Intraop temp monitoring for C-sections

[Vergie]

Do other groups routinely monitor intraop temps for C-section under spinal/epidural? ASA guidelines are somewhat ambiguous about monitoring. We usually use axillary temps but they are pretty variable. Admins are concerned about infection risk with inaccurate monitoring. What are other systems out there doing for C-section intraop temp monitoring? We are supposed to trial 3M forehead sticky probes which is fine I am just curious if they are making this a bigger issue than it really is.

Thanks.

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[GassYous]

No

 

[camkiss]

They’re making a bigger issue than it is. That being said, we use 3M forehead stickers. Everyone reads 96* unless they have chorio.

 

[deleted126335]

Do other groups routinely monitor intraop temps for C-section under spinal/epidural? ASA guidelines are somewhat ambiguous about monitoring. We usually use axillary temps but they are pretty variable. Admins are concerned about infection risk with inaccurate monitoring. What are other systems out there doing for C-section intraop temp monitoring? We are supposed to trial 3M forehead sticky probes which is fine I am just curious if they are making this a bigger issue than it really is.

Thanks.

WNL. We never looked. If you don't take a temp you can't find a fever.

 

[deleted162650]

This is so stupid. So what, do they want you to start putting huggers on them? Kinda interfere’s with that precious skin-to-skin time no??

 

[sevo00]

I just write in 37 Celsius for everyone

 

[jwk]

We don't monitor temps on C-sections. Never have.

 

[Zekchar]

We don't monitor temps during c-sections under neuraxial block. Obviously if GA we do esophageal temp probes.

 

[GassYous]

So at the outpatient sites I don't warm patients unless the case goes over 2 hours and I've never had a patient go below 36c

 

[Vergie]

Thank you everyone. This was helpful. Probably just use skin temps for now and trial these 3M probes but I personally think it’s a complete waste of time and I’m really just humoring them right now.

 

[pjl]

30 min cases don’t need temp monitoring.

 

[nimbus]

So at the outpatient sites I don't warm patients unless the case goes over 2 hours and I've never had a patient go below 36c

It helps if the patient can stay mostly covered and the OR temp is >60deg. I don’t used active warming for facial cases/thyroids/etc and they stay warm. I have the most trouble when doing cases like robo vats where they’re mostly exposed and I can only get a forced air warmer on the legs. Many of mine come out 35c or less. Anybody have a good way to keep them warm?

 

[MirrorTodd]

It helps if the patient can stay mostly covered and the OR temp is >60deg. I don’t used active warming for facial cases/thyroids/etc and they stay warm. I have the most trouble when doing cases like robo vats where they’re mostly exposed and I can only get a forced air warmer on the legs. Many of mine come out 35c or less. Anybody have a good way to keep them warm?

Some places I've been have mattress warmers. We've also used underbody huggers sometimes, although they seem a bit less effective than overbody ones.

 

[pgg]

ASA guidelines are somewhat ambiguous about monitoring.

I disagree that there's any ambiguity - the standard says:

temperature shall be continually evaluated

and

Every patient receiving anesthesia shall have temperature monitored when clinically significant changes in body temperature are intended, anticipated or suspected.

I don't anticipate clinically significant changes in body temperature in any c-section ... unless and until perhaps a tube goes in and a uterus comes out, or something wild happens. I can continually evaluate an awake patient's temperature by talking to them.

Skin temp sensors are garbage. Their only utility is to allow you to nonfraudulently put a 37 on the chart for billing purposes.

 

[Ronin786]

I disagree that there's any ambiguity - the standard says:

and


I don't anticipate clinically significant changes in body temperature in any c-section ... unless and until perhaps a tube goes in and a uterus comes out, or something wild happens. I can continually evaluate an awake patient's temperature by talking to them.

Skin temp sensors are garbage. Their only utility is to allow you to nonfraudulently put a 37 on the chart for billing purposes.

They're vague in the sense that they could have been more specific but the ASA decided against it particularly for the reasons outlined above.

ASA Amends Monitoring Standards to Make End-Trial CO 2 More Specific, But Temp. More General

Two substantive amendments to the "Standards for Basic Anesthetic Monitoring" of the American Society of Anesthesiologists (ASA) that have patient safety

www.apsf.org

"One central idea from the original 1986 standard became the opening of the proposed update: “Every patient receiving anesthesia shall have temperature monitored when clinically significant changes in body temperature are intended, anticipated, or suspected.” After much deliberation, it was decided to propose adding more specificity to the standard due to the documented likelihood of significant heat loss (after an equilibration period of 30-40 minutes) during general anesthesia and a second mandate was included in the proposal: “Every patient receiving general anesthesia lasting more than a short duration (for example, more than 45 minutes) shall have body temperature continually monitored.” This latter proposed standard generated many opinions and significant testimony, both pro and con."

 

[narcotics999]

Jesus, pt is wide awake. Just ask her if she is cold and wants some warm blankets.

 

[GassYous]

It helps if the patient can stay mostly covered and the OR temp is >60deg. I don’t used active warming for facial cases/thyroids/etc and they stay warm. I have the most trouble when doing cases like robo vats where they’re mostly exposed and I can only get a forced air warmer on the legs. Many of mine come out 35c or less. Anybody have a good way to keep them warm?

Maybe just warm them preop? Warmed fluids and low flow gas? Not sure there is much else to do.

 

[fakin' the funk]

Do other groups routinely monitor intraop temps for C-section under spinal/epidural? ASA guidelines are somewhat ambiguous about monitoring. We usually use axillary temps but they are pretty variable. Admins are concerned about infection risk with inaccurate monitoring. What are other systems out there doing for C-section intraop temp monitoring? We are supposed to trial 3M forehead sticky probes which is fine I am just curious if they are making this a bigger issue than it really is.

Thanks.

There's no need to monitor temp if your practice is to universally apply lower body Bair Hugger on full blast and warm all fluids (ie you are already doing all the interventions)

And no there's no routine, easy, and accurate way to monitor core temp in these cases anyway

 

[fakin' the funk]

The neuraxial anesthetic that leads to all the heat loss lasts longer than 30 minutes

30 min cases don’t need temp monitoring

 

[fakin' the funk]

I disagree that there's any ambiguity - the standard says:

and


I don't anticipate clinically significant changes in body temperature in any c-section ... unless and until perhaps a tube goes in and a uterus comes out, or something wild happens. I can continually evaluate an awake patient's temperature by talking to them.

Skin temp sensors are garbage. Their only utility is to allow you to nonfraudulently put a 37 on the chart for billing purposes.

You just made us all dumber with this preposterous bombast

 

[fakin' the funk]

Jesus, pt is wide awake. Just ask her if she is cold and wants some warm blankets.

You do realize that a patient under neuraxial anesthesia can subjectively feel warm, have core hypothermia, warm skin below the sensory level, and impaired shivering? No?

 

[fakin' the funk]

Everyone who dropped a bad take on this thread should read this and come back

Temperature monitoring and perioperative thermoregulation - PubMed

Most clinically available thermometers accurately report the temperature of whatever tissue is being measured. The difficulty is that no reliably core-temperature-measuring sites are completely noninvasive and easy to use-especially in patients not undergoing general anesthesia. Nonetheless...

pubmed.ncbi.nlm.nih.gov

 

[fakin' the funk]

Maybe just warm them preop? Warmed fluids and low flow gas? Not sure there is much else to do.

Robotic VATS can be long so preop warming of limited utility

other than putting a Bair Hugger on the lower body up to the hip, and warming the room, not much you can do

does anyone used warmed CO2 insufflation?

 

[fakin' the funk]

This is so stupid. So what, do they want you to start putting huggers on them? Kinda interfere’s with that precious skin-to-skin time no??

You just put it on their legs...(?!)

 

[deleted162650]

You just put it on their legs...(?!)

It’s a sub 1hr case in a warmer than usual OR with a patient who’s not under GA. I’m not putting a hugger on them anywhere.

Do your next 20 sections with a hugger on the legs, and the 20 after that with no hugger, and let me know if there’s any difference in PACU temps.

 

[GassYous]

Sounds like you care a lot about intraop hypothermia funk. But the patient should be out of the room before you can open and place the hugger unless your obs suck

 

[pgg]

You just made us all dumber with this preposterous bombast

LOL

Seriously man, it's OK to ask an awake patient if they're cold during a 30 minute procedure. Really.

 

[POW16]

I never check temperatures during C sections either but for those inclined a temp sensing Foley is another option. Another waste of resources.

 

[gaspasser127]

We are doing an internal QI project evaluating intra op hypothermia after neuraxial for CDs. They’re having us put on a skin temp prob and a lower body bair hugger. It’s a waste in my mind as I doubt there’s any long term (or even short term) implication from the core hypothermia that exists from the neuraxial.

 

[NoodleIncident]

LOL

Seriously man, it's OK to ask an awake patient if they're cold during a 30 minute procedure. Really.

Except in the occasional case with intrathecal Duramorph-induced hypothermia. They’ll be flushed and complaining of how hot they are, but with a core temperature too low to measure. I don’t think that a skin temp sticker would be helpful in this case though.

 

[dabears505]

I don't even monitor temp for on pump cardiac cases, why would I monitor them for a c section

 

[fakin' the funk]

It’s a sub 1hr case in a warmer than usual OR with a patient who’s not under GA. I’m not putting a hugger on them anywhere.

Do your next 20 sections with a hugger on the legs, and the 20 after that with no hugger, and let me know if there’s any difference in PACU temps.

What if... What if someone had already done that study

Active warming during cesarean delivery - PubMed

Perioperative forced-air warming of women undergoing cesarean delivery with epidural anesthesia prevents maternal and fetal hypothermia, reduces maternal shivering, and improves umbilical vein pH.

pubmed.ncbi.nlm.nih.gov

 

[fakin' the funk]

Sounds like you care a lot about intraop hypothermia funk. But the patient should be out of the room before you can open and place the hugger unless your obs suck

a) maybe you're at a place where it's routinely 75-90 minutes, and
b) maybe it still matters (it does)
c) maybe the circulator can place it and it takes 15 seconds (are your OBs faster than that?)

It's interesting that the OP's question was "do you monitor" and everyone here is arguing that *you shouldn't warm* even though the question of monitoring is a) moot if you warm and b) impossible to do accurately, reliably, and easily, and the intervention of warming has known benefit regardless

 

[fakin' the funk]

Do other groups routinely monitor intraop temps for C-section under spinal/epidural? ASA guidelines are somewhat ambiguous about monitoring. We usually use axillary temps but they are pretty variable. Admins are concerned about infection risk with inaccurate monitoring. What are other systems out there doing for C-section intraop temp monitoring? We are supposed to trial 3M forehead sticky probes which is fine I am just curious if they are making this a bigger issue than it really is.

Thanks.

To constructively answer your question, monitoring is a moot point if you do active forced air warming, and that is where your admins should be directing attention. Putting a Bair Hugger on, avoiding cold fluids, and avoiding a cold room is literally everything you can do, and those things are cheap and easy. Monitoring is worthless here because there are no accurate noncore sites available during routine CS, and no core sites available either, and patients under neuraxial reliably become hypothermic with known adverse effects. Just warm them and you're doing everything possible.