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Maintaining normothermia is critical to safe anesthesia

The recent JAVMA News article “There are only safe anesthetists”1 correctly notes the higher prevalence of untoward anesthetic outcomes in veterinary versus human medicine, but it misses a critical risk mitigation strategy: maintaining normothermia throughout the perianesthetic period. Hypothermia is a routine anesthesia-related consequence that is a major factor in postanesthetic death, and the use of active measures to facilitate normothermia during anesthetic episodes is now the standard of care in human medicine. Even if a hypothermic patient survives, there are often other untoward effects, and measures to restore normothermia once hypothermia occurs are often unsuccessful, underscoring the importance of prevention.

To decrease the prevalence of untoward anesthetic outcomes, the veterinary profession should adopt evidence-based recommendations similar to those used in human medicine.2 Specifically, I suggest that Step 4d (“Anesthetic maintenance, including physiologic monitoring, physiologic support, and troubleshooting of anesthetic complications”) of the anesthesia guidelines presented in the JAVMA News story is insufficient. Monitoring of body temperature should begin in the preoperative phase and continue into the postoperative phase of the surgical procedure. In addition, active measures for maintaining normothermia should be included in the anesthetic protocol.

Once an animal becomes hypothermic, it is difficult to restore normothermia without inducing thermal burns to the skin. Additionally, with other factors being equal, maintaining normothermia becomes more challenging as the size of an animal decreases. Animals that are half the size of larger animals have approximately twice the surface area per pound to lose heat.

I agree that there are multiple factors that can decrease the prevalence of anesthetic complications. Maintaining normothermia throughout the perianesthetic period is one of them.

Jack Wedam, dvm, ms, mpvm

Boerne, Tex


  • 1.

    Burns K. There are only safe anesthetists. J Am Vet Med Assoc 2020;257:10981102.

  • 2.

    Hooper VD, Chard R, Clifford T, et al. ASPAN's evidence-based clinical practice guideline for the promotion of perioperative normothermia: second edition. J Perianesth Nurs 2010;25:346365.

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