Andrzejowski et al have published theirinteresting findings [1] demonstrating that there is a decreased incidence ofperi-operative hypothermia in ASA 1-2 patients receiving 1 l of pre-warmed fluid beforeshort surgical procedures. They quote a study [2], which showed that pre-operativefluid loading reduced the incidence of postoperative nausea and pain inpatients undergoing gynaecological laparoscopic procedure.  It is to be noted that the decreasedincidence of nausea was found in patients receiving an average of 1800 ml offluid loading  (and not 1 l asmentioned by Andrzejowski et al). Also, none of the patients in that study received any prophylactic anti-emetic,which would have contributed to an overall high incidence of PONV.  In view of the above, the routine use ofintravenous fluids in patients undergoing a day case surgical procedure lastingless than 30 minutes is unnecessary. If the patients in the study by Andrzejowski et al [1] had not beengiven any intravenous fluid, a temperature drop of 0.25°C would have been avoided [3], and the median temperature in recoveryward would have been around 36.5° C, negating the need for any fluidwarming strategies. This also has cost saving potential in the currentfinancial climate. The use of pre-warmed fluids in long duration surgicalprocedures, and those involving significant blood loss, may help in minimizingperi-operative hypothermia.

S Kannan

City Hospital

Birmingham 

Email: Santhana.kannan@swbh.nhs.uk

References

1.     Andrzejowski JC, Turnbull D, Nandakumar A, Gowthaman S, Eapen G. Arandomized single blinded study of the administration of pre-warmed fluid vsactive fluid warming on the incidence of peri-operative hypothermia in shortsurgical procedures.  Anaesthesia 2010; 65: 942-5.

2.     Maharaj CH, Kallam SR, Malik A, Hassett P, Grady D, Laffey JG.Preoperative intravenous fluid therapy decreases postoperative nausea and painin high risk patients. Anesthesia andAnalgesia 2005; 10: 675-82.

3.     Gentilello LM, Cortes V, Moujaes S et al. Continous arteriovenousrewarming: experimental results and thermodynamic model simulation of treatmentfor hypothermia. Journal of Trauma 1990; 30:1436-49.