Perioperative thermal insulation

Abstract

To determine the efficacy of passive insulators advocated for prevention of cutaneous heat loss, we determined heat loss in unanesthetized volunteers covered by one of the following: a cloth ''split sheet'' surgical drape; a Convertor® disposable-paper split sheet; a Thermadrape(TM) disposable laparotomy sheet; an unheated Bair Hugger® patient-warming blanket; 1.5-mil-thick plastic hamper bags; and a prewarmed, cotton hospital blanket. Cutaneous heat loss was measured using 10 area-weighted thermal flux transducers while volunteers were exposed to a 20.6° C environment for 1 h. Heat loss decreased significantly from 100 ± 3 W during the control periods to 69 ± 6 W (average of all covers) after 1 h of treatment. Heat losses from volunteers insulated by the Thermadrape(TM) (61 ± 6 W) and Bair Hugger® covers (64 ± 5 W) were significantly less than losses from those insulated by plastic bags (77 ± 11 W). The paper drape (67 ± 7 W) provided slightly, but not significantly, better insulation than the cloth drape (70 ± 4 W). Coverage by prewarmed cotton blankets initially resulted in the least heat loss (58 ± 8 W), but after 40 min, resulted in heat loss significantly greater than that for the Thermadrape® (71 ± 7 W). Regional heat loss was roughly proportional to surface area, and the distribution of regional heat loss remained similar with all covers. These data suggest that cost and convenience should be major factors when choosing among passive perioperative insulating covers. It is likely that the amount of skin surface covered is more important than the choice of skin region covered or the choice of insulating material.