Table 3.

Strategies for the prevention of IPH

	Recommendation	Comments
Before surgery	Identify patients at high risk of IPH (Table 1) Measure patient's core temperature	Active warming should be started before operation in hypothermic or high-risk patients
	Patient should not be transferred to theatre unless their core temperature is >36°C
	Patient should be encouraged to walk to theatre where possible	This increases heat generated by metabolism
During anaesthesia and surgery	Induction of anaesthesia should not be started until the patient's core temperature is >36°C unless clinically urgent
	Active warming is recommended for all high-risk patients regardless of the length of the procedure, and for all patients with total anaesthesia time >30 min	Forced air warmer is the recommended device The temperature setting should be set at maximum and then adjusted to maintain a patient temperature of at least 36.5°C
	Ambient temperature should be >21°C while the patient is exposed to reduce heat loss by convection and radiation	Thereafter, ambient temperature can be reduced for staff comfort Equipment to cool the surgical team should also be considered
	Warm i.v. fluids	Use a continuous fluid warmer incorporated into the giving set Prewarmed fluids are as effective if given within 30 min of removal from warming cabinet9
	Humidification of respiratory gases	Although only a small amount of metabolic heat loss occurs through the respiratory tract, the use of a heat moisture exchanger filter or alternative humidification device is recommended
	The patient's temperature should be measured at least every 30 min and active warming titrated to effect	This is useful to monitor for both hypothermia and hyperthermia This includes patients having regional techniques
After surgery	The core temperature should be measured with the observations in PACU on admission and then every 15 min	Forced air warming should be continued if the patient is hypothermic (warm blankets offer comfort, but do not actively warm the patient) The patient should stay in PACU until the core temperature is >36°C
	Patients should be kept comfortably warm for 24 h after surgery with a duvet and blankets