Update information

December 2016

New recommendations have been added on patients with communication difficulties, measuring temperature, warming patients before induction of anaesthesia and warming patients after induction of anaesthesia. These are marked as [new 2016].

Where recommendations end [2008], the evidence has not been reviewed since the original guideline.

Amended recommendation wording (change to meaning)

Recommendation in 2008 guideline

Recommendation in current guideline

Reason for change

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. [1.2.5]

If the patient's temperature is below 36.0°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] [1.2.3]

Maintain active warming throughout the intraoperative phase. [2008, amended 2016] [1.2.5]

'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The second bullet point in the 2008 recommendation has been replaced by a separate recommendation to maintain active warming throughout the intraoperative phase, which applies to all patients regardless of their temperature before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.

On transfer to the theatre suite:

  • the patient should be kept comfortably warm

  • the patient should be encouraged to walk to theatre where appropriate. [1.2.8]

On transfer to the theatre suite:

  • active warming should be continued (or re-started as soon as possible)

  • the patient should be encouraged to walk to theatre where appropriate. [2008, amended 2016] [1.2.7]

'The patient should be kept comfortably warm' has been amended to 'active warming should be continued (or re-started as soon as possible)' to align with the new recommendation (1.2.4) to start active warming at least 30 minutes before induction of anaesthesia.

1.3.4 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. [1.3.4]

1.3.4 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] [1.3.4]

'Forced air warming' has been amended to 'active warming' to include other types of active warming.

ISBN: 978-1-4731-2214-7

  • National Institute for Health and Care Excellence (NICE)