Perioperative Hypothermia Management

Perioperative hypothermia is a common complication during surgery defined as a core body temperature below 36 degrees C. Body temperature is normally maintained between 36 and 37.5 degrees C through hormonal regulation and cellular metabolism. However, during surgery, hypothermia frequently occurs due to anesthesia-related impairment of temperature regulation and exposure to cold operating room environments. "Perioperative hypothermia causes many complications including cardiac abnormalities, impaired wound healing, increased surgical site infections, shivering and delayed postoperative recovery" (Simegn et al.).

The causes of perioperative hypothermia are multifactorial. Heat loss during surgery occurs primarily through radiation, which accounts for 60% of total heat loss, as well as through conduction, convection, and evaporation. Anesthesia impairs the body's natural thermoregulation mechanisms by affecting the hypothalamus. Additional risk factors include low ambient operating room temperatures, administration of cold intravenous fluids, prolonged surgical exposure, extremes of age, and pre existing medical conditions. The combination of these factors creates an environment where maintaining normal body temperature becomes challenging without active intervention. 

Prevention and management require a comprehensive approach throughout the surgical period. According to AORN, “maintaining normothermia necessitates a coordinated effort among the surgical team, with perioperative nurses playing a central role" (no author). Prevention should begin one to two hours before anesthesia with active prewarming using forced air warming for at least 30 minutes. During surgery, both passive methods like thermal blankets and active warming systems including forced air devices and warmed intravenous fluids should be employed. The operating room temperature should be maintained at least 21 degrees C. Patient temperature must be monitored every 15 minutes during surgery. Postoperative management includes continuing active warming until body temperature exceeds 36 degrees C. This comprehensive protocol significantly reduced hypothermia-related complications and improved surgical outcomes.

Written by Malak Ibrahim at Incisionary

References:

AORN. (2024, September 16). The essential role of perioperative nurses in preventing hypothermia: Strategies and guidelines for maintaining normothermia. https://www.aorn.org/article/the-essential-role-of-perioperative-nurses-in-preventing-hypothermia--strategies-and-guidelines-for-maintaining-normothermia

Simegn, G. D., Bayable, S. D., & Fetene, M. B. (2021). Prevention and management of perioperative hypothermia in adult elective surgical patients: A systematic review. Annals of Medicine and Surgery, 72, 103059. https://doi.org/10.1016/j.amsu.2021.103059

Stoelting's Anesthesia and Co-Existing Disease. (n.d.). Normothermia management: Prevention of harm from perioperative hypothermia. Aneskey. https://aneskey.com/normothermia-management-prevention-of-harm-from-perioperative-hypothermia/