The critical importance of managing patient temperature before, during and following surgery has been well known for quite some time. Undergoing surgery can cause a patient's core temperature to drop for a variety of reasons, leading to slower recovery times and increased risk of infection. As such, it is advantageous in most cases to keep patients warmed to their normal levels.

Of course, temperature management in the operating room covers more than simply keeping patients at 98.6 degrees. There are cases, such as in certain cardiac and neurological procedures, where it has proven beneficial to patients to have their core temperatures lowered. In these types of procedures, systems and techniques that can quickly and efficiently lower and then raise a patient's temperature can be vital to the success of the surgery.

There are currently a number of technologies and systems available to address patient warming and cooling in the OR and beyond; and recent and emerging advances in temperature management are continuing to give surgeons new and innovative approaches to patient care. Here is a look at some of the latest systems and technologies that are helping surgeons to keep their patients' core temperature under control in the surgical suite.

Cincinnati Sub-Zero (CSZ) is a leader in temperature management and offers a full range of heating and cooling solutions, combined with the security of over 60 years of experience. The extensive CSZ product portfolio includes convective warming systems as well as multiple liquid-based systems that can both cool and warm patients depending on their individual needs.

CSZ’s WarmAir® convective warming system, which utilizes the company’s robust FilteredFlo® blankets, is the only system to double-filter the air and, as the blankets require no perforation, avoids unwanted and potentially dangerous particles in the OR. The WarmAir and FilteredFlo warming blankets provide a low-profile, form-fitting contour that prevents the blanket from lifting away from the patient during use, but can also be easily folded back by the caregiver to allow better access to the patient.

The Gelli-Roll from CSZ provides full-body patient warming and cooling while reducing the risk of pressure ulcers.

Another innovative CSZ offering is the Kool-Kit® system, which includes the Head Wrap, the Vest and the Lower Body Blanket to provide complete body coverage. This system is the fastest external cooling system and poses no risk of infection from the use of catheters, according to a recent study by UT Houston Vascular Neurology Program. In addition, the newly designed Kool-Kit goes further to provide immediate access to the patient for both therapy delivery and tissue inspection.

A recent addition to the CSZ product line is the Gelli-Roll®, which provides whole-body cooling and warming capabilities combined with the reduction in the risk of pressure ulcers. This innovative system incorporates a blanket encapsulated within industry-leading Acton® polymer pads from Action Products, allowing it to maintain constant patient temperature throughout surgery while reducing pressure. Other liquid-based systems from CSZ include Norm-O-Temp® for whole-body warming and the Micro-Temp LT® or the Electri-Cool II® for treating localized post-injury sites. CSZ also offers the ECMO and the Hemotherm® blood temperature management systems.

The RapidBlue Endovascular Cooling & Warming System from INNERCOOL therapies.

INNERCOOL therapies, Inc. offers a complete spectrum of temperature modulation tools to address virtually every patient cooling and warming need. The RapidBlue™ Endovascular Cooling & Warming System is a closed-loop, catheter-based system that can modulate whole body temperature without fluid induction. It consists of a disposable endovascular heat transfer catheter, administration cassette and a console. The distal portion of the catheter has a flexible, metallic temperature control element (TCE) that is cooled or warmed by sterile saline circulated within it from the RapidBlue Console. The administration cassette connects the catheter to the console, maintaining the sterility of the saline conduit. The TCE does not expand inside the body so the outer diameter of the TCE will remain consistent throughout the entire cooling/warming procedure.

Also from INNERCOOL therapies is the CoolBlue™ System, a non-invasive surface pad cooling and warming system. It consists of a console which connects to surface pads that are applied to the patient's torso and upper thighs. The console regulates water circulation through the pads to achieve and maintain desired patient temperature. The CoolBlue pads are easy to place on patients and remove if necessary as adhesive gels are not used to contact pads to the patient’s skin.

The Bair Hugger System from Arizant Healthcare consists of a warming unit and a line of 24 disposable blankets for pre-, intra- and post-op warming.

Arizant Healthcare Inc. is the maker of a variety of surgical patient temperature management systems including the widely used Bair Hugger®, Bair Paws® and Ranger® product lines. The Bair Hugger system, which uses forced-air warming to prevent and treat perioperative hypothermia, consists of warming units and a line of 24 different disposable warming blankets for use before, during and after surgery. Bair Hugger warming units are used in more than 80 percent of U.S. hospitals. The most recent addition to the Bair Hugger product line is the Spinal Underbody blanket that addresses the challenges of patient warming unique to spinal surgery. It includes numerous features suited for warming spinal surgery patients who are typically difficult to warm because of their positioning on a spinal surgery table. The blanket can be placed on the table before the patient arrives to the operating theater and allows for full visualization and adjustment of all patient supports and pads. As with all Bair Hugger Underbody blanket models, the new Spinal Underbody blanket provides convenient, full access to the patient while helping to prevent unintended patient hypothermia.

The new Bair Paws+ gown incorporates a second clinical hose port for greater flexibility in procedures requiring lower body forced-air warming.

Arizant’s Bair Paws Gown, which was the world’s first forced-air warming gown, now offers clinicians even more flexibility in the OR. The new Bair Paws+™ gown incorporates a second clinical hose port for greater flexibility in procedures requiring lower body forced-air warming. Currently, the Bair Paws gown is used in more than 1,000 facilities in the U.S. and provides both comfort and clinical warming throughout the perioperative period. By incorporating a second clinical hose port to the lower portion of the Bair Paws+ gown, clinician access is simplified and the need to re-position the gown to provide lower body warming is eliminated.

Another new addition to the Arizant product line is the Ranger Irrigation Fluid Warming System. The Ranger irrigation system offers the high-volume delivery of warmed fluids required by demanding urology, gynecology or orthopedic procedures, while alleviating concerns about water in the OR and the potential sources of nosocomial pathogens associated with water bath-based warmers. Unlike traditional warming cabinets where active warming ends when fluid is removed, the Ranger irrigation system warms fluid as it is being delivered to the patient through the use of highly responsive heating plates and a unique irrigation fluid warming disposable set. Arizant's SmartHeat® technology eliminates potential dangerous hot spots and overheating of fluids, monitoring the temperature four times every second and automatically adjusting as needed to maintain a consistent 41°C set point.

One innovative new product for intraoperative patient temperature management that recently joined the market is the LMA PerfecTemp™ Patient Warming System from LMA North America, which provides warming to the patient from the very moment that they are transferred to the surgical table. The system replaces the existing surgical table pad and is available in most table configurations and models. Since the warming component is under the patient, the surgical staff has full, unrestricted access to the surgical site. Furthermore, the system is completely silent and does not blow hot air onto the surgical staff.

The LMA PerfecTemp uses a resistive (electric) technology that provides an evenly distributed warming surface and utilizes a state-of-the-art fiber-optic temperature sensing system to monitor and control the patient/system interface temperature. So, the system knows the precise temperature to which the patient’s skin is being exposed and regulates itself to that temperature. As an added bonus, the system incorporates pressure reduction foam allowing the system to provide both patient warming as well as pressure reduction within the same system without having additional equipment cluttering the OR.

The Kimberly-Clark Patient Warming System maximizes access to the patient during surgical procedures.

Another company that has developed a system designed to help surgeons warm patients intraoperatively is Kimberly-Clark Health Care, based in Roswell, Georgia. The Kimberly-Clark Patient Warming System consists of a small, portable, easy-to-use control unit and thermal pads that are placed on the patient's body. The control unit circulates heated water through the innovative thermal pads, providing precise, automated or customizable patient temperature management. The advanced, non-slip, hydrogel thermal pads provide an optimal energy transfer path. Heat is conducted directly through the skin, safely maintaining normothermia with only 20 percent of the patient's skin covered, maximizing surgical access. Various pad sizes allow placement on nearly all body surfaces, making the system ideal for a wide variety of patients and surgical procedures. Plus, the pads are disposable, so when treatment is finished they can simply be thrown away, avoiding the risk of cross contamination.

Soon the be available in the United States is the Hot Dog patient warming system form Hot Dog USA, LLC. Hot Dog warming is an electric warming system that uses a semi-conductive polymer fabric heater encased in an antimicrobial waterproof shell to create a blanket that conductively and radiantly transfers heat to the surgical patient. It can maintain patient normothermia in all phases of the surgical process; pre-, intra-, and post-operatively. The Hot Dog full body blanket is ideal for pre- and post-op patient warming and costs a fraction of disposable blankets and gowns. For intraoperative warming, Hot Dog offers upper body, lower body and multi-purpose blankets that are adaptable enough to effectively warm in any procedure or patient position.

The innovative Hot Dog patient warming system from Hot Dog USA, LLC becomes available in the United States later this summer.

Hot Dog warming is air-free and cleanable so there is no risk of airborne contamination in the operating theater. Plus, the system is noise-free with no moving parts, no blower, no bulky hoses and no excess heat blowing on the clinicians and surgeons. And, since the Hot Dog system consumes about 80 percent less energy than forced-air systems, it allows hospitals to warm all patients, comply with quality initiatives and reduce spending on temperature management. The Hot Dog patient warming system will be available in the United States in late summer.

Another new and innovative approach to patient warming that has applications in emergency, patient transport and throughout healthcare facilities is Thermoflect from Encompass Group, LLC. Thermoflect is based on technology pioneered by NASA. It works by reflecting back the body’s own heat to help prevent cooling. Thermoflect also prevents convective heat loss. It is lightweight, durable and comfortable for the patient.

Thermoflect is also being used by the U.S. military to help prevent hypothermia in injured soldiers as they are transported from the battlefield. Since it requires no electricity and no maintenance, Thermoflect is cost effective and versatile. It is available in a wide range of products, including blankets, caps, patient gowns and jackets.

Thermoflect from Encompass Group works by reflecting the body's own heat back on itself.

Given the importance of controlling and maintaining patient temperature, there is an aspect of temperature management in OR that is often overlooked. This is the temperature and comfort of the surgeons and staff. With the extensive equipment being used to ensure that the patient is kept warm, and the overall warmth of the OR to accommodate and simplify patient warming, surgeons can often find themselves in a very hot and uncomfortable environment. Fortunately, there are a few companies that are addressing this side of temperature management in the OR with surgeon cooling systems and apparel.

Shafer Enterprises LLC has over 30 years of experience in the medical field and manufactures the most widely used personal cooling systems for surgeons and staff. The Platinum Series Surgeons COOL VEST System provides active, on-demand cooling for surgeons. It is specifically designed to keep the surgeon cool when the OR temperature is kept warmer to prevent patient hypothermia. Quick, dry disconnects provide the surgeon with total mobility while the temperature control ensures that the user easily finds their personal cooling comfort level. This completely portable personal cooling system with cart and wheels works with Cool Vests or the Resposable Ponchos. Single, Dual, and Multi-user Systems are available.

New to the Shafer product line is the Short Surgeon Cool Vest for the surgeon that performs surgery while sitting or with a combination of sitting and standing. The longer vests proved uncomfortable for many surgeons performing these type of surgeries, so they requested a shorter vest as a special order. Shafer Enterprises now provides the short version of the Surgeon Cool Vest as a stock item at no additional charge. The Short Surgeon Cool Vest works with all Shafer hospital systems.

Another manufacturer of effective operating room personal cooling systems is Polar Products. Offering cold water circulating vests as well as phase change and cold pack vests, their fitted vests are constructed of a comfortable fabric with a small amount of stretch which allows a comfortable, snug fit with a clean, neat appearance. The lightweight vests may be worn under lead aprons, air filtration suits or any other gown. These OR personnel cooling vests can be worn standing or sitting and, with the dry, quick disconnect couplings, gives surgeons the freedom to move as desired.

There is no shortage of innovative equipment, systems and technologies aimed at helping surgeons address temperature management in the OR. And, with the full range of existing technologies and those still being developed, surgeons are assured of having the right tools for each procedure.