Refining Anesthesia Practice - Part 1: Temperature
Temperature regulation under anesthesia
Keywords:
temperature regulation, hypothermia, coagulopathy, shivering under anesthesiaAbstract
Body temperature is among the classical vital signs, and rightly so, since thermal perturbations both cause and indicate disease. (1) Mean core temperature in humans is 36.5°C–37.3°C. Periphery is typically 2°C–4°C cooler than the core. This gradient is maintained by tonic thermoregulatory vasoconstriction. (2)
By far the most common perioperative thermal disturbance is inadvertent hypothermia. Randomized trials show that even mild hypothermia causes serious complications including surgical wound infection, coagulopathy, platelet dysfunction and increased allogeneic transfusions and delayed post anesthesia recovery. Maintaining normothermia during surgery has therefore become routine. (1)
Yet, body temperature is seldom monitored intraoperatively and treated even more rarely. This review article is first in the series of articles on refining and tailoring perioperative anesthesia management.
References
References:
A thorough internet search was done on PubMed, Google scholar, Medline and standard anesthesia reference books to formulate the crux of peri-operative temperature management under anesthesia.
) Sessler DI. Perioperative Temperature Monitoring. Anesthesiology. 2021 Jan 1;134(1):111-118. doi: 10.1097/ALN.0000000000003481. PMID: 32773677.
) Bindu B, Bindra A, Rath G. Temperature management under general anesthesia: Compulsion or option. J Anaesthesiol Clin Pharmacol. 2017 Jul-Sep;33(3):306-316. doi: 10.4103/joacp.JOACP_334_16. PMID: 29109627; PMCID: PMC5672515.
) Nemeth M, Miller C, Bräuer A. Perioperative Hypothermia in Children. Int J Environ Res Public Health. 2021 Jul 15;18(14):7541. doi: 10.3390/ijerph18147541. PMID: 34299991; PMCID: PMC8308095.
) Torossian A. Thermal management during anaesthesia and thermoregulation standards for the prevention of inadvertent perioperative hypothermia. Best Pract Res Clin Anaesthesiol. 2008 Dec;22(4):659-68. doi: 10.1016/j.bpa.2008.07.006. PMID: 19137809.
) Harper CM, Andrzejowski JC, Alexander R. NICE and warm. Br J Anaesth 2008;101:293‑5.
) Monzon CG, Arana CA, Valz HA, Rodriguez FA, Mejia JJ, Gomez JA. Temperature management during the perioperative period and frequency of inadvertent hypothermia in a general hospital. Rev Colomb Anestesiol 2013;41:97‑103.
) De Witte J, Sessler DI. Perioperative shivering: Physiology and pharmacology. Anesthesiology 2002;96:467‑84.
) Grote R, Wetz AJ, Bräuer A, Menzel M. Vorwärmung entsprechend der „S3 Leitlinie Vermeidung von unbeabsichtigter perioperativer Hypothermie 2014“ : Retrospektive Analyse von 7786 Patienten [Prewarming according to the AWMF S3 guidelines on preventing inadvertant perioperative hypothermia 2014 : Retrospective analysis of 7786 patients]. Anaesthesist. 2018 Jan;67(1):27-33. German. doi: 10.1007/s00101-017-0384-3. Epub 2017 Nov 20. PMID: 29159490.
) Engelen S, Himpe D, Borms S, Berghmans J, Van Cauwelaert P, Dalton JE, et al. An evaluation of underbody forced‑air and resistive heating during hypothermic, on‑pump cardiac surgery. Anaesthesia 2011;66:104‑10.
) Arkiliç CF, Akça O, Taguchi A, Sessler DI, Kurz A. Temperature monitoring and management during neuraxial anesthesia: an observational study. Anesth Analg. 2000 Sep;91(3):662-6. doi: 10.1097/00000539-200009000-00031. PMID: 10960396.
) Frank SM, Beattie C, Christopherson R, Norris EJ, Rock P, Parker S, et al. Epidural versus general anesthesia, ambient operating room temperature, and patient age as predictors of inadvertent hypothermia. Anesthesiology 1992;77:252‑7
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