Pediatric Patients
Pediatric patients, especially neonates and infants, are at higher risk for perioperative temperature disturbances due to their large surface area relative to body mass and immature thermoregulatory mechanisms. They have a limited ability to shiver and rely more on non-shivering thermogenesis through brown adipose tissue, a response that volatile anesthetics inhibit, so an anesthetized neonate has essentially no heat-generating defense left. Thin subcutaneous fat and a proportionally large head add to the loss, so warming the room before the patient is exposed, covering the head, and warming fluids are standard alongside forced-air warming. As a result, these patients require careful monitoring and active warming strategies, including pre-warming and intraoperative forced-air warming, to maintain normothermia.
Geriatric Patients
Geriatric patients are also more susceptible to hypothermia, as aging impairs the body's thermoregulatory responses: under anesthesia the vasoconstriction threshold is about 1 C lower in patients over 60 than in young adults, and lower muscle mass and metabolic rate reduce heat production. Additionally, older patients may have comorbidities that increase their vulnerability to temperature-related complications, such as cardiovascular disease or impaired metabolic function. Anesthesia providers must adjust temperature management strategies accordingly, paying particular attention to the cardiovascular consequences of hypothermia in this population.
Obstetric Patients
Temperature regulation in pregnant patients presents unique challenges due to the physiological changes that occur during pregnancy. Increased metabolic demand and altered thermoregulatory thresholds may influence temperature control during anesthesia. Hypothermia is common during cesarean delivery under neuraxial anesthesia and also cools the newborn; active warming of the mother improves maternal temperature and reduces shivering and neonatal hypothermia. Hyperthermia, in particular, poses risks to both the mother and fetus: maternal fever is associated with fetal tachycardia and distress, and sustained hyperthermia in the first trimester is teratogenic (notably neural tube defects). Anesthesia providers should ensure normothermia is maintained in pregnant patients through continuous monitoring and appropriate warming techniques.
