Why operating rooms are cold (not what you thought)

[@DamonJohnCollins]

Thank you. I manage construction in hospitals. It's worth pointing out that in OR construction, we strive to have more supply duct surface area in the ceiling (over the patients) so we can get those 20 air changes done with slower air speed. And we balance the supply to be the same speed across the entire face so that we create a laminar flow (of HEPA filtered air) across the patient (and sterile field) to also lower SSI. Another factor is making that air speed slow enough to reduce noise in the OR, but, fast enough so that movement around the Sterile field doesn't stir up dirty air around the patient while keeping the OR positively pressured (relative to the corridor). Thanks again, your content really helps me to understand why it's important to construct OR's the way we do.

[@MaxFeinsteinMD]

Wow that is amazing! Let me know if you’d ever want to make a video together, I’d love to learn more about what you do!

[@ReclusiveMountainMan]

@@MaxFeinsteinMD That would be a cool video!

[@JohnVKaravitis]

tl;dr

[@DamonJohnCollins]

@@MaxFeinsteinMD let me know what questions you have and I'll do my best to answer. I love your channel and I'll keep an eye out for any other topics you cover that cover the built environment. In the meantime, if you are in Orlando in the near future, I'll show you the current specialty hospital we have under construction. It includes 10 OR's and is joined to a 10 station bioskills lab and an ASC with another 12 OR's.

[@cliffontheroad]

@@DamonJohnCollins If lighting is a contributor to heat, maybe an alternative to current bulbs is overdue. Whale oil excluded. LOL

[@loverlei79]

Everytime I go in for surgery I have to tell everyone involved especially the anesthesiologist: "I have an upper spinal injury and can't regulate my body temperaturen so I'll need that really cool heated blanket thing, and you will need to watch me." The anesthesiologist always appreciates the heads up that I'm a lizard person and not to ever trust my body temp.

[@mustang8206]

That's actually fascinating

[@klyxes]

How does the injury prevent your body from self regulating?

[@loverlei79]

@@klyxes ​ The doctors aren't really sure what exactly went wrong in my case. The cervical spine break was c1, c2, c4, c5 with shattered c1 and c2; c4 and c5 overlapping. the shattering caused a piercing of my spinal cord and the overlapping caused a kink in the spinal cord. There was also undiagnosed brain trauma, which left a shrunken hippocampus, affecting my long and short term memory. I was in a coma for a few weeks and spent 2 years getting my left side back. Eventually I was diagnosed with Brown Sequard Syndrome and Non Epileptic seizures of unknown origin. Its been 20 years this March and the right side and temperature regulation never came back. I once got hypothermia in 68 degree weather, and will pass out in temperatures above 80 degrees F.

[@klyxes]

@@loverlei79 if u don't mind, what happened? Is hotter weather worse for you then cold? Does your body not start to sweat?

[@loverlei79]

@@klyxes It was a car accident in 2003. I was sleeping in the backseat of a small car and we were hit by a drunk driver. Neither hot or cold is better, but at least in hot weather I can go outside for an hour or so before over heating. As far a sweat is concerned it took several years for my body to produce sweat. Even now though, I don't sweat much, which is why we need ice packs to cool me off when i overheat. Same thing goes for fevers. If i get a fever from illness, i will take ice cold showers until my temp goes down.

[@jmacd412]

After a literal 48 surgeries, I’m finally getting an explanation. I was always flippant with my Doctors that they were taking me to the morgue instead of the operating room. Thanks for the important information.

[@CJGfarm]

😅😂

[@IAMZERG]

LOL. Hope I won't need to use that line any time soon, but I'm sticking that one in my back pocket.

[@Finduski]

48 surgeries and you never asked? Bruh

[@dulcilass]

The last time I went in for surgery I commented on how cold the room was and was told it was to help lower the germ count. We had to wait a bit to start the surgery so they kept wrapping and re-wrapping me up in warm blankets. I began to feel like a warm wrapped mummy. This video was great for getting the real reason for the chilled air.

[@valariewillis6000]

48 surgeries.....Explain 🤯

[@sissyroxx]

I quit my surgical nursing position because I kept getting very ill from the constant cold. I constantly shivered and couldn't control my body movements. It also caused me to feel a frequent need to empty my bladder. I never questioned the cold temperature because my nursing instructors taught us it was to lower the chance of infection for patients. Wow!

[@williamjones391]

I worked at Klondike in St Petersburg FL packaging those little ice cream bars ..12 hours shifts 5 days a week ..They kept that building so cold that people dressed like Eskimos in there ...I shiver so bad in there .ooh lordy ...every night when I went home it was like I had a cold everyday .i finally quit .Couldn't take the cold

[@drinkwatereatmelons7048]

A person with anemia...These jobs definitely wldn't be good🥶

[@safffff1000]

@@williamjones391 I just wore more layers of cloths

[@somethingsomething404]

@@williamjones391 lol never move to Canada. Florida people don’t know cold

[@missophelie3781]

​@@somethingsomething404You don't feel the cold in Canada! It's not wet but dry in Canada compared to Europe.

[@valuedhumanoid6574]

I commented that I didn't think the surgery was going to happen in a meat locker. The nurse went into the blanket heater and returned with 3 heated blankets. The doctor was wearing all the crap you were saying, the nurse even said he would overheat if it wasn't that cold. No joke, that surgeon had two helpers getting all the stuff on and when he came to visit me afterwards in recovery, he looked like he was playing basketball. He just looked hot and sweaty. He said he goes thru scrubs all day long

[@morganschiller2288]

Yep! So true! Most of my guys wear cooling shirts where ice cold water is circulated under their lead and scrubs. We have some spine cases that go for 8-14 hours. It can get rough for them

[@jerrym1070]

Wonder if cool suits would be practical . I am a hvac tech of 30 years . The man who brought me to the trade use to talk about his cool suit , could sit in hot attics 130⁰-140⁰ and not break a sweat he would say . Only guy I knew that ever had one

[@robertheinkel6225]

Those warming blankets feel great.

[@badgirlhollywood9741]

Yea they’re working you

[@TheDisturbed0Angel]

I remember when I was going through my military nursing school roughly 18 years ago, I spent some time in a burn unit and that OR was kept quite warm (100F if I remember?) due to how extensive the burns we delt with were (often 80% and more TBSA) and I vaguely remember being told it was due to how unequipped the patients were to regulate their own body temp.

[@Lew114]

That makes sense. One of our skin’s main jobs is to regulate our body temperature. If 80% of that system is damaged it makes sense that temperature regulation would suffer.

[@MP-in4or]

I worked in the OR with burn patients. That is a very rough environment. As you said, we have to maintain their body temp because they cannot do it themselves. This puts a lot of stress on the OR team.

[@Sashaa555]

Wow that’s interesting. Thank you for sharing. I want to be a military nurse 🙌🏽

[@XRROW_]

This really opens my eyes to how hard anesthesiologists work and what they have to take into consideration.

[@jewelhome1]

We don’t just put people into drug induced comas. Our job is to keep people alive and healthy while they are being dissected and repaired by the surgeons, so we take over controlling and monitoring your various bodily functions. Physiology is our game.

[@williamgibb5557]

The anesthesiologist can do a better job of keeping a person alive then the doctor.

[@playfulpanthress]

@@williamgibb5557 They ARE doctors, sweetie.

[@bugwar5545]

Yep. Course once you look at their paychecks, it all seems not so bad. "The average salary for an anesthesiologist is $331,937. Anesthesiologists can make up to $663,000 as a top earner, or a little as $113,000 for those beginning their careers."

[@XRROW_]

@@bugwar5545 they deserve every bit of it

[@IHeartQuilting2]

Both surgeries I've had since 2014, they put heated blankets on me once moved to the surgery room. They automatically do this for patients with diabetes, but also patients over the age of 60 (I was in 50s at the time). If you tend to be cold when others are comfortable or hot, be sure to mention this when you are in the pre-surgery prep room.

[@missblackwood]

I had two surgeries at about 30 and both times I woke up with heated blankets. I assumed everyone got one so that’s interesting. The second time I was shivering like crazy for a few minutes even with the blanket!! That OR felt absolutely frigid lol.

[@amycronkright6421]

I do this for every patient.

[@sally8708]

My normal body temp is 97.5 thanks to my hypothyroidism. However, I actually like being cold because I’m further away from being too warm. I’m quite hefty, so I get overheated easily when I’m active or if it’s summer. I’m happiest when my skin is a bit cool to the touch. Should I warn anesthesiologists if I go in for surgery? If they don’t know 97.5 is my baseline, it might be concerning. I won’t care if they stick heating blankets on me because I’d be out, so how would I even know until I woke up?

[@pacdude11]

@@sally8708 I’m not a medical professional, but whenever myself or a loved one has been in hospital they check vitals regularly so if your temp was abnormally low they would probably be aware

[@Benlucky13]

@@sally8708 never hurts to talk to them if you're worried about it. any sort of planned surgery the anesthesiologist will come in and explain the process and ask if you have any concerns or questions well before actually putting you under

[@GeoffreyFeldmanMA]

You might find it interesting to visit a semi-conductor production facility. The standards for removing particulates and exchanging air are many times more rigorous than OR's. In fact, in some parts, there isn't anyone in the facility at all. It's just robots. I worked for a company that had a smoke-enders program in which the technicians participated. The production crashed. It turned out that earlier they had tweaked the process to get the yields they wanted. Now that technicians were not smoking, not exhaling or sweating out the biproducts of the habit, the tweak was now wrong. They untweaked and all was well. This demonstrates just how sensitive the chemistry is. All that was a "Sub micron" facility but now, it's 5 nanometers and - no humans allowed.

[@SeekingTheLoveThatGodMeans7648]

Secondhand (thirdhand?) smoking in semiconductors, huh.

[@fluffysheap]

Semiconductor manufacturing is far more sensitive than surgery. In surgery you're worried about a bacterium that is maybe a micrometer long. This is more than a hundred times the size of the features on a chip. And a lot depends on the body's ability to take care of itself, which chips don't have at all.

[@tazzer9]

I work in a cleanroom that produces time critical medicine (it goes out in syringes and because it's injected it needs to be totally sterile). It amazes me how stringent the standards for us are compared to these operating rooms. If our regulator saw us producing our medicines in one of these operating rooms wearing the same gowns and masks as the surgeons our licence would be revoked on the spot.

[@NZKiwi87]

@@tazzer9 that sounds like an interesting job!

[@lizziebjl]

@@tazzer9 I would hope so!

[@swagnilla_ice]

I once got too much anesthesia when I went for a cornea transplant, that I almost died, and slept like a baby for the next week. The next time the specialist gave me less of the medicine and my surgery was more normal, like the last time I had surgery when I got my inflamed appendix removed. It made me really appreciate those who do your job, so thank you for all the hard work you do for your patients!

[@drewzalo]

Hope you’re doing well now

[@Dutch3DMaster]

A family member who had the same surgery mostly experienced the anesthetic administered as feeling like fire being poured into his veins. He can still remember the heart monitor sound immediately shooting up in pitch and tempo due to the stress this induced. I'm not sure if it was this response or something else, but they were ready to give him an adrenaline shot after surgery because he refused to regain consciousness in the average time to be expected. For the next 2-3 weeks he kept falling asleep at random moments for very short amounts of times, and when he woke up and he heard "Welcome back in the waking world", the response almost always was "I wasn't asleep!" :P

[@FoxDragon]

When I was a few weeks away from turning 13, I had an accident that resulted in a skull fracture requiring a fairly intensive surgery. I think it was the nurse who said something to either myself or my parents about asking for a warm blanket for my surgery, or maybe it was someone else on the team. I don't remember a whole lot of those 2 weeks that I was in the hospital, but I do remember the discussion of a hot blanket, and when it was actually time for my surgery, the sensation of a heavy, warm something being draped over me as someone told me to start counting back from 100 (and I only remember getting as far as 98) and then I was talking to someone in the recovery room.

[@kellyharper367]

Retired R.N. here: This video is amazing. Well presented as is your usual.

[@peachmelba9333]

I firmly believed it was to freeze out bacteria, viruses and other pathogens. I did have one warm operation, when I had my gastric Bypass at the Ohio State University in Columbus Ohio. My anestheologist actually asked if I was comfortable before I went off to LaLaLand- I knew if He was That Considerate- I was in Pefect Hands!

[@playfulpanthress]

Trust me, they just wanted an excuse to warm the room. Getting you warm blankets or putting the bair hugger under the sheets before you come into the OR would have been better.

[@publicenemynumerouno]

Okay, I watched this from beginning to end. I hope you keep an affiliation with a hospital that trains doctors and nurses. You have an enormous aptitude for keeping the material interesting and engaging. I've had three 'procedures' so far and while it was just an idle curiosity why the room was so cold now I at least understand some of the reasons why. Thank you very much!

[@tedk2814]

I just discovered your channel and can't wait to watch all the videos. My name is Ted and I retired 6 years ago from a 42 year career in nurse anesthesia. I feel so blessed to be doing something that I loved and I still miss the hustle and bustle to this day but at 73 years old the memories will do. I can remember the banter between the surgeon and OR staff complaining about the room temperature. I wore a long sleeve undershirt under my scrubs and a disposable surgical gown over top. Occasionally we could swipe an extra bair hugger from across the hall and put the nozzle under our gowns. Could you speak on the topic of loud music in the OR. Some younger surgeons insisted on blaring their tunes all the while the staff and I could barely hear the monitor alarms and the loud noise can be detrimental to the thought process. No kidding, I've had arguments when asking to turn the music down so I would just call my chief and let those two go at it. Thanks , I will subscribe . Ted in Sebastian, Florida

[@Inkling777]

An interesting observation. Our society seems to be dividing between those who NEED music as a background to what they do, and those who HATE that and see it as a distraction. Apart from requiring surgery staff who want that music to wear headphones, which would raise all sorts of issues, I don't see a solution.

[@xisotopex]

nothing has change LOL! CNA's still love to put the bair hugger under their lead!

[@marvinmuller1085]

For a pulmonary endarterectomy the patient`s body temperature needs to be at around 18°C. Therefore, the warming blanket is actually used to cool the patient down, the heart-lung-machine cools the patient`s blood but also the room temperature is lowered even more. In my opinion it gets really cold in the OR during this specific procedure. Thats why i like to wear scrubs with long sleeves for a PEA.

[@franks2910]

How often do you do those?

[@marvinmuller1085]

@@franks2910 We perform more than 150 of those each year

[@mrvwbug4423]

The pressure on the surgeons with that procedure must be immense. Having to work very quickly on incredibly delicate lung tissue because the patient is in a state of clinical death, the hypothermia is how it's able to be done without brain damage or the patient just outright dying.

[@Suiseisexy]

@@franks2910 He's done them like much more often since the mRNA therapies, in fact, this is probably why the question was asked with an increasing frequency such that a med youtuber would make an answer video just now: lots of ORs have been colder more often thus prompting a re-asking of the question in general. Don't feel too bad doc, not only did my gasto admit it for safety reasons (Cirr, MELD=8) but in the past I got one of the military eggheads to talk about what the army does with it's elderly enlisted, we actually played TF2 together, so I know how the sausage gets made. Still, though, it's these little off-hand confirmations of reality that help my sanity. Yeah, I bet it's been cold in that OR lately.

[@xXDESTINYMBXx]

@@Suiseisexy worst bot ever

[@valeriecarpenter3800]

Matt's video series on general anethesia was a huge help for me. Had surgery shortly after watching these and I was significantly less anxious & stressd out because I knew what the anesthesiologist would be doing, in what order & why they were doing each part of the procedure. I can''t thak you enough for making this series. Great job. 👍

[@deadskimountaineer]

We had a Bair Hugger in the infirmary at the ski hill I patrolled at to help warm up patients we brought in on cold days. It was a great addition to the kit.

[@gendoll5006]

We kept our recovery room pretty cool after I gave birth and the doc actually told us we had to turn it up cause it could’ve been contributing to our newborn daughter not gaining weight quick enough. Like her body was working to keep her warm and in turn burning calories. She never shivered or anything and the nurse turned the temp down, not us lol. It was just interesting!

[@AmoreMiu]

She did not shiver because babies don’t get the capability to shiver until they’re about 6 months old.

[@gendoll5006]

@@AmoreMiu well isn’t that a neat fact, no wonder she didn’t shiver! Lol.

[@eden1588]

It’s freaking freezing in the OR. This is really interesting

[@johnrowland3105]

I had spinal surgery last year. First time i'd been in hospital for an operation since i was five. I was surprised at just how cool the operating theatre was when i got there. Have to give a shout out to the Anesthesiologist i had though. He was wonderfully calm and reassuring as i was going through the process of it. Really settled any nerves i had.

[@laurawood7571]

Thank you for your videos, I’ll be having my 10th surgery tomorrow thanks to my autoimmune disease. No matter how many times I’ve been through it, anesthesia still makes me nervous every time. But watching your videos really humanizes it and makes it less nerve wracking. Thank you! 😊

[@The_New_Abnormal_World_Order]

I hope it went smoothly for you.

[@JohnDlugosz]

@@jonathanparle8429 "might even die" if they told you that the trip to the hospital by automobile was the most dangerous part, including "you might even die", it would help put things in perspective.

[@ReyOfLight]

My mum had surgery on Monday of this week to remove a rare (but thankfully not aggressive) tumor from her stomach. It was planned as laparoscopic, but ended up being open surgery once they had started operating because they needed to go more hands on to find the tumor. They managed to remove the entire tumor and some tissue around it to really ensure that it was all gone and mum is now considered cured! We were also expecting her to need to be in hospital until the weekend but I actually picked her up and brought her home already yesterday, and she could have been discharged already on Wednesday from a medical point of view, the reason she came home yesterday was because I need to know about such long drives beforehand (the hospital is almost 50 miles away) as I’m disabled and deal with severe chronic pain, so longer drives and longer excursions from home is something I need to plan ahead a bit and ensure I’m well rested. The extra night in the hospital for mum also gave her a bit more time to ensure she was indeed ready to go home and also gave us a bit of peace of mind to have her heal a little bit more before getting in and out of the car and such. Mum had an absolutely amazing team caring for her both during surgery and at the ward! She didn’t mention feeling cold so I’m guessing she had plenty of cozy blankets on her before being put under. Anytime I’ve been in an operating room, I’ve always needed a ton of blankets because I’m actually shivering in there, I feel cold very easily, and I always mention to the team working on me that “it’s amazing you can work in this, it feels like we’re in Antarctica” XD

[@lizziebjl]

I also believed it was to reduce bacteria. I wonder where these ideas start? I’ve had 14 operations in my life and I must say the most important person in the operating room is you! When I have my pre-op chat with the anesthesiologist, I tell them so ! ❤

[@Allegory_of_Wolves]

I believed this, too, and I was even told this by the nurses in the OR, when I had a surgery in 2019. Hailing from Germany. So apparently these ideas start from medical personell telling this to patients? I wonder why, because they should know better, if it's instead really like the guy in this video says.

[@BioTheHuman]

At what grades do you maintain your fridge? (A practical example to easily understand what's the real cold to reduce bacteria). I'm sorry but there is no way you can regulate bacteria with cold room in a human body. Even if the body reaches hypothermia, we're talking about 35 C° or let's even say 34 C°, which is still incredibly warm (outside human body). Try to put your hand in 34 C° water and you'll understand :)

[@amycronkright6421]

I’m a nurse in the OR and I was told this too. Bacteria love warm moist environments, so we keep it cool and dry. Also for the surgical team comfort; it was twofold.

[@debbied9842]

Unless I missed it, one reason wasn’t mentioned. I’m a nurse and I worked outpatient surgery, we always kept the temp at around 66 degrees. One day our air conditioning was not working and temps were rising. We were notified that if it wasn’t fixed we were going to have to cancel the rest of the cases for the day. The reason being that our equipment needs those temps in the 60’s in order to function, and that is what I would tell my patients when they complained about the cold.

[@Nic1Moreno]

Always wondered the same....never really made a issue over it have MS and cold is my friend plus I've realized nurses have one of the most difficult jobs there is.....very appreciative of what they do....but I've seen things work faster and are more productive if I do treat them as they want to be treated...RESPECTED...

[@muntacamil1463]

You are truly impacting a lot of youngsters in Aneasthesia school. Thank you.

[@MileinaJuarez]

I started shaking from the cold at my c section last fall. I was scared anyways because my baby was taken to the NICU because she swallowed amniotic fluid ( she was fine and with us soon after )but the cold was too much. They had to pause the stitches because my shaking was so bad. It took a few minutes until the shaking was under control. But I look happily back to my surgery now. Everyone was so caring. Everybody in the room knew that we lost multiple pregnancies before that one and that our son was stillborn. When our daughter came out alive and healthy, everyone was genuinely happy for us.

[@amycronkright6421]

In addition to all that, you probably had the post-partum shakes to, caused by the rapid shift in hormones. I have had several patients shake so violently (not cold or anxious) that they couldn’t even hold their babies.

[@df20001]

These videos were a KZbin rabbit hole recommendation. And I must say, Dr. Feinstein is such a reassuring voice and I admire his temperament. And when (if) the day comes for me to have surgery, I hope that someone quite similar and just as competent is “at the controls” and safeguarding my life in the OR.

[@mrspress8057]

Before a recent surgery I actually had one of the nurses tell me exactly this. I appreciated the honesty.

[@sonrog8877]

OMG after several procedures in freezing ORs, the latest one they finally gave me the heater in the recovery room. I’m really sensitive to cold & drafts & this was like heaven. Thanks for explaining.

[@exotic_lover465]

It's interesting to hear an explanation on the human medicine side of things. I perform anesthesia in veterinary medicine. We always hear about human medicine being vastly more advanced with research/technology and whatnot but it's comforting to know most of my job is pretty similar to what's mentioned here ☺

[@tedfisk1211]

I was in an outpatient facility yesterday for a knee replacement and the place was cold. But when the anesthesiologist did his thing, I was out and never knew the temp. Everything Max presented makes sense. Good video

[@karenvonbargen4472]

Outpatient knee replacement is absolutely barbaric. There are so many things that can go wrong and pain control alone can be a huge issue. I hope you’re ok.

[@richardmerriam7044]

I wondered the same thing when I had my first surgical procedure (pacemaker). It was almost like being on a different planet. All went well, the staff was great, and the surgeon complimented me about how cooperative I was. I neglected to tell him that he was the one wielding the scalpel...

[@melissaforbes8414]

I work in a hospital…. A secretary… and I always believed it was because germs don’t like the cold…. Very interesting and thank you so much for sharing😊

[@bettysmith4527]

Virus actually survive much better in the cold, which is why winter is prime time for colds, flu, COVID etc.

[@NickzAndMikz]

@@bettysmith4527 I’m not sure that’s true, but cold weather is a contributor to a change in human behavior

[@bettysmith4527]

@@NickzAndMikz It is true, it's a medical fact! "Viruses are actually protected by cold air. According to the National Institutes of Health, cold temperatures allow the virus's outer layer, it's envelope, to harden into a "rubbery gel." This protects the virus, allowing it to better transmit, or spread. Cold, dry conditions can also increase the spread of germs. "The dryer air may also allow the virus to stay airborne longer and increase the chance of another person coming in contact through inhalation," says Bilsky."

[@NickzAndMikz]

@@bettysmith4527 ah thanks for sharing

[@queenbunnyfoofoo6112]

Winter has a higher cold and flu rate because people tend to be inside more, in closer contact.

[@peterblackmore7560]

Hi Max, Thanks for answering that one! I am an AV consultant and in my first business, videotaped some Orthopaedic procedures in Melbourne Australia in the 80s. A specialist in Melbourne had developed a novel, faster procedure for hip replacement and Howse Protheses, owned by Johnson and Johnson, came back afterwards and said that this was the best quality video of a procedure that they have ever commissioned. I used a high quality camera, studio lighting and the camera was positioned over the operating table the night before the procedure by a Grip from the film industry. They were so happy that they got the Surgeon and us to do two more procedures. I was fascinated by everything in the Operating Theatre. In the last few years I have had two emergency procedures (a terrible triad elbow and a quads tendon rupture) as well as two prostate biopsies. And now to my point. The Anaesthetist usually appears before the procedure, introduces themself and a bit later, either they or an Anaesthetist Nurse, put you to sleep before entering the OT and then they hold your life in their hands - sometimes literally! Generally, you never see them again. So do they/you go into this important speciality to avoid patient contact? BTW - before the last biopsy, I asked the Anaesthetist if I could stay conscious unit after I had been wheeled into Theatre so that I could see everything. He agreed! Max - keep the vids coming, I enjoy really enjoy them.

[@tkay821]

So I'm an neuro IR tech and we were coiling an unstable cerebral aneurysm and our biplane angio table overheated and shut down WHILE THE INTERVENTIONALIST WAS ABOUT TO DEPLOY A COIL. I will never EVER forget that case. The room was unusually warm but not enough to warrant it as unusable. The scrub team wearing 12-15 lbs of lead plus surgical gowns....well we were super uncomfortable but this case was an emergency. So what happened to the patient? We kept them intubated, secured the sheath in the groin, transferred them to another room, moved all of the anesthesia equipment all the while the interventionalist was pacing back and forth (still impressed he kept his composure) Horrific situation I will never ever forget and I will never raise the temp of my room I don't care how damn cold the staff is. And for the patient there are bair huggers for a reason. The coiling went great by the way. And this was at a top ten hospital

[@MaxFeinsteinMD]

Yikes that sounds like a nightmare scenario. But well-handled!

[@AnimalMother60]

The lead really seals in the juices. Sometimes we come out drenched in sweat. Great for giving hugs!

[@donaldvincent]

I have worked at my hospital for 22 years. Some years ago a new wing was almost finished that would create a new main entrance with the standard foyer with two sets of doors and it was very cold in between, in the foyer. I had the occasion to ask the architect about the cold air in the foyer. He explained that it was a "flying insect barrier" to help prevent disease transmission.

[@tookitogo]

_Almost_ finished? Did they not finish it?

[@donaldvincent]

@@tookitogo "Some years ago" was almost finished. This explains why the architect was there. They finished it a few months later.

[@PrimeObserver-1]

As a former pediatric OR nurse, I agree with the answer 100%. Our patients were "slept" on heating pads, and covered as much as possible with piles of blankets from the warming cabinet. All of the staff, anesthesiologists included, usually wore warm-up jackets and were then swathed in old cloth scrub gowns. We were still cold and, as the circulating nurses, we were moving around quite a bit. I actually had a disagreement once with an anesthesiologist who wanted to open the windows (Florida location), but this would be an impossibility because of contamination risk. Fortunately, the windows were sealed shut, thus putting an end to that idea!

[@livewellwitheds6885]

I'm really surprised people think the cold stops infection lol. also it's fascinating how anesthesia impacts heat retention in the body. great video!

[@jenniferdaulby5519]

I've been a Theatre RN for 30yrs & am so used to being cool, theatre garb, concentration & the light keep me awake. Thanks for your video.

[@Melissa0774]

I actually had a series of major operations at Mount Sinai in 2012 and I asked the anesthesiologist right before one of them, why the ORs are always so freezing cold. I thought it might have something to do with whatever the reason is, that MRI rooms are also always freezing. But he told me the same thing that was said in this video. I forget what the reason is that MRI rooms are always so cold too, but it's completely different. I was kind of surprised he actually bothered to answer my question when he knew I was going to be out in literally another two seconds. I didn't think the reason might be to control infections, like some people think. I would think if they wanted to control infections, they'd have to actually make the room way colder, like at least the temperature of a walk in refrigerator or freezer. And that low of a temperature, you'd have frostbite to contend with. I did always wonder how to lower temperature and exposure to air to, affects a person's insides, though.

[@Inkling777]

For MRIs, the reason might be to keep all the equipment and electronics cool. In the late 1960s when I was in college the rooms for mainframe computers were kept cool for much the same reason.

[@notsogreen]

Have you ever heard of Listeria? It loves the cold and flourishes in freezing temperatures.

[@itsmickybroski3806]

Mad respect for answering the question at the beginning, then giving more information if we are still interested.

[@tibor29]

It would have been an interesting addition to the video to discuss what sort of clothes you are allowed and not allowed to wear in the OR if you want to make yourself more comfortable.

[@acloudshapedcloud7785]

At my hospital you can wear hospital laundered scrubs only, a new set each shift. They do provide hospital laundered jackets as well. You're not supposed to wear any "outside" clothes, so no shirts or pants under your scrubs as an extra layer. During long surgeries you'll often find the nursing and anesthesia staff wrapped in blankets from the warmer!

[@amycronkright6421]

For us, no street clothes can be visible under our scrubs, but we are allowed to wear something underneath if it doesn’t show. Normally, if I’m cold, I just grab one of those wonderful warm blankets!! 😜

[@cathymckay3784]

That was the first thing I noticed at the operating room's temperature, but I was hot at the time and the coolness of the room felt great.

[@whydoweneedousehandlesihateit]

Just finished OR rotation as a nursing student. I loved how it was always cold. And yes, I agree that the surgeons love it cold. It happened to me twice where the surgeon complained that it was hot. They had to lower the thermostat.

[@khills]

Heh. In my last surgery, I was actually kept awake, which was novel - the anesthesiologist let me have input in my level of sedation - and one of the first conversations we had was over what temperature we were going to keep me, because my body temperature is generally about a degree cooler than "standard" (I'm sure you're aware of the variability of body temperature). It was kind of funny to have a nurse bringing up my EPIC EHR to verify that yeah no, I generally run cold, so please don't make me uncomfortably warm!

[@VeryRGOTI]

wow, did you not feel any pain during the surgery?

[@khills]

@@VeryRGOTI Nope, no pain. I mean, she was clearly keeping an eye on things and making adjustments, but I only had to tell her twice when I felt a bit of random, distance tugging (I was having a finger debrided and partly amputated). Otherwise, we talked about her sneakerhead kid, travel, COVID, and other general stuff. I didn't actually notice when they began amputating (which wasn't a given when I went into surgery). I made an offhand comment that she should let me know if they do, and she gave me an odd look and was all "honey, they already did." Utterly pain-free experience and it meant I didn't have any violent reactions waking up from surgery and no amnesia period after. I definitely preferred it!

[@LittleKitty22]

I tend to run cold too, my normal body temperature is between 34 and 35 degrees Celsius. Trouble is, I never get believed. I'm in the UK and the motto here is - according to people who train up new staff: "all patients are stupid and don't understand anything, ignore everything they say, always remember all patients are stupid". They are not aware here of the variability of body temperature.

[@gladyshancock6601]

I have been in recovery and freezing but couldn’t tell any one because I wasn’t totally awake yet. Finally shivering violently I was able to speak and ask for a warm blanket! Thank you for discussing this very important aspect of surgery!

[@mattbrown817]

Doctor F is the man. He is the person I want on my care team full stop. Thank you Doc for all these nuggets of wisdom and humor.

[@debmary2999]

Hi Max, thanks for your videos, they are invaluable. I’m an ICU nurse who cares for patients after very long, complex operations. I’d love to know the effects of anaesthesia/drugs on the body after hours of surgery. A recent young exenteration patient had a lot of facial oedema that took a long time to resolve for example. Would be good to know from a nursing perspective.

[@crazygirl_irl2189]

I had a good few orthopedic surgeries after a serious car crash because doctors couldn’t fix me at first time and they needed to break a bone to redo surgery. I am a type of woman which loves warmth and heat (cold feet and hands) and every time I woke up from general anesthesia I always shivered and was shaking uncontrollably. I love watching your videos as I like to get to know some interesting facts about medicine and biology/anatomy.

[@scrumptious9673]

I was also shivering!

[@janetroush5775]

I had surgery this past August. When I was taken to the OR O said it feels like a meat locker in here. LOL They gave me a warm blanket and it was wonderful.

[@franklinstephen3268]

Hello 👋 how are you doing?

[@sdfiddler]

Enlightening. I as a CBET, I would suggest discussing with a Biomed about troubleshooting some of the common issues with OR equipment. Items like Gas Machine circuit test issues, infusion pump problems, etc.

[@samsanderson224]

I had some foot surgery done quite a few years ago….I have neuropathy in my foot, so I never felt a piece of metal get trapped in my sandal to make its way into my heel. It required surgical intervention to remove it…it had gotten embedded pretty deep. Anyway, the OR was freezing! My surgeon kindly asked for heated blankets for me🥰. Quite a guy, my doc. He’s done all of my ortho surgeries. I kid him all the time that I’ll never let him retire.

[@fluffigverbimmelt]

If you feel uncomfortably warm in an adult OR, go to a paediatric one. Those can be well above anaesthetist temperatures

[@MaxFeinsteinMD]

That’s the plan. Starting peds anesthesia fellowship later this year

[@amycronkright6421]

Yes, this! And burns!

[@susangrande8142]

Thank you for this explanation. In 2002, I had to have an emergency appendectomy. I noticed how cold the operating room was for the minute or 2 I was in it before I was knocked out; the table they made me move myself onto was cold, too! 🥶 But about 2 minutes later, I was waking up in my hospital bed in my room. I wish they’d used something like the Bair Hugger on me then.

[@mark111943]

Thanks, enjoyed that more in depth explanation. I actually did know that but only because I asked an OR nurse as I was being wheeled in once! Cheers from Western Australia

[@apriliagayatri1730]

thank you for the explanation doc, I used to shiver during a cesarean section. my head and hands were shaking. the nurse had wrapped me in a blanket, but I was still cold. The anesthesiologist finally turned up the room temperature, but I was still shaking. The Obgyn doctor during the operation protested why the room was so hot.

[@benburns5995]

Hi Max, thanks for this great video about temperatures in operating room. I imagine that while the pandemic was going on, the amount of material and protections surgeons wore was even more. I would also think that a surgeons adrenaline is quite high so that also would make them warmer as well. Your channel is so helpful to lay people, that want more information about being an Anesthesiologist and it's challenges.

[@xisotopex]

no the level of protection was the same. when the patient is intubated it is a closed circuit so the patient is not respirating into the room.

[@maintenance2medicine631]

Plant operations here. I saw your title and immediately thought, "because a surgeon told a tech to call us and lower it." On a more serious note, we also have to take into consideration other factors, like humidity. Cooler air doesn't hold moisture as well as warmer, so when we lower the temp for the surgeon it causes the relative humidity to go up. This can lead to condensation in the ductwork or sterile field. I have had to refuse to adjust temp because we didn't have dehumidification at the time and were dancing at the upper limit (60%).

[@amandacarr6141]

Yes, you’re right it keeps the surgeon and surgical tech cool, but it has a more important role. It helps to keep the humidity down as well. Humidity/condensation can present a problem with maintaining a sterile field. Also, you don’t want a surgeon sweating his eyebrow over an open patient.

[@Sherirose1]

The cold temperature and the height of items made me not pursue theatre scrub nurse. Cold makes me unhappy and I like being happy. Thank you for your hard work.

[@adithyakaushik8069]

I'm an anaesthesia resident in Germany and I'd always wondered about this before starting my residency. On a lighter note, the best part of the video is that you used Celsius instead of Fahrenheit. Lol

[@MaxFeinsteinMD]

We actually use celcius in the OR!

[@adithyakaushik8069]

@@MaxFeinsteinMD Really? That's interesting. I really like watching your videos. They're informative and at the same time provide an insight into the practice of anaesthesia in the US.

[@mustang8206]

@@adithyakaushik8069 Yeah while the Imperial system is easier for Americans we use the Metric system for science, medicine, sports and other international things

[@SeekingTheLoveThatGodMeans7648]

This also means "a couple of degrees colder" is almost twice that much."

[@lizziebjl]

United States will never get it’s act together with metrics. We had a chance in the 1970s, but people were dead set against it.

[@kevindavis8175]

I wondered about the cold OR temperatures! That’s why the warm blanket is my favorite part when I have surgery.

[@Carol_Pearson]

I had knee surgery about a month ago. (Side note: the anesthesiologists for that and for my colonoscopy, which was done 7 months prior, were both women. Just found that neat.) I honestly don’t recall the temp being too cold before I was put under, though I was covered in a heated blanket before we went in, so that helped.

[@franklinstephen3268]

Hello 👋 how are you doing?

[@suesax9945]

Hi Max, My name is John. Just retired after 40 yrs as a surgical first assistant. Agree totally with your assessment of Temp in the OR. As a scrubbed team member, I'm more on the side of anesthesia than surgeons. lol. Froze many a day. hey good luck with your career, stay warm.

[@karlkascha1261]

I always thought that it was to control bleeding. Thank you for another informative video Max.

[@acloudshapedcloud7785]

I've been told that too about spine and neurosurgeries. That the cold helps constrict peripheral blood vessels. These patients are often getting the warmed blood products mentioned in the video so I wonder if that changes anything.

[@DCL26]

Thanks Dr M. Feinstein for all the thorough and less mysterious explanations about Anesthesia, Meds, OR, Temperatures, etc, etc.

[@noelborden8787]

Love you caps. I can understand wanting cooler air.

[@franklinstephen3268]

Hello 👋 how are you doing?

[@dave900575]

1.) I had no idea anesthesiologist has that large of a role during surgery. 2.) I've had four surgeries, yet never seen the inside of an operating room (thank you for that). 3. I remember that BAIR blanket after one of my surgeries. It was much appreciated.

[@amycronkright6421]

Can only comment for my facility, but for us, the CRNA does WAY more than the anesthesiologist (MDA). The CRNA is responsible for prepping for anesthesia before the surgery (preparing meds, making sure any emergency equipment is in the room), screening the patient, screening the patient, bring patient to the room, starting arterial lines prior is necessary, pushing meds to induce anesthesia, intubating, monitoring diring surgery, and managing wake up. Usually the anesthesiologist just pops in for induction and makes sure nothing goes wrong during intubation, then leaves. We usually don’t see them again for the rest of the surgery. It’s the CRNA that does all the work.

[@dr.sakshinbelgavi]

Once when I was assisting with LSCS as a intern in the OR and i remember the AC weren't working that day (at night 3am), the heat from the scrubs and the OR lights made me feel intensely hot and this churning sensation in the stomach and i almost fainted. That made me realise why I would never become a surgeon 😂

[@juanpagan8796]

When I was rolled into the O.R. for my first surgery ever, I wondeed why it was, so cold in there... you explained it in a most excellent way. Thank you!

[@darriontunstall3708]

Great video man! I learned a lot! Great info! I really enjoyed donating to the anesthesiologist Foundation, since it was hard for me to go to college to be a anesthesiologist after I graduated high school in 08 because of my cerebral palsy! I think it takes special people to be a anesthesiologist, and you’re one of those special people, I’m one of those special people too!! I love anesthesiology! Anesthesiology is the best

[@johnmichaelrichards]

There is a notable exception: here in the UK for major burns surgery, especially with neonatal and paediatric burns cases, we keep the OR hot at around 35 - 40 Centigrade and also increase the humidity. This is in addition to close proximity warming devices beneath and over the patient. Children lose heat more rapidly than adults when anaesthetised and this greatly manifests with burns.

[@moboticusmaximus7320]

A few weeks ago I was diagnosed with a pheochromocytoma. I've read that they are sometimes called "an anesthesiologist's worst nightmare" in the context of an unknown one discovered during abdominal surgery for an unrelated reason. Fortunately, mine was caught when we found an adrenal tumor while getting a chest CT for unrelated reasons, so I know surgery won't be nearly as dangerous for me. My understanding, though, is that it is kind of a capital B, capital D Big Deal surgery. Especially as it pertains to anesthesiology. Can you tell us more about that? Are there other rare conditions those pose a similar degree of threat if you just happen upon them? And as a complete aside, when I saw my neurologist the other day and I told him about the pheo (the clinician who diagnosed me isn't in Epic so he didn't immediately see it in my chart) he said, "Wow. We all learn about these in med school but almost no one will ever see one." Do you feel like that rings true? I

[@MaxFeinsteinMD]

Yes an undiagnosed pheochromocytoma has the potential to be devastating if someone undergoes anesthesia/surgery. The surgery to address a pheo requires special considerations for blood pressure management, often necessitating getting drugs into the OR that aren’t typically kept there. It’s a relatively rare condition but in anesthesiology we do occasionally do pheo removals. Take care.

[@bezelleblanc2580]

I had surgery almost a year ago and when they wheeled me into the operating room I did notice it was rather chilly but I never really thought about it until this video popped up in my recommended.

[@charlsironborn2798]

Great video Doc! You teach us so much!

[@TheMOX125]

I’ve had 15 surgeries with ET general anesthesia. As I also have several AU, and am ‘old’ 68 for my last surgery, don’t do well with cold or hot. (Also am a 40 year nurse and have been on the other side of that ‘bed’ during surgeries. So can appreciate the temp layered up and moving.) Surely enjoy your videos. Keep them coming!

[@legobuildert909]

I dont like freezing rooms and they always put me warm blanket

[@chrisfox1065]

Thank u for your videos I have learned so much from your videos as I was in and out of hospitals for 5 years oh, yes I remember that noise and so cold my body looked like I was having a seizure-got them all freaked out. Those operating rooms r way to cold I always called them the ice room. I remember they had to put multiple blankets on me to get me warm. I found it odd the last major surgery I had while recovering in a room they turn the heat down so much I layed in bed so cold and they told me they keep the rooms cool to kill bacteria-I didn't buy it, I was always asking for blankets finally 1 nurse just turn the heat up. When I got home in my warm environment I came down with a nasty cold. Thank u for making these videos I learn so much from u have a great day, stay safe and keep making videos

[@virginiamoss7045]

This is so informative. Seems to me that it would be a lot easier for the anesthesiologist to wear warmer clothes than to try to accommodate them with air temperature. As for hot lighting, the recent invention of non-hot lighting would seem to lessen that problem. Why is that not possible?

[@timothyburrows9622]

My OR actually has jackets specifically for OR staff. When I’m circulating (as opposed to scrubbing) I wear one.

[@mustang8206]

Yeah seems like having a jacket would be the easiest solution

[@jilledmondson6894]

I had squamous cell cancer removed from the palm of my left hand. The cancer covered half of my palm. Had Mohs surgery on 12-29-22, and then went to plastic surgery for closure. In post op I was given a Bair hugger to keep warm. Worked wonderfully,.better than heated blankets.. My core temp is about 96 even on a hot day. Very good video.

[@michaelfink64]

As a surgeon, I was sure when you said "The most important person in the rooms at all times is ...", the answer was going to be the anaesthesiologist!

[@shaunaward925]

It’s always so nice when the nurse offers you a heated blanket!

[@MikeIsCannonFodder]

This idea might be harder with your work schedule, but chatting about the uses of anesthesia in dentistry would be interesting. For instance I tend to be hard to get numb for my lower molars and sometimes that means pumping 2x the normal amount in or hitting nerves on both sides. When I was a kid I got what I think was light sedation to help with the anxiety I had. Drank a small cup of thick flavored stuff which eventually made me relaxed and tipsy.

[@phyllojoe5346]

Imagine the dentist actually just gave you vodka in a milkshake

[@sufenta67]

There are a few measures that can be taken to ensure the density of the block or speed the onset or prolong the block.....besides just giving you double the dose.

[@river8760]

@@sufenta67can you elaborate please? I too, have this issue. Thank you.

[@lizziebjl]

This is why I love my dentures! 😂🤣

[@iconoclad]

I instruct my dentist - no anesthetic. I just suck up the pain. Extractions and root fills excepted.

[@phyllisschulman5389]

As a retired PACU nurse that floated frequently to the back to help circulate the surgeons were CONSTANTLY B******* about the room being hot (especially if said surgeon, first assistant or scrub nurse/tech were overweight) which I understand standing under lights in scrubs and sterile garments I always wore cuddle duds under my scrubs to stay warm. Thank heaven for Bair Huggers ( PACU RN's were happy campers when the came on the market) and the blanket warmer to get the core body temp back up.

[@musman9853]

Even in a full surgical gown I was freezing in my surgery rotation lol

[@WhileMyGuineaPigGentlyWheeks]

Haha the heated pun was amazing. In all seriousness, Thank you for all you do! Lots of love to all ❤️

[@painmt651]

As a patient who has been through many surgical procedures, I can attest to the fact that the operating room definitely feels cold to a patient

[@roxsanakourov.4513]

I love the warm blanket out of that blanket warming drawer

[@elishannon3855]

My assumption was actually always that the ORs were cold to keep the surgeons comfortable lol. This might sound silly but I also assumed it was likely more helpful to the patient in some way, so it is interesting to see that the opposite is likely true. I guess I just sleep really well in a cold room and thought it translated. Maybe the surgeons need a cold bair hugger so that the patient and anesthesiologist can be a bit warmer.

[@markiangooley]

Going unconscious from anesthesia is such a relief from feeling cold… I’ve been awake for some operations and it’s sometimes chilly.

[@robyns1348]

As a CRNA for over 17 years... Thank you for mentioning this. It's the menopausal nurses and techs usually cranking the temp down. Personally, I'm miserable when it's that cold and I later up at work. Patients always think it's to prevent "the bugs" 🧐

[@liv0003]

Menopausa has nothing to do with keeping the temperature low. Is one of the most idiotic reasons I come around to listen

[@playfulpanthress]

Menopausal? Do you wanna fight? We are working and moving around. If we were sitting still playing on our phone or doing a sudoku, yeah we'd be cold like you. But you can get a warm blanket. You can put on a gown. Get up and walk around. Hell, you can get a bair hugger. Meanwhile, we are getting supplies the surgeon decides they have to have that wasn't on the card. Or lifting multiple trays to get to the couple of instruments they never use. You may not understand or respect what we do, but don't you dare suggest some selfish reason as to why. Even if you do a half-assed job at trying to cover it with a lame biological excuse.

[@playfulpanthress]

@@Kitty_Sakura The surgeons are working too hard for that. I've only ever had anesthesia sleeping in a warm room. The rest of us are too miserable.

[@Mad_Catter_]

This explains to me everything that transpired when I hit the cold OR table. Thanks!

[@anisaromano5352]

Can you do a video about staying in the room with the patient the whole time, vs. stepping out (only being there to put the patient under and bring them back), and managing one patient at a time vs. a few at a time? I saw a news report about this years ago and they warned viewers to always ask about this.

[@kekelauren6251]

I feel like that would put a lot of surgeries behind, wait times for life saving procedures would double wouldn't they? There is always a line, more people are seeking advanced Healthcare now than ever.

[@lizziebjl]

Is that even ethical?! They have to be monitoring you continuously!

[@kalei7599]

Hey! An anesthesiologist will typically be there for the beginning and end of a surgery while an anesthesia assistant or nurse anesthetist will stay for the entirety of a surgery.

[@PanamaRose]

It depends on what state you live in. Some states have licensed certified anesthesia assistants (CAA's), some use CRNA's-certified registered nurse anesthetists. CRNA's are practicing nurses in critical care, have a BS degree usually and then they can attend a program, usually 2 years, for their certification. Not sure on the education base and program requirements for a CAA. A CRNA can practice under an anesthesiologist or not depending on the hospital or surgery center.

[@jb6712]

I'm not an anesthesiologist, nor any licensed medical professional, but I did work behind the desk of my hospital's ICU, working closely with doctors and nurses for over three decades. My understanding is that an anesthesiologist, or a CNA, has to be present with the patient at all times because things can go wrong so quickly, a licensed professional MUST BE there to respond to whatever alarms sound off. I've been retired for just 6 1/2 years, though, so maybe things have changed since then. I've had two minor surgeries just recently myself, both under gen anesthesia, and both times, there was a CNA present, and the anesthesiologist was in the room even if not right at my head.

[@amythomas1124]

Before my spinal fusion, my Neurosurgeon had me put in this heated zipped up blanket, warming up my spine area. Loved it.

[@mrsNetty34]

I always figured it was so the surgery staff wouldn’t get too hot

[@MaxFeinsteinMD]

You figured correctly!

[@cryssanie]

While still being a medical student, coming to the OR for the first time and finding out how cold it is there, I was worried that with my cold-bloodedness I'd be miserable in my workplace if I become a surgeon and get sick from the cold all the time... ...it took me very little time of actually working as a surgeon to understand the real struggle is how to keep yourself from overheating :-D

[@candisham1978]

To keep them comfortable? Nothing more uncomfortable than freezing for hours. I can understand it being kept cool, but that cold? Nah.

[@B-5102]

Surgeons and staff aren’t actually freezing when you’re wearing lead aprons to protect from radiation of X-rays, etc but also the BRIGHT OR lights

[@Navigator2166]

I love that Beir hugger! In the 80’s, before it’s invention, I was shaking so hard my surgeon actually hugged me while chastising the OR staff to let me get that miserable before The anesthesia was applied.