- Adult surgical patients are at risk of developing hypothermia at
any stage of the perioperative pathway
- Inadvertent perioperative hypothermia is a common but preventable
complication of perioperative procedures
- It is associated with poor outcomes for patients
- Hypothermia is defined as a patient core temperature of below
36.0°C
- During the first 30 to 40 minutes of anaesthesia, a patient’s
temperature can drop to below 35.0°C
- Reasons for this include
- Loss of the behavioural response to cold
- Impairment of thermoregulatory heat-preserving mechanisms under
general or regional anaesthesia
- Anaesthesia-induced peripheral vasodilatation
- Patient getting cold while waiting for surgery on the ward or in
the emergency department
- It is important to prevent inadvertent perioperative hypothermia
Perioperative care
- Patients should be informed that
- Staying warm before surgery will lower the risk of postoperative
complications
- The hospital environment may be colder than their own home
- They should bring additional clothing, such as a dressing gown,
a vest and warm clothing
- They should tell staff if they feel cold at any time during
their hospital stay
- When using any device to measure patient temperature, healthcare
professionals should
- Be aware of, and carry out, any adjustments that need to be made
in order to obtain an estimate of core temperature
- Be aware of any such adjustments that are made automatically by
the device used
Preoperative phase
- Each patient should be assessed for their risk of inadvertent
perioperative hypothermia
- Patients should be managed as higher risk if any two of the
following apply
- ASA grade II to V
- Preoperative temperature below 36.0°C
- Undergoing combined general and regional anaesthesia
- Undergoing major or intermediate surgery
- At risk of cardiovascular complications.
- If the patient’s temperature is below 36.0°C
- Forced air warming should be started preoperatively on the ward
or in the emergency department
- Forced air warming should be maintained throughout the
intraoperative phase
Intraoperative phase
- The patient’s temperature should be measured and documented before
induction of anaesthesia
- It should be repeated every 30 minutes until the end of surgery
- Induction of anaesthesia should not begin unless the patient’s
temperature is 36.0°C or above
- Intravenous fluids (500 ml or more) and blood products should be
warmed to 37°C using a fluid warming device
- Patients who are at higher risk of inadvertent perioperative
hypothermia and who are having anaesthesia for less than 30 minutes
should be warmed intraoperatively from induction of anaesthesia using
a forced air warming device
- All patients who are having anaesthesia for longer than 30 minutes
should be warmed intraoperatively from induction of anaesthesia using
a forced air warming device
Postoperative phase
- The patient’s temperature should be measured and documented on
admission to the recovery room and then every 15 minutes.
- Ward transfer should not be arranged unless the patient’s
temperature is 36.0°C or above
- If the patient’s temperature is below 36.0°C, they should be
actively warmed using forced air warming until they are discharged
from the recovery room or until they are comfortably warm
Bibliography
Forbes S S, Eskicioglu C, Nathens A B et al.
Evidence-based guidelines for the prevention of perioperative
hypothermia. J Am Coll Surg 2009; 209: 492-503
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