BOX 15.1
Key priorities for implementation of perioperative care (adapted from ‘CG 65 Inadvertent perioperative hypothermia: the management of inadvertent perioperative hypothermia in adults. London: NICE. Available from www.nice.org.uk/ Reproduced with permission. NICE 2008a)
Patients (and their families and carers) should be informed that:
- staying warm before surgery will lower the risk of postoperative complications
- the hospital environment may be colder than their own home
- they should bring additional clothing, such as a dressing gown, a vest, warm clothing and slippers, to help them keep comfortably warm
- they should tell staff if they feel cold at any time during their hospital stay.
When using any device to measure patient temperature, healthcare professionals should:
- be aware of, and carry out, any adjustments that need to be made in order to obtain an estimate of core temperature from that recorded at the site of measurement
- be aware of any such adjustments that are made automatically by the device used.
Preoperative phase
Each patient should be assessed for their risk of inadvertent perioperative hypothermia and potential adverse consequences before transfer to the theatre suite. Patients should be managed as higher risk if any two of the following apply:
- American Society of Anesthesiologists (ASA) grade II–V (the higher the grade, the greater the risk)
- preoperative temperature below 36.0 °C (and preoperative warming is not possible because of clinical urgency)
- undergoing combined general and regional anaesthesia
- undergoing major or intermediate surgery
- at risk of cardiovascular complications.
If the patient’s temperature is below 36.0 °C:
- 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)
- forced air warming should be maintained throughout the intraoperative phase.
Intraoperative phase
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