Fore-sight Cerebral Oximetry

[periopdoc]

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Thinking about adding cerebral oximetry to our CV anesthesia practice, and I am interested in any thoughts on the FORE-SIGHT absolute cerebral oximetry system.

Anyone use this system or heard good or bad things about it? Anyone using a different system that they like or don't like?

We used the Invos system in residency and fellowship, but the requirement to obtain a baseline measurement was very problematic since we didn't use it on every case. Sometimes we would wish we had if part way through a case, sometimes a sensor would get dislodged etc.

- pod

 

[cchoukal]

.

 

[lushmd]

We use the foresight system at the hospital where I'm doing fellowship. They (like the other cerebral oximetry systems) occasionally fail due to light creep but generally seem to work well enough (i.e. I don't feel strongly enough about their performance either way to recommend buying or avoiding them). A minor nuisance is that the foresight system requires two plugs per probe vs one for the somanetics and nonin systems (and the boxes that their probes plug into are a bit bulkier than those of their competitors). The foresight and nonin folks make a big deal about using an absolute scale that doesn't require a baseline measurement but it seems to me that, when used in the intended patient population, there's still merit in having a baseline and trending the cerebral oximetry values.

 

[periopdoc]

Hmmm, I thought that Nonin uses a relative scale, and requires baseline reading/ calibration just like Invos. I agree that a baseline, even with the Fore-sight, is optimal, but there are times when it is not possible/ practical.

I could just drop jugular bulb catheters in high risk patients, but I am not sure how my partners and colleagues would feel about that.

-pod

 

[lushmd]

Nonin has a new "advanced" model that uses an absolute scale.

Of course, there are times when you're not able to obtain true baseline cerebral oximetry readings.

 

[urge]

Thinking about adding cerebral oximetry to our CV anesthesia practice, and I am interested in any thoughts on the FORE-SIGHT absolute cerebral oximetry system.

Anyone use this system or heard good or bad things about it? Anyone using a different system that they like or don't like?

We used the Invos system in residency and fellowship, but the requirement to obtain a baseline measurement was very problematic since we didn't use it on every case. Sometimes we would wish we had if part way through a case, sometimes a sensor would get dislodged etc.

- pod

Both systems give you the same info. Whether that info is clinically meaningful is another story. However, it is nice not to have to obtain a baseline.

How do you envision these monitors helping you?

Those things are super expensive. How much are they charging you for the stickers? Is the hospital paying for them?

I have heard it's over $100.

 

[Soparklion]

I've done some experiments on healthy volunteers. The ForeSight can start with some strange numbers and be very asymmetric at baseline.

They are only useful if they drop precipitously. I personally don't think that they are worth the investment.

 

[ProRealDoc]

Never used them and no plans to do so at this time

 

[periopdoc]

Never used cerebral oximetry in fellowship even? Or just not the Fore-Sight system?

- pod

 

[Bertelman]

Used Invos in residency, fellowship. ForeSight now, for the last couple months. In that brief time, I can say that I have had fewer faulty probes or specious numbers with the ForeSight. The additional box adds equipment to the room setup, but with the way the cardiac rooms look these days, it's hardly noticeable. Wires and machines and ceiling-mounted monitors all over the place.

I really can't recall the last time one of those monitors truly opened my mind. More like "Ohh, look, the cereb Ox is down now. Must have been from that drop in pump flow 5 minutes ago...Oh look....it's back up again." But I suspect there is the occasion when it is valuable.

 

[neusu]

In neurosurgery we've been looking for a useful, noninvasive cerebral oxygen monitor for some time. Unfortunately, nothing on the market has proven reliability. I don't suspect placing a licox would be indicated but it would be the most reliable tool for monitoring.

 

[periopdoc]

Given my druthers, I would probably choose a good, accurate, continuous jugular bulb oximetry catheter. In the fantasy realm, bilateral continuous SjO2 would be even better.

I like the licox idea (in fantasy world of course), but I would probably need two so that I could monitor differential perfusion of the hemispheres in a patient with unilateral cerebral vascular disease.

Generally, I don't see how cerebral oximetry is going to have a major effect on my management strategies. That is why I haven't pushed to have it available here. However, I had a recent case where the numbers would have saved a lot of heartburn in communicating with physicians from other specialties. I can't get too specific due to HIPAA concerns, but it would be nice to have those numbers now, even though they would have just reflected how my strategy was working, not changed my approach. As we take on more DHCA cases and more cases with challenging cerebral vascular anatomy, I can see this monitor being helpful from a medico-legal perspective.

The cost is not insignificant for the disposables, and that is another reason why I like the absolute monitors. You can choose to place them only when needed instead of having to always place them ahead of time. Most of the time, you can predict when it will be needed, but I have had times when I thought I would need it then didn't.

- pod

 

[neusu]

Given my druthers, I would probably choose a good, accurate, continuous jugular bulb oximetry catheter. In the fantasy realm, bilateral continuous SjO2 would be even better.

I like the licox idea (in fantasy world of course), but I would probably need two so that I could monitor differential perfusion of the hemispheres in a patient with unilateral cerebral vascular disease.

Generally, I don't see how cerebral oximetry is going to have a major effect on my management strategies. That is why I haven't pushed to have it available here. However, I had a recent case where the numbers would have saved a lot of heartburn in communicating with physicians from other specialties. I can't get too specific due to HIPAA concerns, but it would be nice to have those numbers now, even though they would have just reflected how my strategy was working, not changed my approach. As we take on more DHCA cases and more cases with challenging cerebral vascular anatomy, I can see this monitor being helpful from a medico-legal perspective.

The cost is not insignificant for the disposables, and that is another reason why I like the absolute monitors. You can choose to place them only when needed instead of having to always place them ahead of time. Most of the time, you can predict when it will be needed, but I have had times when I thought I would need it then didn't.

- pod

First, are you meaning CV for cerebrovascular or CV cardiovascular? Second, a single licox in the hemisphere of the diseased surgery would allow for accurate monitoring for loss of oxygenation. Third, an aggressive posture with respect to cerebral perfusion change in cerebrovascular surgery would enable a study with licox. I think this would be highly useful and something you may want to pursue if so enabled.

For what it's worth, JVB monitoring, even if bilateral, is not a great measurement of cerebral oxygenation. We have shown that since the 90s in neurosurgery. I do wish we had a better noninvasive monitor, but we are stuck with what we are.

 

[proman]

First, are you meaning CV for cerebrovascular or CV cardiovascular? Second, a single licox in the hemisphere of the diseased surgery would allow for accurate monitoring for loss of oxygenation. Third, an aggressive posture with respect to cerebral perfusion change in cerebrovascular surgery would enable a study with licox. I think this would be highly useful and something you may want to pursue if so enabled.

For what it's worth, JVB monitoring, even if bilateral, is not a great measurement of cerebral oxygenation. We have shown that since the 90s in neurosurgery. I do wish we had a better noninvasive monitor, but we are stuck with what we are.

Unfortunately the Licox is too invasive for a patient with anticoagulation. The Nonin system has the lowest rate of extracranial contamination, the Fore-Sight second and the Invos system has the most. Changes in scalp perfusion and oxygenation influences the NIRS results. Invos does have exclusive rights to technology that can provide information on cerebral autoregulation. I don't know if they've gotten FDA approval on it yet, but it would definitely be a reason to use them.

 

[sevoflurane]

We use it. I find it valuable during certain cases (chronic high grade HTN, chronic polycythemia/erythrocytosis with subsequent hemodilution, h/o CVA, high grade carotid stenosis, large PFO's, >70 y/o, etc.) or when things start to get a little dicey.

We place them on every heart we do. Just another monitor and should be used as such (taking into consideration the global picture of what's going on during any particular case).

Cerebral oxymetry I think may help establish early interventions. If my cerebral oximetry was 70 and 75 during sternotomy and now it's 35 and 45, my spider sense is going off.

 

[sevoflurane]

BTW, last year my wife had a case where the numbers took an acute dive. Patient @ full flows with stable hemoglobin and MAPs. She had a high suspicion of a stroke and alerted the surgeons intra-op. I can't fully remember the details, but there was no reason for the cerebral oximetry to take an acute dive other than being a calcium-type vasculopath.

The patient woke up with deficits.

 

[urge]

BTW, last year my wife had a case where the numbers took an acute dive. Patient @ full flows with stable hemoglobin and MAPs. She had a high suspicion of a stroke and alerted the surgeons intra-op. I can't fully remember the details, but there was no reason for the cerebral oximetry to take an acute dive other than being a calcium-type vasculopath.

The patient woke up with deficits.

How did the monitor change the outcome?

 

[urge]

Cerebral oxymetry I think may help establish early interventions. If my cerebral oximetry was 70 and 75 during sternotomy and now it's 35 and 45, my spider sense is going off.

Let's make this an educational opportunity for the residents.


1 What causes the cerebral sat to drop?

2 What can you do to fix it?

3 Is there such thing as too high a cerebral sat?

 

[periopdoc]

First, are you meaning CV for cerebrovascular or CV cardiovascular? Second, a single licox in the hemisphere of the diseased surgery would allow for accurate monitoring for loss of oxygenation. Third, an aggressive posture with respect to cerebral perfusion change in cerebrovascular surgery would enable a study with licox. I think this would be highly useful and something you may want to pursue if so enabled. For what it's worth, JVB monitoring, even if bilateral, is not a great measurement of cerebral oxygenation. We have shown that since the 90s in neurosurgery.

Cardiovascular. As mentioned by Proman, Licox isn't really an option for our patients who are fully anticoagulated, thus my mention of fantasy land. Unlike neurosurg/ anesthesia situations I am looking for changes that could effect one or the other or both hemispheres in an unpredictable fashion, a unilateral monitor would be problematic.

Having trained with Art Lam, I disagree that SjO2 is not a great measurement (the continuous fiber optic type lines have not proven out, but a properly drawn sample from a simple catheter can give very useful data), but I understand that is probably a minority opinion. I used both the Licox and SjO2 extensively in residency when doing neuro-anesthesia and neuro-critical care.

Invos does have exclusive rights to technology that can provide information on cerebral autoregulation. I don't know if they've gotten FDA approval on it yet, but it would definitely be a reason to use them.

Will they be able to add the capability to existing monitors, or will it require new monitors/ sensors? I can see this being a marginally beneficial number.

How did the monitor change the outcome?

Well, if I had a documented precipitous drop in my most recent case, it would have been helpful to me if not the patient. I can see that if you had a precipitous drop you could bump up your MAP to try to improve collateral perfusion while keeping an eye on the other hemisphere to be sure it's sat wasn't getting too high.

- pod

 

[OB1🤙]

I don't have experience with the fore sight. We trialed the nonin equanox briefly in fellowship, and I thought favorably of it relative to the somanetics, which I've used throughout residency, fellowship, and now private practice.

My main use for any of these systems is as a transfusion trigger in conjunction with other data. Your hct is 26 and cerebral sat hasn't budged? No blood for you. Hct 26 and cerebral sat looks ugly? Have some oxygen carrying capacity.

When I had cco swans and therefore real time svo2 on every patient, less useful. Now that I swan way less people, I like having some monitor of the adequacy of end organ oxygen delivery, even an admittedly imperfect one.

 

[urge]

Well, if I had a documented precipitous drop in my most recent case, it would have been helpful to me if not the patient. I can see that if you had a precipitous drop you could bump up your MAP to try to improve collateral perfusion while keeping an eye on the other hemisphere to be sure it's sat wasn't getting too high.

- pod

Sounds good on your head. But how did sevo's wife's real life pt benefit if he still stroked out?

Which artery suddenly got occluded that you need to rely on collateral circulation? What is the mechanism of such occlusion?

 

[urge]

My main use for any of these systems is as a transfusion trigger in conjunction with other data. Your hct is 26 and cerebral sat hasn't budged? No blood for you. Hct 26 and cerebral sat looks ugly? Have some oxygen carrying capacity.

There is literature on that. Treating the number increases the number of blood transfusions patients get, however no improvement in outcome has been demonstrated.

 

[proman]

Will they be able to add the capability to existing monitors, or will it require new monitors/ sensors? I can see this being a marginally beneficial number.
- pod

I think that upgradability is something that is negotiated with the company. They work under the Gillette model: Monitors are free, sensors aren't. Last I heard the sensors run $75 a piece.

I actually think that determining the lower limit of autoregulation will be important. There's a fair amount of evidence that shows that some people don't tolerate 10% from their baseline while others will tolerate 40%. We can't predict which way the patient will behave. Having the ability to know that the cerebral blood flow has gone from autoregulated (constant flow over changing pressure) to pressure passive (flow depends on pressure) will allow for individually managed BP goals. I think that is important, and hopefully large scale studies will support that.

As for suspecting strokes, I hope people are changing management based on that. Therapeutic hypothermia, avoidance of cerebral hyperthermia, changing in rewarming while on CPB, possibly magnesium are all treatment options. If I suspected a patient has a neurologic event while on bypass I would separate from bypass around 32-34 keep them there for at least 24 hours and then gradually rewarm. I'd also increase perfusion pressure.

 

[urge]

As for suspecting strokes, I hope people are changing management based on that. Therapeutic hypothermia, avoidance of cerebral hyperthermia, changing in rewarming while on CPB, possibly magnesium are all treatment options. If I suspected a patient has a neurologic event while on bypass I would separate from bypass around 32-34 keep them there for at least 24 hours and then gradually rewarm. I'd also increase perfusion pressure.

This would assume these forehead lights are specific. I don't think they are at a point where they radically change management. Hypothermia is not without morbidity or increased cost.

I don't think anybody does intentional cerebral hyperthermia, avoiding it is a mute point Reminds me of "avoid hypotension & hypoxia" on some consults.

Who is not already running high MAPs on high risk patients?

So, how did we change management?

 

[proman]

This would assume these forehead lights are specific. I don't think they are at a point where they radically change management. Hypothermia is not without morbidity or increased cost.

I don't think anybody does intentional cerebral hyperthermia, avoiding it is a mute point Reminds me of "avoid hypotension & hypoxia" on some consults.

Who is not already running high MAPs on high risk patients?

So, how did we change management?

I'd say that the risk of hypothermia is outweighed by the possible benefit, in the specific setting of trying to limit neurologic injury.

How high a MAP is enough? We have no idea without EEG or presumably a monitor of cerebral blood flow. Some patients will have alterations in CBF within 5% of their baseline. I'm sure you don't routinely run MAPS less than 5%, even in high risk patients. Then there are the patients who you don't think is high risk, but become pressure passive at the usual MAP of 50-60.

 

[sevoflurane]

Maneuvers:

• Higher MAPs do attempt to perfuse
• Ventilation with 100% oxygen
• Propofol gtt (thanks FDA)
• Hypothermia for 24hrs.
• +/-Steroids.

If it’s air embolism versus ruptured plaque/clot add: steep t-burg, suctioning of air out of central line ports, retrograde SVC perfusion, carotid compression if appropriate, etc, etc---> CPB if needed.

Check either the pump/tubing or other causes of air embolism such as CO2 form vein harvest or pneumoperitoneum.

Had one of these last year... pretty impressive to see Cerebral Oxymetry pick up after incising the RA. Equally impressive was the CO2 exiting RA after incision and return of cardiac function.

I think that cerebral oxymetry may help you intervene earlier during catastrophic neurological events in the heart room.

Irreversible brain damage takes how long... 5-6 minutes? Not saying Cerebral oxymetry is the be all and end all. It's specificity isn't great. It's sensitivity isn't great either... but with large insults, I think it can give you some early clues as to what is going on.

 

[sevoflurane]

...of coursre during the above case I didn't have cerebral oximetry as it started outside of the heart room.

ETCO2 of 15mm hg is something you'll never forget when you see it. TEE>air embolism manuevers>Lined up > transfered to CT OR and onto bypass in about 15 minutes.

Probably one of the most challanging cases I've had to do in PP.

It was april fools day and when I requested one of my CT surgeon to prep for crash bypass, he thought I was kidding.... 🙄

 

[sevoflurane]

If I suspected a patient has a neurologic event while on bypass I would separate from bypass around 32-34 keep them there for at least 24 hours and then gradually rewarm. I'd also increase perfusion pressure.

I had to look this up last year after this case. Is 32-34 degrees what people are doing for these cases? I believe I've read articles that describe colder temps. Just curious as this is one of those things you don't have time to look up as you are often pretty busy during these events. Any literature comparing specific temps.?

 

[proman]

I had to look this up last year after this case. Is 32-34 degrees what people are doing for these cases? I believe I've read articles that describe colder temps. Just curious as this is one of those things you don't have time to look up as you are often pretty busy during these events. Any literature comparing specific temps.?

Most places seem to target a temp of 33. I don't know what the ideal temp target is. You rarely get complications at 32 or higher. There's a lot of work being done now looking at the what the ideal targets are. Gradual rewarming is also key.

 

[proman]

I don't think anybody does intentional cerebral hyperthermia, avoiding it is a mute point Reminds me of "avoid hypotension & hypoxia" on some consults.

So one more point on this. There's no intentional hyperthermia but there is quite a bit of accidental.

How do you measure temperature on bypass?
What sites do you use?
What rewarming strategy is used?
How big of a temperature gradient do you use if <28? Does that change if >28?
Do you come off CPB at a lower temperature if post DHCA?
How about if there's suspected neurologic injury?

 

[urge]

...of coursre during the above case I didn't have cerebral oximetry as it started outside of the heart room.

ETCO2 of 15mm hg is something you'll never forget when you see it. TEE>air embolism manuevers>Lined up > transfered to CT OR and onto bypass in about 15 minutes.

Probably one of the most challanging cases I've had to do in PP.

It was april fools day and when I requested one of my CT surgeon to prep for crash bypass, he thought I was kidding.... 🙄

I don't get how cerebral sat would help you. You have an air embolism that is impeding cardiac out. You have no blood pressure. How does a cerebral sat add any information to the fact that you are coding?

 

[urge]

So one more point on this. There's no intentional hyperthermia but there is quite a bit of accidental.

How do you measure temperature on bypass?
What sites do you use?
What rewarming strategy is used?
How big of a temperature gradient do you use if <28? Does that change if >28?
Do you come off CPB at a lower temperature if post DHCA?
How about if there's suspected neurologic injury?

We come off when rhythm is regular and nasoph temp is 35 for any case.

Pts are usually less than 34 when they hit the icu. I have seen a 28 in the icu. Didn't fibrillate.

 

[sevoflurane]

I don't get how cerebral sat would help you. You have an air embolism that is impeding cardiac out. You have no blood pressure. How does a cerebral sat add any information to the fact that you are coding?

It was worthless during this case... although nice to see the numbers go from 15 to mid 40's over a 5 minute period.

 

[urge]

It was worthless during this case... although nice to see the numbers go from 15 to mid 40's over a 5 minute period.

That's $100 to give you warm fuzzy feelings. No change in outcome.

 

[sevoflurane]

Yep. We put them on all of our hearts. Our circulators and nurses didn't know any better. They did exactly what they were suppossed to do which is to crash onto bypass speading through our typical dance and routine which includes putting on a bis, cerebral oxymetry, prep the MAC kit, get drips from the front desk and prime them, etc, etc. I was a bit busy to worry about $100 during a rather expensive hospital stay.

I did get some warm fuzzy's once they came up though.... 😀

I actually don't find the oxymetry data worthless despite the fact that it won't change outcome.

 

[urge]

I have used the cerebral sat extensively. If I had the money from the probes I have used I would be driving a nice Bugatti. This has been my experience with the cerebral sat:

I have seen pts stroke with low numbers and with good numbers.

I have seen pts not stroke with low numbers and with good numbers also.

I have seen a lot of blood transfusions based on low numbers.

I have seen a lot of people complacent with hypotension because the numbers are good.

I have not seen the hypothermia protocol just because the cerebral sat is low.

I have not been convinced they are woth the price and stress caused by a low number.

 

[ProRealDoc]

i have used the cerebral sat extensively. If i had the money from the probes i have used i would be driving a nice bugatti. This has been my experience with the cerebral sat:

I have seen pts stroke with low numbers and with good numbers.

I have seen pts not stroke with low numbers and with good numbers also.

I have seen a lot of blood transfusions based on low numbers.

I have seen a lot of people complacent with hypotension because the numbers are good.

I have not seen the hypothermia protocol just because the cerebral sat is low.

I have not been convinced they are woth the price and stress caused by a low number.

+1

 

[periopdoc]

+2...

except for the Bugatti part, I haven't used it that much.

still thinking about getting it again though


- pod

 

[sevoflurane]

I have seen pts stroke with low numbers and with good numbers.

These are the people I hope to pick up early.

I have seen a lot of blood transfusions based on low numbers.

I have seen a lot of people complacent with hypotension because the numbers are good.

I have not seen the hypothermia protocol just because the cerebral sat is low.

I know you know this Urge, but this is not the way to use cerebral oximetry.

Again, I find it to be just another monitor like the bis. I do believe it can help with early interventions.

Say you are scanning the ascending aorta or do an epiaortic scan and discover a grade 5 atheroma in multiple places along the corse of the ascending aorta.

Say your cerebral sats are running 70's up until the time the aortic cannula goes in.

Say soon after the rSo2 drops to 25 on the left side...

Say you start to get HTN and bradycardia that wasn't there before..

Say you check under the drapes and you have asymetric pupils, the left being dilated and fixed.... etc, etc.

This is extremely concerning to me. I would have a discusison with the CT surgeon regarding my findings in the context of a very diseased aorta and consider a hypothermia protocol.

I find it pretty interesting that you can control the cerebral oxymetry numbers by controlling CO2. Higher CO2 levels will dilate cerebral vasculature and often times raise rSo2. Conversely, when you hyperventilate these same individuals, your numbers drop. In my mind I extrapolate this physiology to embolic phenomena and drop in rSo2.

ETCO2 of 29

Same patient with an ETCO2 of 48

Again, not great at either sensitivity or specificity (def. no silver bullet), but I find it useful in certain cases especially when CMRO2, ET/PaCO2, etc, has been kept near neutral. Neuroprotection is important and not everyone gets EEG's.

That being said, Urge has been doing this for a while and his experience with cerebral oxymetry is extensive so I def. appreciate his comments on the use of this technology.

I like our setup here. Just makes for a nice platform to work from . I don't think cerebral oxymetry is going anywhere as our surgeons have grown to like them too.

Just my 2 cents. Appreciate the discussion. 👍

 

[urge]

Say your cerebral sats are running 70’s up until the time the aortic cannula goes in.

Say soon after the rSo2 drops to 25 on the left side...

Say you start to get HTN and bradycardia that wasn’t there before..

Say you check under the drapes and you have asymetric pupils, the left being dilated and fixed.... etc, etc.

This is extremely concerning to me. I would have a discusison with the CT surgeon regarding my findings in the context of a very diseased aorta and consider a hypothermia protocol.

The pt will still stroke anyway. Plaque is not going anywhere. It's not air which will disappear eventually.

BTW, that was a really fast herniation. I don't think hypothermia is the treatment for that.

The discussion that should have taken place was whether to cannulate femoral/axillary, use embol-x system, ....

Not after the pt is compromised.

You are always so tidy.

 

[sevoflurane]

The discussion that should have taken place was whether to cannulate femoral/axillary, use embol-x system, ....

Not after the pt is compromised.

Correct. Been there and cannulated femorals. Still had a patient wake up with a stroke. Grade 5 in ascending and likely all over his vascular tree with little nuggets just waiting to break off.

I haven't seen cushings in the CT OR, but plenty in the Neruro OR. I bet you could easily see it during a 4-6 hour run of the mill CT case if they had a large enough plaque compromise cerebral circulation with extravesation all the while having an ACT of 400+.

 

[sevoflurane]

You are always so tidy.

I wanna be a type B... but my wife insists I'm a type A with OCD tendencies. 😡

 

[proman]

We come off when rhythm is regular and nasoph temp is 35 for any case.

Pts are usually less than 34 when they hit the icu. I have seen a 28 in the icu. Didn't fibrillate.

That's a fairly uncommon practice. You do greatly reduce the risk of hyperthermia that way but I think most places come off 36-37 nasal which can mean 38-39+ cerebral. Are you continuing the Bair warmer after coming off? You might not warm up much but you shouldn't cool off to 28. The colder you come off the better for the brain.

 

[urge]

That's a fairly uncommon practice. You do greatly reduce the risk of hyperthermia that way but I think most places come off 36-37 nasal which can mean 38-39+ cerebral. Are you continuing the Bair warmer after coming off? You might not warm up much but you shouldn't cool off to 28. The colder you come off the better for the brain.

No Bair Hugger.. They are always cold.

 

[proman]

No Bair Hugger.. They are always cold.

Well, get an underbody Bair or the Gaymar underbody water blanket. The Kimberly Clark patient warming system is very nice but not cost effective for routine cases.

 

[sevoflurane]

Do not buy these. Made by the same dude who came up with the bair hugger I believe.

We've been trialing them for over a month. Terrible at keeping your patients warm- we have been collecting our own data as we were thinking of making the switch. Particularly terrible during long back cases when the room is 60 degrees. The fact that they are reusable is kinda gross as well. Oh.. and they time out after six hours... so you need to remember that if anyone goes this route.

 

[proman]

Do not buy these. Made by the same dude who came up with the bair hugger I believe.

We've been trialing them for over a month. Terrible at keeping your patients warm- we have been collecting our own data as we were thinking of making the switch. Particularly terrible during long back cases when the room is 60 degrees. The fact that they are reusable is kinda gross as well. Oh.. and they time out after six hours... so you need to remember that if anyone goes this route.

Seems hard to do heart surgery with that on.

 

[sevoflurane]

You place them under the patient.
Ok @ keeping them warm... but not for warming them up.