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The Guideline for Patient Temperature Management was approved by the AORN Guidelines Advisory Board and became effective as of December 19, 2024. Information about the systematic review supporting this guideline, including the PROSPERO registration number, systematic review questions, description of the search strategy and evidence review, PRISMA 2020 flow diagram, evidence rating model, and evidence summary table is available at https://www.aorn.org/evidencetables/.

Purpose

All perioperative patients are at risk for developing inadvertent hypothermia, and patients who are susceptible to malignant hyperthermia (MH) are at risk of experiencing an MH crisis. This document provides guidance to the perioperative team for

  • patient assessment and monitoring,

  • development of a patient temperature management plan,

  • strategies to prevent and manage inadvertent perioperative hypothermia,

  • management of patients with MH susceptibility,

  • education, and

  • quality assurance and performance improvement activities.

Although the definitions for hypothermia and hyperthermia vary among sources, this document adopts the definitions for hypothermia provided by the National Institute for Health and Care Excellence (NICE). Hypothermia is defined as a core body temperature of < 36° C (< 96.8° F).1  Hypothermia is further delineated as

  • mild (35° C to 35.9° C [95° F to 96.6° F]),

  • moderate (34° C to 34.9° C [93.2° F to 94.8° F]), or

  • severe (< 33.9° C [93° F]).1 

Despite advances in technology to detect and prevent inadvertent perioperative hypothermia (eg, temperature measurement devices, active warming devices) and greater awareness of the associated risks, the incidence of inadvertent perioperative hypothermia is significant and reported to vary from about 2%2  to more than 80%3  among different patient populations and with varying degrees of warming measure implementation.

Hyperthermia can be defined as a core body temperature that exceeds 38° C (100.4° F).4 

At the opposite end of the spectrum, hyperthermic states associated with MH are much rarer. While the incidence of MH is underreported and therefore difficult to determine, the Malignant Hyperthermia Association of the United States (MHAUS) estimates it occurs in about one in 100,000 adult surgeries and one in 30,000 pediatric surgeries,5  although there is significant variation in the literature related to reporting (eg, prevalence, incidence, presence of genetic changes or MH episodes, geographic variation).6,7  Deviance from normothermia is still an area of concern for patients undergoing operative and other invasive procedures, and health care organizations are challenged to develop strategies for managing patient temperature with the goal of maintaining normothermia during the perioperative period.

These topics are beyond the scope of this guideline:

  • planned, intentional, or therapeutic hypothermia and subsequent rewarming;

  • pharmacologic agents used for the treatment of shivering;

  • enhanced recovery after surgery protocols (see the AORN Guideline for the Implementation of Enhanced Recovery After Surgery)8 ;

  • management of accidental or extreme hypothermia that occurs outside of the perioperative setting (ie, related to trauma or conditions outside of a health care facility);

  • hyperthermic intrathoracic chemotherapy or hyperthermic intraperitoneal chemotherapy (see the AORN Guideline for Medication Safety)9 ;

  • a cost-benefit analysis of treatment methods; and

  • specific treatment interventions for patients experiencing an MH crisis (eg, an algorithm).

For an emergency consultation during an MH crisis, contact the Malignant Hyperthermia Association of the United States (MHAUS) hotline at (800) 644-9737 or access https://www.mhaus.org.

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