Normal thermoregulation is disrupted during anaesthesia and surgery due to multiple factors. Unintended perioperative hypothermia is common in surgical patients, and has been reported to be associated with platelet dysfunction, bleeding, wound infection, alterations of pharmacotherapeutic effects and shivering.
Overview of evidence (non-systematic literature review)[edit source]
No systematic reviews were undertaken for this topic. Practice points were based on selected published evidence. See Guidelines development process.
Effects of perioperative body temperature on wound site[edit source]
One randomised controlled trial of 200 patients undergoing colorectal surgery reported that maintenance of a normal body temperature (near 36.5°C) during colorectal surgery using forced-air warming combined with fluid warming decreased the rate of surgical site infectionand reduced length of stay, compared with allowing body temperature to decrease to approximately 34.5°C.
Avoidance of hypothermia should be encouraged for its other benefits, which may include improved wound healing associated with a reduction in hospital stay.
Strategies for maintaining perioperative body temperature[edit source]
Strategies for maintaining perioperative body temperature include warming intravenous (IV) and irrigation fluids, the use of reflective blankets or clothing, and forced air warming, and prewarming.
The use of warmed IV fluids has been shown to be effective in maintaining body temperature in adults. Pre-warming for a minimum of 30 minutes may also reduce the risk of subsequent hypothermia. There is no clear evidence that the use of reflective blankets or clothing increases body temperature, compared with usual care.
Perioperative normothermia should ideally be maintained at or above 36.0˚C.
The use of warmed IV fluids and forced-air warming can be used to minimise perioperative hypothermia.
- Sessler, DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology ;2008 Aug; 109(2): 318–338. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2614355/.
- Joanna Briggs Institute. Strategies for the management and prevention of hypothermia within the adult perioperative environment Best Practice: evidence-based information sheets for health professionals. 2010; 14(13):1-4.;.
- Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 1996 May 9;334(19):1209-15 Available from: http://www.ncbi.nlm.nih.gov/pubmed/8606715.
- Baucom RB, Phillips SE, Ehrenfeld JM, Muldoon RL, Poulose BK, Herline AJ, et al. Association of Perioperative Hypothermia During Colectomy With Surgical Site Infection. JAMA Surg 2015 Jun;150(6):570-5 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25902410.
- Lehtinen SJ, Onicescu G, Kuhn KM, Cole DJ, Esnaola NF. Normothermia to prevent surgical site infections after gastrointestinal surgery: holy grail or false idol? Ann Surg 2010 Oct;252(4):696-704 Available from: http://www.ncbi.nlm.nih.gov/pubmed/20881777.
- Hart, SR; Bordes, B; Hart, J; Corsino, D; Harmon, D;. Unintended perioperative hypothermia. The Ochsner Journal ;2011;11(3):259-270.
- National Collaborating Centre for Nursing and Supportive Care. National Institute for Health and Clinical Excellence (commissioner). The management of inadvertent perioperative hypothermia in adults. (NICE CG65). London: National Institute for Health and Clinical Excellence; 2008 Available from: https://www.nice.org.uk/guidance/cg65/evidence/cg65-perioperative-hypothermia-inadvertent-full-guideline2.