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Perioperative hypothermia is common and adversely affects clinical outcomes due to its effect on a range of homeostatic functions. Many of these adverse consequences are preventable by the use of warming techniques. A literature search was conducted to identify relevant published articles on perioperative hypothermia and warming. The databases searched include MEDLINE (1966 to February 2005), EMBASE (1974 to February 2005), CINAHL, the Cochrane library and the health technology assessment database. Reference lists of key articles were also searched. The primary beneficial effects of warming are mediated through increased blood flow and oxygen tension at tissue level. Reduction in wound infection, blood loss and perioperative pain with warming is promising. However, more evidence from good-quality prospective randomised controlled trials is needed to evaluate the role of warming in improving overall morbidity, mortality and hospital stay as well as to clarify its role as an adjunct to resuscitation and during the pre-hospital transport phase of critically ill patients. Awareness of the risks of perioperative hypothermia is the key to prevention. Achieving normothermia throughout the patient's journey is a worthwhile goal in surgical patients.

Seventy-three samples of acute wound fluid were collected from 47 patients during the first 3 postoperative days (POD) following mastectomy for cancer (n=47 on POD-1, n=19 on POD-2, and n=7 POD-3). Samples were analyzed by enzyme-linked immunosorbent assay for growth factor levels (epidermal [EGF], platelet-derived [PDGF], basic fibroblast [bFGF], transforming growth factor-beta1 [TGF-beta1], vascular endothelial [VEGF]), interleukin-6 (IL-6), matrix metalloproteinases (MMPs-2, -3, -9), and the tissue inhibitor of metalloproteinase 1 (TIMP-1). The levels of EGF, bFGF, PDGF, and interleukin-6 peaked on POD-1, with a significant decrease by POD-3, while total and active MMP-2, MMP-3, and tissue inhibitor of metalloproteinase 1 showed a progressive and significant increase from days 1 to 3. The wounds that later developed an infection (11%) were found to have a significantly lower PDGF and EGF on day 1 (PDGF, median 169 pg/mL [range, 86-2,595]) than the noninfected wounds (2,098 [17-66,506] p<0.05, Mann-Whitney U-test). Sixty-two percent patients developed a seroma and the levels of bFGF were significantly less in these patients (441 pg/mL [45-4,108]) than in those patients where there was no seroma (807 [245-3,133] p<0.05). The levels of certain growth factors in acute wound fluid may be important markers for wound outcomes.

Warming may allow wounds to heal with fewer complications. In addition, warming for only two hours immediately after surgery may provide similar benefits to seven days of warming.

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