PERIOPERATIVE PRACTICE Hypothermia: prevention and management
in adults having surgery (CG65) Recommendation in 2008 guideline
If the patient’s temperature is below 36˚C: l forced air warming should be started preoperatively on the ward or in the emergency department (unless there is a need to expedite surgery because of clinical urgency, for example bleeding or critical limb ischaemia).
l forced air warming should be maintained throughout the intraoperative phase.
On transfer to the theatre suite: l the patient should be kept comfortably warm.
l the patient should be encouraged to walk to theatre where appropriate.
Recommendation in current guideline
If the patient’s temperature is below 36˚C, start active warming preoperatively on the ward or in the emergency department (unless there is a need to expedite surgery because of clinical urgency, for example bleeding or critical limb ischaemia). [2008, amended 2016] Maintain active warming throughout the intraoperative phase. [2008, amended 2016]
On transfer to the theatre suite: l active warming should be continued (or re-started as soon as possible)
l the patient should be encouraged to walk to theatre where appropriate. [2008, amended 2016]
In the theatre suite: the ambient temperature should be at least 21˚C while the patient is exposed once forced air warming is established; the ambient temperature may be reduced to allow better working conditions; using equipment to cool the surgical team should also be considered.
Table 1
In the theatre suite: the ambient temperature should be at least 21°C while the patient is exposed once active warming is established; the ambient temperature may be reduced to allow better working conditions; using equipment to cool the surgical team should also be considered. [2008, amended 2016]
Reason for change
‘Forced air warming’ has been amended to ‘active warming’ to include other types of active warming. The second bullet point in the 2008 recommendation has been replaced by a separate recommendation to maintain active warming throughout the intraoperative phase, which applies to all patients regardless of their temperature before they leave the ward or emergency department.
‘The patient should be kept comfortably warm’ has been amended to ‘active warming should be continued (or restarted as soon as possible)’ to align with the new recommendation to start active warming at least 30 minutes before induction of anaesthesia.
‘Forced air warming’ has been amended to ‘active warming’ to include other types of active warming.
MARCH 2017
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