Thermoprotection in the perioperative period: an international consensus statement for the maintenance of normothermia

Background Thermoregulation maintains core temperature within a narrow physiological range necessary for normal physiologic homeostasis and organ function. During surgery, exposure to cool environments, anesthetic-induced impairment of thermoregulatory responses, and infusion of unheated fluids predispose patients to unintentional perioperative hypothermia (UPH). In the absence of active warming, core temperature commonly decreases by 1–2°C, largely due to early redistribution of heat from the core to the periphery. UPH is associated with adverse outcomes, including cardiovascular stress, coagulopathy and increased bleeding, delayed drug metabolism and recovery, impaired immune function, postoperative shivering, and reduced patient comfort. Objective To develop an international, evidence-based consensus providing practical recommendations for thermoprotection and prevention of UPH across the perioperative continuum. Methods This consensus statement was developed in accordance with the ACCORD framework. A multidisciplinary international panel formulated clinical questions through structured virtual meetings. A comprehensive literature search and critical appraisal were conducted for each question. Recommendations were developed and graded using the GRADE system. Each recommendation underwent independent review by multiple authors, followed by group discussion, methodological oversight, and structured voting. Consensus activities were conducted between March 2025 and January 2026. Results The panel generated graded recommendations addressing institutional policies, risk stratification, environmental control, temperature monitoring, maintenance of intraoperative normothermia (36.0–37.5°C), active prewarming, safe use of warming devices, multimodal warming strategies (including warmed fluids), and systematic postoperative temperature management. Integration of thermoprotection into enhanced recovery, patient blood management programs, and patient-experience assessment was emphasized. Conclusions UPH remains common, preventable, and clinically significant. Continuous temperature monitoring and systematic thermoprotection strategies are cost-effective measures that should be embedded into perioperative care pathways to improve safety, outcomes, and patient experience.