Perioperative and Post Operative Patients   

Preoperatively 

• Ensure temperature is taken on admission and patients are appropriately dressed and consider active warming if indicated preoperatively. 

• Provide a warm blanket if patient’s temperature is between 35.5⁰C and 36⁰C.

• Initiate forced air warming for patients less than 35.5⁰C if clinically indicated. Escalate to treating anesthetist

• For neonates

  • Continue the neonate's current thermoregulation i.e., radiant warmer and consider use of warm blankets as needed

  • Initiate forced air warming for neonates if patient temperature is < 36.5

• In consultation with the anesthesia team, consider preoperative forced air warming blanket for all patients if indicated and tolerated by the patient.

Anesthesia

Consider forced air warming for all patients undergoing anesthesia and surgery, especially:

• Neonates

• Cases greater than 30 minutes with large areas of exposed skin

• History of CP/Musculoskeletal disorder where thermoregulation is impaired

• Patients undergoing major surgery such as orthopedic procedures, laparotomies and large tumor removal with open body cavities.

• Patients with burns

Intraoperatively

• Active warming via forced air warming (Bair Hugger) is recommended for patients undergoing surgery when clinically indicated

• All patients with major burns where forced air warming devices are unable to be used should be placed on a heating mat (that is activated by the pressure of the patient lying on it).

•  Patients with major burns, neonates and patients undergoing free flap surgery should have the ambient temperature in theatre increased in consultation with the anesthesia and surgical teams.

• Theatre warming cabinets set to 40⁰C where irrigation fluids, IV fluids and blankets can be sourced from.

• Use warm irrigation fluids were possible.

• Apply warm blankets if patient is exposed or being transferred.

• Neonates: ensure that radiant heaters are used, preheated prior to patient transfer from theatre. Neonates should be kept warmed with beanies, blankets and appropriate clothing.

Recovery

• Ensure temperature is taken on admission to PACU and 15 minutely thereafter

• Initiate active warming via forced air warming (Bair Hugger) if neonatal patient temperature is less than 36.5⁰C or pediatric patients' temperature whose temperature is less than 35.5⁰C.

• Temperature should be taken every 5 minutes whilst a patient is receiving active warming.

• If overheating or burns occur, stop active warming and seek anesthetic review (treating or in charge). Cool patient if appropriate. Document event via EMR.

• Patients with chronic conditions which cause lower baseline body temperatures should return to their baseline prior to transfer to ward. This baseline temperature should be discussed with parents/caregivers and communicated to the receiving ward or day surgery. 

• Discharge temperature is greater than or equal to 36.6⁰C for neonatal patients and greater than or equal to 36⁰C for pediatric patients.  Ensure clinical indicators are completed and active warming interventions are documented in EMR. 

• If the post-operative temperature is less than 36⁰C but greater than or equal to 35.5⁰C, for pediatric patients and the patient is rousable and all other vital signs are stable and within normal range, they can be transferred to in-patient units. If clinically indicated, forced air warming can be made available to the in-patient units for continued use. This should be discussed with parents/caregivers and communicated to admitting unit.