ORs are kept very cold for the surgeons' comfort ONLY -- however, I have
seen surgeon's start to drip sweat, so it is a legitimate concern.  

As Sam pointed out, cold patients can have a variety of problems -- I'd also
add impaired metabolism of medications (and possible prolongation of the
anesthetic's effects).  The idea of a cold OR/patients promoting infection
control and coagulation is proven to be absolutely incorrect.  

Monitoring of patients' temperature is one of our standards of care, and if
we're doing a general anesthetic I will normally drop down an esophageal
probe to obtain a core temp.  And to try to maintain my patients'
temperature, I'll use warmed IV fluids, warmed forced air blankets (Bair
huggers), a humidifier on the end of the ET tube, low-flow O2/air, and
stacks of blankets from the outset.  As a last resort, I'm "allowed" to turn
up the temp in the room, and usually only if the patient's temp drops below
35.5 or so.  Honestly, I'm happy when I can keep a patient's temp above 36
in the OR.  When patients are awake, I usually don't monitor their temp, as
we only have these stickers for their foreheads that are wildly inaccurate.
 The fever associated with labor epidural analgesia is *usually* associated
with longer infusions, not necessarily an epidural inserted right before a
cesarean delivery.  Epidural analagesia causes vasodilation and so patients'
legs often feel very warm, although this does not reflect changes in core temp.

Our C/S ORs are usually VERY VERY cold.  I wear a long-sleeved t-shirt under
my scrubs plus a scrub jacket on top, and I am usually dancing around the
head of the bed trying to stay warm.  I have occasionally successfully
inched up the temp in the room, but when the poor moms are shivering, the
OBs cheerfully always say "yeah, that's the effects of the epidural and the
hormonal shifts, sorry" (yes, true to some degree, but moms are cold too). 
It is possible to get baby onto mom quickly and covered up again, but it
gives ME the shivers when we've done it, just because it is so cold to have
baby uncovered even for just a few seconds. 

I was talking about sts with the OB chair and my attending last night and
both of them were mostly concerned just having someone available to help mom
support the baby.  OB wants me to try to design some kind of wrap or
something that we could use to help prop baby between mom's breasts. :) 
We'll see how that works out, as baby might (gasp) want to nurse at that
point too...  And the other resident (and my attending) also reiterated that
when they've offered to help mom hold the baby on the table, they just don't
want to.  In order for us to try to make it somewhat of a standard and
convince mom to do it, it will require *significant* buy-in from everybody
involved because it would be a huge change.  I think everybody is just happy
that we keep baby in the OR and dad usually gets to hold him/her for a long
time.

-Sarah Reece-Stremtan M.D. (anesthesiologist in training, with my last OB
call tonight for 5 months... yay!) :)

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