Context

Guidance

Inadvertent perioperative hypothermia is a common but preventable complication of perioperative procedures, which is associated with poor outcomes for patients. Inadvertent perioperative hypothermia should be distinguished from the deliberate induction of hypothermia for medical reasons, which is not covered by this guideline.

In this guideline, hypothermia is defined as a patient core temperature of below 36.0°C. 'Temperature' is used to denote core temperature. Adult surgical patients are at risk of developing hypothermia at any stage of the perioperative pathway. In the guideline, the perioperative pathway is divided into 3 phases: the preoperative phase is defined as the hour before induction of anaesthesia (when the patient is prepared for surgery on the ward or in the emergency department), the intraoperative phase is defined as total anaesthesia time, and the postoperative phase is defined as the 24 hours after entry into the recovery area in the theatre suite (which will include transfer to and time spent on the ward). The phrase 'comfortably warm' is used in recommendations relating to both the preoperative and postoperative phases, and refers to the expected normal temperature range of adult patients (between 36.5°C and 37.5°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 and the impairment of thermoregulatory heat-preserving mechanisms under general or regional anaesthesia, anaesthesia-induced peripheral vasodilation (with associated heat loss), and the patient getting cold while waiting for surgery on the ward or in the emergency department.

In 2016 we updated the guideline to take account of new evidence on active warming devices. We also added new recommendations on the site and method of measuring temperature, which had been identified as an area where guidance would be clinically useful.