Burns from warming devices in anesthesia. A closed claims analysis.
BACKGROUND
Prevention of hypothermia is an important aspect of anesthetic management. Methods used for its prevention may, however, cause cutaneous burns. We reviewed the American Society of Anesthesiologists (ASA) Closed Claims Project database to determine if there were recurrent patterns of injury arising from intraoperative warming methods.


METHODS
The ASA Closed Claims Project database is a collection of closed malpractice claims that have been reviewed in a standardized format. All claims for burns were reviewed.


RESULTS
Among the 3,000 total claims there were 54 burns, of which 28 resulted from materials or devices used to warm patients. Intravenous fluid bags or bottles warmed in an oven and then applied to the patient's skin were responsible for 18 of the 28 (64%) burns associated with warming devices. These burns from intravenous fluid bags or bottles occurred in predominantly healthy (ASA physical status 1-2) young (age 38 +/- 17 yr, mean +/- standard deviation) women undergoing routine gynecologic or peripheral orthopedic surgery under general anesthesia. Of the eight burns from electrically powered warming equipment, five resulted from circulating-water mattresses.


CONCLUSIONS
Intravenous fluid bags or bottles warmed in an operating room oven represent a hazard to anesthetized patients. Because intravenous fluid bags or bottles are not an efficient method of patient warming, there seems to be little justification for their use.
Department of Anesthesiology, University of Washington School of Medicine, Seattle 98195.
F W
FW
Cheney
K L
KL
Posner
R A
RA
Caplan
W M
WM
Gild
D000328:Adult; D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods; D000776:Anesthesiology / Q000295:instrumentation / Q000331:legislation & jurisprudence* / Q000379:methods; D002056:Burns / Q000209:etiology*; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000517:prevention & control; D007262:Infusions, Intravenous; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D008318:Malpractice; D008875:Middle Aged