Assessment of Perioperative Temperature Management Strategies in Major Abdominal Operations

Abstract

Inadvertent perioperative hypothermia remains a common and largely preventable complication of major abdominal surgery, driven by anesthesia-induced impairment of thermoregulatory vasoconstriction, large peritoneal heat and fluid losses, and prolonged operative times. This review synthesizes recent comparative evidence on prewarming, intraoperative active surface warming, fluid and irrigation warming, and continuous core-temperature monitoring, including validation data for zero-heat-flux cutaneous sensors against esophageal reference measurement. Randomized and meta-analytic data indicate that prewarming combined with sustained full-body forced-air or resistive warming reduces the incidence and severity of intraoperative hypothermia more effectively than intraoperative warming alone or passive insulation, and that hypothermia is consistently associated with increased surgical site infection risk and greater blood loss across abdominal surgical cohorts. Large trial data further indicate that the appropriate clinical target is reliable normothermia rather than supranormal core temperature, since aggressive warming beyond normothermic targets has not been shown to reduce perioperative cardiac events relative to routine normothermic management. We conclude that a layered protocol combining prewarming, full-body active intraoperative warming, fluid warming, and continuous accurate monitoring represents the best-supported approach to perioperative temperature management in major abdominal operations, while noting persistent gaps in device comparison data for prolonged open procedures.