Should Plastic Surgeons Prevent Chills in Patients?

V. Leroy Young, MD

by V. Leroy Young, MD | August 10, 2010 @ 01:00PM

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Patients hate it when a physician puts a cold instrument anywhere on their bare bodies.

But, increasingly, medical science is coming to understand that excellent medical reasons exist about why patients should not be cold -- or even chilly -- before, during, or after their plastic surgery procedures.

The most recent finding, reported in the January issue of Anesthesiology was about a study done at the Cleveland Clinic that found surgical patients with lower than normal temperatures -- even less than a single degree -- can lead to increased blood loss and the need for transfusions. Read more.

At the time of surgery, perhaps 50 to 90 percent of patients become too cold unless physicians and staff help keep the patient warm. Indeed, many patients have said that being chilly was the worst part of their cosmetic plastic surgery. Whatever the case, it should be taken seriously because being too cold is not a benign process -- it actually carries some serious medical risks.


Goose Flesh

We know a patient is too cold by the usual signs -- he or she is shivering, has goose flesh, and the arteries in the arms and legs shrink. We also know the best body temperature for surgery is 96.8 F.

When you are cold, your body reacts in various ways without you being aware of it. For instance, the actual purpose of shivering is to increase body heat. But general or regional anesthesia can make the patient actually become colder because some types of anesthesia block the body's ability to maintain a normal temperature.

What usually happens under anesthesia is the reverse of normal: the body's core cools because the extremities release heat into the environment.

Physicians can add to the chill, too. For instance, when cool antiseptic surgical prepping solutions and other unwarmed fluids are used, body temperatures can drop further.

Moreover, the longer you are under anesthesia, the cooler you may become. You also lose heat during surgery because your skin is bare, exposing more of your body to the air while more cool fluids are often used for irrigation as the surgery progresses.

Longer procedures with larger incisions cool the body even more. It's not much different when you are awake and the surgical site on your body has been numbed with a nerve blocking agent. Your core temperature can drop.

Plastic Surgery Procedures

So what does all this mean to your procedure? How will it affect the outcome of cosmetic plastic surgery? The consequences of being too cold during your plastic surgery are increased opportunities for bleeding, infection, delayed wound healing, and post-operative shivering. The most serious complications include rare cardiac events and increased mortality. Being too chilly affects the staunching of bleeding for many technical reasons including delaying the body's natural clot formation process.

However, there are some things plastic surgeons can do to make the patient warmer.


The most common is using a forced air heating system that increases body heat by warming the patient's surroundings. Surgeons also can use special blankets powered by batteries; the patient lays on the blanket during surgery. Or, a device known as a circular warming system consists of garment segments that are placed under the patient and then wrapped around the torso, legs, shoulders, or upper arms when that part of the anatomy is not within the surgical field.

Most patients appreciate being warmed up before surgery; many often complain of being cold in the preoperative holding area while being prepared for surgery.

Some thoughtful surgeons will warm irrigation, intravenous and infiltration fluids before implementing them on the patient.

Although this patient is in an emergency room, he is being warmed with a medical wrap that allows the surgeon to work.

Scar Healing

Being too chilly is additionally known to impair the body's natural immune functions. That means the odds of a surgical incision being infected are greater. Less collagen -- which is a very important substance in rejuvenation surgery -- is deposited at incision sites and that delays healing even when no infection is present. That, in turn, delays scar healing, possibly causing a longer hospital stay and leaving stitches that must stay in longer. All that can increase the total cost of a procedure.

What should patients do if they find themselves chilly before or during a plastic surgery procedure? If you are awake, ask for a forced air body warmer or if a blanket can be put on the uncovered parts of your body not under surgery. But just the fact that shivering is a major source of patient discomfort is enough to keep them warm.

About Dr. Young: The St. Louis based V. Leroy Young, M.D. is a board certified plastic surgeon and chief of surgical services at Barnes-Jewish West County Hospital. Dr. Young is a three-time winner of the Tiffany Award, given yearly for Best Scientific Presentation at the annual Aesthetic Society meeting. 

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