Case Study 3 - Girling & Fraser Training

Why do you need quality improvement in practice?

Thinking about surgery of small mammals and birds, I’ve been looking at the current evidence in the prevention of intra-operative and post-operative hypothermia.
As we all know, small mammals and birds are prone to hypothermia during anaesthesia / surgery due to their small size. There are a number of different methods that can be used to minimise the risk of developing hypothermia during anaesthesia, but what evidence is available, and from the evidence, which methods should we be using in practice?

There are number of questions that come to mind:

- What are you doing in practice?
- Do you have a standard protocol to keep your patients warm?
- What methods of heat support do you use?
- Are they the best method or is there something else that would work better?
- Do you routinely monitor temperature throughout anaesthesia and during the post-operative period?
- When did you last review your protocol?

Would you know where to start to carry out a clinical audit, or find evidence to support what you're doing in practice? If not and you would like to find out more then we have the ideal course for you. The Quality Improvement in the Nursing Care of Exotics course will be running online between 21st May - 18th June. Find out more HERE.

And also, if you want to find out more about hypothermia during anaesthesia and how to prevent it, then I found some open access articles that might be of use.

References and further reading
- Bailey KT, Jantre SR, Lawrence FR, Hankenson FC, Del Valle JM. Evaluation of Active Warming and Surgical Draping for Perioperative Thermal Support in Laboratory Mice. J Am Assoc Lab Anim Sci. 2022 Sep 1;61(5):482-494. doi: 10.30802/AALAS-JAALAS-21-000036. Epub 2022 Aug 31. PMID: 36045004; PMCID: PMC9536828.
- Henderson (2012) Peri-operative hypothermia and the preventative role of forced air warming devices The Veterinary Nurse https://www.theveterinarynurse.com/review/article/peri-operative-hypothermia-and-the-preventative-role-of-forced-air-warming-devices
- Lamb (2009) Perioperative hypothermia – prevention is better than cure. Vet Times https://www.vettimes.co.uk/app/uploads/wp-post-to-pdf-enhanced-cache/1/perioperative-hypothermia-prevention-is-better-than-cure.pdf
- Pennock (2021) Warm air blanket and hypothermia audit. RCVS Knowledge https://knowledge.rcvs.org.uk/document-library/knowledge-award-2021-champion-warm-air-blanket-and-hypothermia/
- Rembert MS, Smith JA, Hosgood G. A comparison of a forced-air warming system to traditional thermal support for rodent microenvironments. Laboratory Animals. 2004;38(1):55-63. doi:10.1258/00236770460734407 https://journals.sagepub.com/doi/10.1258/00236770460734407?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
- Robertson, S (2015) Hypothermia – More important than you believe. WSAVA Congress Proceedings https://www.vin.com/apputil/content/defaultadv1.aspx?id=7259242&pid=14365&print=1
- Rufiange M, Leung VSY, Simpson K, Pang DSJ (2020) Pre-warming before general anesthesia with isoflurane delays the onset of hypothermia in rats. PLoS ONE 15(3): e0219722. https://doi.org/10.1371/journal.pone.0219722
- Schuster CJ, Pang DSJ. Forced-air pre-warming prevents peri-anaesthetic hypothermia and shortens recovery in adult rats. Laboratory Animals. 2018;52(2):142-151. https://journals.sagepub.com/doi/pdf/10.1177/0023677217712539