Perioperative normothermia in Asia and Australasia: challenges, implementation strategies, recommendations, and correct use of forced air warming

Inadvertent perioperative hypothermia, a common complication secondary to anaesthesia and surgical exposure, affects patients globally and is associated with adverse outcomes. Interventions to prevent perioperative normothermia include consistent core temperature monitoring and active warming strategies. Forced-air warming is the key active warming strategy recommended in guidelines and requires consistent perioperative application to prevent hypothermia. Implementation of guidelines varies across the Asian Australasian Regional Section (AARS), characterised by diverse healthcare systems and resource constraints. An advisory panel was convened to identify regional challenges and propose recommendations for perioperative normothermia guideline implementation, including forced air warming. An expert advisory panel of 15 healthcare professionals, including anaesthesiologists, registered nurses, and perioperative normothermia research experts from Australia, Japan, Korea, Malaysia, Singapore and Thailand, convened during October 2024. Panellists reviewed relevant literature, shared clinical experiences, discussed challenges, and proposed evidence-based recommendations for safe practices. Meeting outcomes are summarised in this publication. Obstacles for guideline implementation of perioperative hypothermia prevention were identified and classified into four areas: 1) economic constraints, 2) practical limitations, 3) educational gaps, and 4) environmental challenges. Limited insurance coverage for forced air warming systems, resource limitations, time pressures and inconsistent technology availability were among the identified barriers. The panel recommended leveraging cost-effectiveness studies and conducting future analyses to support hypothermia prevention, emphasising long-term financial benefits of avoiding complications associated with hypothermia. Panel members advocated for the adoption of established guidelines and simplifying and customising them to align with the unique contexts of individual institutions. They recommended improved access to accurate non-invasive monitoring devices within each institution, and for training regarding continuous temperature monitoring. To enhance knowledge among surgical teams, the panel emphasised the importance of establishing ongoing comprehensive training and structured workflow systems, supplemented by regular audits. The panel identified incorrect use of forced air warming systems as a significant barrier to perioperative hypothermia prevention. Members stressed the necessity of incorporating proper usage training into a comprehensive educational program detailing correct application of forced air warmers, infection control, and liability awareness. This work aims to enhance patient safety, improve clinical outcomes, and reduce economic burdens across diverse AARS healthcare systems.