Why are operating rooms (ORs) so cold, and why is that so annoying to anesthesiologists? In the video above, Max Feinstein, MD, explains why ORs are cold, and what measures are taken to protect patients against problems associated with low temperatures.
Following is a transcript (note errors are possible):
Feinstein: My name is Max Feinstein and I'm an anesthesiology resident from 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 our 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 subscribe 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 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° Celsius is associated with a threefold 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.
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. When a core body temperature drops below that optimal range, then these proteins and 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 -- is 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. 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 is 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. 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 are 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.
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." I couldn't have said it better myself.
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. I do recall it is actually uncomfortably hot when you have a gown on and you're underneath the surgical lights. 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 have actually been studied under different environmental temperatures in the operating room. Unsurprisingly, people feel like their performance is not as good when they are uncomfortably hot and they also just feel frustrated, but on objective measures of performance there is actually no difference in terms of feeling uncomfortably hot versus just comfortable.
Just for the sake of being thorough, it was actually found that surgeons have an optimal operating room temperature of 19° Celsius while anesthesiologists prefer 21.5° Celsius. It sounds perfect to me.
Max Feinstein, MD, is a PGY-4 anesthesiology resident at the Mount Sinai Hospital in New York City, where he is also chief resident of teaching. His YouTube channel focuses on perioperative medicine, especially the role of the anesthesiologist.