Perioperative Thermoregulation and Hypothermia Management

Perioperative thermoregulation refers to the maintenance of core body temperature during the stages of surgery, anaesthesia and recovery. Under normal conditions, the human body conserves heat via vasoconstriction and shivering, and dissipates excess warmth through vasodilatation and sweating. General anaesthesia disrupts these mechanisms by impairing hypothalamic control, reducing metabolic heat production and promoting core-to-peripheral heat redistribution. As a result, inadvertent perioperative hypothermia (core temperature < 36 °C) commonly occurs. Even mild hypothermia can impair coagulation, increase blood loss, delay drug metabolism, raise the risk of surgical-site infections and prolong hospital stay. Effective management encompasses preoperative warming to reduce redistribution, intraoperative active warming devices and warmed intravenous fluids, and vigilant postoperative temperature monitoring. Environmental factors such as ambient operating-room temperature and procedural factors including the duration and extent of surgery further influence thermal balance. Contemporary guidelines advocate a multimodal warming bundle tailored to patient risk, procedural complexity and resource availability.

Research from Nature Portfolio

Recent studies have demonstrated that prewarming with forced-air devices for as little as 30 minutes before induction of anaesthesia significantly lowers the incidence and duration of intraoperative hypothermia during complex procedures such as living donor liver transplantation. This strategy acts primarily by counter-acting the rapid core-to-peripheral heat redistribution that follows anaesthetic induction, and also yields improved metabolic parameters such as reduced lactate accumulation. Separately, a predictive risk-scoring model has been established and externally validated to identify individual patients at high risk of inadvertent hypothermia. The model exhibits robust discrimination and calibration characteristics, thereby enabling clinicians to personalise active warming interventions in a cost-effective manner and to prioritise resources for those most vulnerable.

Perioperative Thermoregulation and Hypothermia Management publication trend

The graph below shows the total number of articles in perioperative thermoregulation and hypothermia management across all publications each year (not limited to Nature Index journals).

Technical terms

Thermoregulation: The physiological process by which the body maintains its core temperature within a narrow, optimal range despite external changes.

Hypothermia: A perioperative state in which core temperature falls below 36 °C, leading to coagulopathy, impaired drug metabolism and increased risk of infection.

Forced-air warming: An active warming technique using a blower-heated blanket to circulate warm air over the patient and prevent heat loss.

Core-to-peripheral redistribution: The rapid movement of heat from internal organs to the peripheral tissues after induction of general anaesthesia, causing an initial drop in core temperature.

Active warming: The application of external energy sources, such as heating mattresses or warmed intravenous fluids, to maintain patient normothermia during surgery.

References

1. Nurse anesthetists’ perceptions of heat conservation measures in connection with surgery – a phenomenographic study. BMC Nursing (2023).
2. Forced-air prewarming prevents hypothermia during living donor liver transplantation: a randomized controlled trial. Scientific Reports (2023).
3. Intraoperative hypothermia and its clinical outcomes in patients undergoing general anesthesia: National study in China. PLOS ONE (2017).
4. Perioperative Hypothermia—A Narrative Review. International Journal of Environmental Research and Public Health (2021).
5. Establishment and Validation of a Prediction Equation to Estimate Risk of Intraoperative Hypothermia in Patients Receiving General Anesthesia. Scientific Reports (2017).