Bennett J, Ramachandra V, Webster J, Carli F. Prevention of hypothermia during hip surgery: effect of passive compared with active skin surface warming. Br J Anaesth.. 1994; 73:(2)180-183

Billeter AT, Hohmann SF, Druen D, Cannon R, Polk HC Unintentional perioperative hypothermia is associated with severe complications and high mortality in elective operations. Surgery. 2014; 156:(5)1245-1252

Boet S, Patey AM, Baron JS Factors that influence effective perioperative temperature management by anesthesiologists: A qualitative study using the theoretical domains framework. Can J Anaesth.. 2017; 64:(6)581-596

Burger L, Fitzpatrick J. Prevention of inadvertent perioperative hypothermia. Br J Nurs.. 2009; 18:(18)1114-1119

de Brito Poveda V, Clark AM, Galvão CM. A systematic review on the effectiveness of prewarming to prevent perioperative hypothermia. J Clin Nurs.. 2013; 22:(7-8)906-918

Horosz B, Malec-Milewska M. Inadvertent intraoperative hypothermia. Anaesthesiol Intensive Ther.. 2013; 45:(1)38-43

Kim EJ, Yoon H. Preoperative factors affecting the intraoperative core body temperature in abdominal surgery under general anesthesia: an observational cohort. Clin Nurse Spec.. 2014; 28:(5)268-276

Kurz A, Sessler DI, Lenhardt R Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med.. 1996; 334:(19)1209-1216

Lynch S, Dixon J, Leary D. Reducing the risk of unplanned perioperative hypothermia. AORN J.. 2010; 92:(5)553-565

Matsukawa T, Sessler DI, Christensen R, Ozaki M, Schroeder M. Heat flow and distribution during epidural anesthesia. Anesthesiology. 1995; 83:(5)961-967

Mitchell AM, Kennedy RR. Preoperative core temperatures in elective surgical patients show an unexpected skewed distribution. Can J Anaesth.. 2001; 48:(9)850-853

National Collaborating Centre for Nursing and Supportive Care. The management of inadvertent perioperative hypothermia in adults. Full version of NICE guideline CG65. 2008. (accessed 28 January 2020)

National Institute for Health and Care Excellence. Hypothermia: Prevention and management in adults having surgery. NICE clinical guideline CG65. 2016. (accessed 28 January 2020)

Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice.Philadelphia (PA): Wolters Kluwer; 2016

Rajagopalan S, Mascha E, Na J, Sessler DI. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology. 2008; 108:(1)71-77

Read TE, Brozovich M, Caushaj PF. Perioperative hypothermia during colectomy: When do patients get cold?. Tech Coloproctol.. 2018; 22:(5)343-346

Scott E. Thermoregulation. Chapter 15. In: Woodhead K, Fudge L (eds). Chichester: Wiley-Blackwell; 2012

Scott EM, Buckland R. A systematic review of intraoperative warming to prevent postoperative complications. AORN J.. 2006; 83:(5)1090-1113

Sessler DI. Perioperative heat balance. Anesthesiology. 2000; 92:(2)578-596

Sessler DI. Temperature regulation and monitoring. Chapter 54, 8th edn. In: Miller RD (ed). Philadelphia, PA: Elsevier/Saunders; 2015

Sessler DI. Perioperative thermoregulation and heat balance. Lancet. 2016; 387:(10038)2655-2664

Tansey EA, Johnson CD. Recent advances in thermoregulation. Adv Physiol Educ.. 2015; 39:(3)139-48

Tollerud L, Botsford J, Hoglan MA, Price JL, Sawyer MM, Manuel BJ. A model for perioperative nursing practice. AORN J.. 1985; 41:(1)188-194

Torossian A, Bräuer A, Höcker J, Bein B, Wulf H, Horn EP. Preventing inadvertent perioperative hypothermia. Dtsch Arztebl Int.. 2015; 112:(10)166-172

Wang L, Yin H, Di Y, Liu Y, Liu J. Human local and total heat losses in different temperature. Physiol Behav.. 2016; 157:270-276

Wetz AJ, Perl T, Brandes IF, Harden M, Bauer M, Brauer A. Unexpectedly high incidence of hypothermia before induction of anesthesia in elective surgical patients. J Clin Anesth.. 2016; 34:282-9

World Health Organization. WHO guidelines for safe surgery 2009: safe surgery saves lives. 2009. (accessed 29 January 2020)

World Medical Association. Declaration of Helsinki. 2008. (accessed 29 January 2020)

Preoperative peripheral and core temperature: an observational study at a day-surgery unit

13 February 2020
Volume 29 · Issue 3



Hypothermia is a common problem in the surgical context and can lead to serious consequences for the patient and increased costs for society.


To study day-surgery patients' peripheral and core temperatures during the preoperative phase.


In total, 50 day-surgery patients participated in the study. Two sets of measurements of temperatures were made: core temperature and peripheral temperatures (two measuring points on the upper body and lower extremities respectively) were measured on arrival at the day-surgery unit, as well as on arrival at the operating theatre. The data were normally distributed and a paired t-test was used for statistical analysis.


Peripheral temperatures had significant changes, with measuring points on the upper body decreasing and measuring points on the lower extremities increasing in temperature. The results show no significant change in core temperature.


The measurements show that 28% of the patients were below recommended preoperative temperature on arrival at the operating theatre. Further research is needed to study the development of body temperature perioperatively as well as at what point reheating interventions should be introduced.

The human body strives for a core temperature within a narrow interval around 37 °C (Sessler, 2015). All cellular activity is temperature dependent and a change of ±0.2 °C affects vital organs and their function and will start a range of compensatory mechanisms to maintain normal core body temperature in a healthy individual (Sessler, 2015). When a patient is anaesthetised normal temperature regulation is disturbed due to vasodilation, leading to greater heat redistribution (Sessler, 2016). Inhibition of the thermoregulatory response leads to a delay in compensatory factors, which will not occur until a temperature change of up to 4 °C (Scott, 2012).

The National Institute for Health and Care Excellence (NICE) clinical guideline defines normal body temperature as a core temperature of 36-37.5 °C and recommends a preoperative core temperature of 36.5-37.5 °C (National Collaborating Centre for Nursing and Supportive Care (NCCNSC), 2008; NICE, 2016). Hypothermia is defined as a core temperature below 36 °C. Despite a database search, the authors were unable to find any guidelines relating to recommended peripheral temperatures. National recommendations or guidelines regarding hypothermia do not currently exist in Sweden, hence the use of British guidelines. According to the NICE guideline, interventions should be put in place when a patient's core temperature drops below 36 °C, but it also states that it is better to prevent hypothermia as it is difficult to increase the temperature of an already hypothermic patient (NCCNSC, 2008: 55).

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