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Everyday throughout the United States and globally, patients undergo surgery and anesthesia. Inadvertent hypothermia, a core body temperature less than 36°C (96.8°F), remains a significant concern for these patients. Although the untoward physiological outcomes are well-documented, perianesthesia nurses remain challenged with keeping patients warm before, during, and after surgery. The ability to promote normal thermal balance in surgical patients requires a team effort. Using best evidence to guide clinical practices aimed at promoting thermal balance in the surgery patient is critical to the provision of safe, quality care. This article will provide an overview of the physiology of intraoperative temperature fluctuation and risk factors associated with unintentional perioperative hypothermia, and suggest prevention and management strategies.