Our readers are always interested in knowing more about surgical procedures.

As a means of broadening how we think about surgery, we have decided to put some qu estions before our Anesthesiologists. HOI: We would like to know more about patient warming. We understand that active patient warming is associated with normalizing patient temperature. What is the role of the anesthesiologist in normalizing patient temperature? Anesthesiologists: The Hoag Orthopedic Institute and the Department of Anesthesi ology are working hard to stay at the forefront of this important issue. HOI s appro ach includes not only our Anesthesiologists, but our Surgeons and our Peri-Opera tive Nurses as part of a team-based approach that allows us to maximize the bene fit to the patient. Specifically, the Anesthesiologist will consult with the sur geon and agree on how best to warm the patient. Once that decision is made our d octors and nurses can begin warming the patient in the pre-operative area and th e Anesthesiologist can continue the warming process throughout the entire proced ure, given that there are no circumstances that contraindicate active warming. O ur goal is to maintain normal body temperature throughout the procedure in order to maximize patient safety and comfort. HOI: Can peri-operative hypothermia have serious consequences? Anesthesiologists: Despite the best efforts of doctors and nurses, a patient may become hypothermic (for a variety of reasons). At the Hoag Orthopedic Institute we are examining ways to minimize this risk. Our efforts may help reduce incide nce of infection, blood loss and the need for a blood transfusion. It may also r educe the risk of something as serious a heart attack. It can make waiting for s urgery more comfortable, reducing post-operative shivering or reducing time in t he post-operative care unit. This low-risk, easily controllable intervention can help minimize many of the risks associated with surgery. HOI: The American Society of Anesthesiologists recommends that normothermia shou ld be a goal during emergence and recovery, and that when available, forced-air warming systems should be used for treating hypothermia. What type of patient wa rming is used at Hoag Orthopedic Institute, and is there more than one type depe nding upon the patient or the circumstances? Anesthesiologists: At the Hoag Orthopedic Institute we are attempting to go beyo nd government recommendations and find ways to maximize our patients safety. The De partments of Anesthesiology and Surgery are collaborating to examine the various modalities available for patient warming. They are working to determine whether forced-air, or convection warming, is the safest and most effective method of w arming a patient. The Hoag Orthopedic Institute is at the forefront of warming p atients before they enter the operating room, in an effort to prevent hypothermia. The H oag Orthopedic Institute and its Anesthesiologists and Surgeons will continue to go beyond the standard guidelines to bring the best care to its patients. HOI: Are some patients more at risk for peri-operative hypothermia than others? Anesthesiologists: Our Anesthesiologists and Surgeons recognize that patient car e is a unique process that requires personal attention to each individual. Patie nts who require a large portion of their body to be exposed or surgeries of part icularly long duration are at increased the risk of hypothermia. In addition, nu merous medical conditions can increase the risk of infection, blood loss, and he art problems, all of which can be reduced by maintaining normothermia. HOI: Are there preventive warming measures? Anesthesiologists: The Hoag Orthopedic Institute and its Doctors and Nurses are

committed to patient care and to providing the best outcomes possible. Therefore we are examining the benefits of warming patients immediately upon their arriva l as a method for significantly improving outcomes, and also evaluating various techniques for preventing hypothermia. The hospital, its Surgeons, Anesthesiolog ists, and Nurses will continue to evaluate this critical issue in order to provi de the safest surgical experience possible to its patients. _____________________________ We d like to thank Dr. S. Todd Newman of Newport Harbor Anesthesia Consultants who h as responded to our questions on behalf of the Hoag Orthopedic Institute Departm ent of Anesthesiology.