Perioperative hypothermia in the high-risk surgical patient

Perioperative hypothermia is common in high-risk surgical patients. Anaesthesia impairs central thermoregulation, allowing re-distribution of body heat. Cool ambient temperatures and high-volume fluid administration accelerate loss of heat to the environment. Randomized, controlled trials have proven that mild hypothermia increases the incidence of wound infection and prolongs hospitalization, increases the incidence of morbid cardiac events and ventricular tachycardia, and impairs coagulation. Other complications include enhanced anaesthetic drugs effects, prolonged recovery room stays, shivering, and impaired immune function. There is compelling animal evidence for cerebral protection by mild hypothermia. However, evidence for protection in surgical patients is not yet available. The most effective means of preventing perioperative hypothermia is active pre-warming. High ambient temperatures, warmed intravenous fluids and active cutaneous warming are useful intra-operatively, while active cutaneous warming and intravenous pethidine abolish post-operative shivering. Proper thermal management may reduce complications and improve the outcome in high-risk surgical patients.