Under the bright shadowless lights, every pediatric surgery is a silent battle against disease. Yet there is an invisible “enemy” that often lurks in the background – intraoperative hypothermia. Today, let us step into the operating room and learn how to build a warm protective barrier for the “little suns” on the operating table, using caring hands and professional skills.

I. Small Body, Big Challenge: Why Are Infants and Young Children More Prone to Hypothermia?

Even adults feel a chill when they enter an operating room – how much more so for infants whose thermoregulatory center is not yet fully developed? They are like little stoves, but their “heat output” is still unstable.

Research [1] has found that infants and young children have a relatively large body surface area, thin skin, and rich blood vessels, causing them to lose heat much faster than adults. At normal room temperature, a one‑year‑old infant’s body temperature can drop by 0.5°C after one hour of surgery, and by 3–4°C after two hours [2]. This drop in temperature is no small matter – it can trigger a cascade of reactions like falling dominoes.

The laminar flow purification systems commonly used in modern operating rooms, while ensuring a sterile environment, increase air convection and carry away more body heat. General anesthetics act like a “pause button” on the thermoregulatory center, plunging the delicate temperature control system into “hibernation” – the body misreads its temperature, blood vessels dilate, and heat is quietly lost.

II. The Invisible “Cold Current”: The Chain of Risks from Hypothermia

Intraoperative hypothermia is never just an isolated change in numbers. When core body temperature drops below 36°C, the body sounds a series of alarms:

1. Increased burden on metabolism and the circulatory system. For every 1°C drop in temperature, oxygen demand decreases by about 7% [3]. However, once postoperative shivering occurs, oxygen consumption rises sharply, placing additional stress on the cardiovascular system. For pediatric patients, especially those with congenital heart disease or weak circulatory function, such fluctuations may pose higher risks.

2. Impact on coagulation function. Hypothermia reduces platelet function and inhibits the coagulation cascade, leading to a marked increase in intraoperative blood loss. A study on pediatric surgery has shown that maintaining normal body temperature helps reduce the risk of coagulation dysfunction.

3. Potential suppression of immune function. In theory, a low‑temperature environment can affect white blood cell function, thereby increasing the risk of infection. Maintaining normal body temperature remains important for protecting immune function in children.

4. Prolonged recovery of the nervous system. For the central nervous system, hypothermia means reduced cerebral blood flow, slower metabolism of anesthetic drugs, and consequently longer recovery and extubation times. The incidence of agitation during emergence from anesthesia also increases, which is detrimental to rapid postoperative recovery.

III. A Warm “Multi‑Layer Shield”: Full Protection from Before to After Surgery

Facing these serious challenges, the nursing team has built a sophisticated system of heat preservation. Both the latest domestic and international guidelines and clinical studies consistently emphasize that combined thermal insulation is the core strategy for perioperative temperature management.

First layer: Environmental pre‑warming. Before the child enters the operating room, the room temperature should be appropriately raised. According to the Expert Consensus on the Prevention and Treatment of Perioperative Hypothermia (2023 Edition) [4], the temperature in pediatric operating rooms should be no lower than 23°C. Multiple studies have confirmed that preoperative pre‑warming is an important protective measure to reduce the incidence of hypothermia – a large‑sample study showed that neonates who received preoperative pre‑warming had a significantly lower risk of intraoperative hypothermia (OR = 0.081) [5].

Second layer: Active warming devices. Pre‑positioned warming devices on the operating table become a “warm fortress.” Electric blankets are safely set to 36–40°C; circulating water blankets precisely control body temperature by adjusting the water temperature; forced‑air warming blankets apply warm convective air to the body surface, reducing internal heat loss while isolating ambient heat loss. Forced‑air warming blankets have been proven effective in maintaining core temperature in children during surgery and can also shorten postoperative recovery time.

Third layer: Temperature protection in every detail.

1. During disinfection, volatile disinfectants are avoided to prevent alcohol evaporation from taking away large amounts of heat.

2. During anesthetic manipulation, body exposure is minimized, and any area not being operated on is covered with insulating blankets.

3. Warm saline gauze (about 40°C) is used to cover exposed organs, and body cavity irrigation fluid is also preheated to 40°C.

4. Intravenous fluids and banked blood are warmed to about 37°C, effectively preventing a drop in body temperature while preserving red blood cell integrity.

5. A special mention goes to respiratory warming – using a respiratory evaporator to heat inhaled oxygen, preventing cold air from directly entering the lungs and “sweeping away” deep body temperature. This detail often determines the success or failure of the battle against hypothermia.

Fourth layer: Seamless connection during transport. One hour before the end of surgery, the ward or ICU should have been notified in advance to adjust the room temperature and pre‑warm bedding. During transport, the child is tightly wrapped in pre‑warmed cotton quilts to minimize the impact of temperature differences between rooms.

Continuous temperature monitoring acts as a precise “temperature radar.” The circulating nurse constantly observes changes in the child’s skin temperature, ensuring that every degree of body temperature is under control.

IV. Keeping Body Temperature, Keeping Hope

What seems like simple temperature management is actually an important measure of perioperative nursing quality. For children undergoing general anesthesia, maintaining normal body temperature is not just a matter of comfort – it is a core safety requirement for coagulation, immune, cardiovascular, and nervous system function.

As research in this field has revealed, the chain reaction caused by hypothermia cannot be ignored. The nursing measures that prevent hypothermia are, in essence, a “bridge of warmth” built with professional skill and compassionate care – helping these tiny lives safely cross the difficult journey of surgery.

The next time you see the closed doors of an operating room, you can understand a little more: behind those doors, a team of nurses and doctors is using scientific methods and warm hands to protect the light of life for every “little sun.”

References

[1] Zhu RF, Song JZ, Xiao XL, Liu XY. Nursing study on intraoperative hypothermia in infants undergoing general anesthesia [J]. Nursing Practice and Research, 2011, 8(19): 149-150.

[2] Ge DM. Clinical study and nursing strategies for maintaining constant intraoperative body temperature in patients [J]. Qilu Journal of Nursing, 2006, 12(6): 1120-1121.

[3] Wu ZM, Yue R, Zeng J, et al. Research and nursing care of hypothermia during liver transplantation anesthesia [J]. Chinese Journal of Practical Nursing, 2005, 21(9): 98.

[4] National Center for Anesthesia Quality Control. Expert consensus on the prevention and treatment of perioperative hypothermia (2023 edition) [J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(4): 734-743.

[5] Zhao J, Le Z, Chu L, et al. Risk factors and outcomes of intraoperative hypothermia in neonatal and infant patients undergoing general anesthesia and surgery. Frontiers in Pediatrics. 2023;11:1113627. DOI: 10.3389/fped.2023.1113627

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