me, but I'll live.
if you enjoyed this video you might want to check out this video where
I go through all the considerations for recording a YouTube video inside
of an operating room thanks very much for watching. I'll see you next time [Music]