Temperatur

e
Regulation
and
Monitoring

Dr Balasubramaniam M.D.
Mammals and birds are homeothermic, Requiring a

Nearly constant internal body temperature.

 Cold signals travel
Afferent primarily via Aδ nerve
Thermal fibers and
Sensing warm information by
unmyelinated C fibers,
although

72 HOURS. Regulated by central

structures (primarily
some overlap occurs

4 HUMANS.
the hypothalamus) that Central
compare integrated Regulation
thermal
inputs from the skin

1 CAR. 3 DOGS.
surface, neuraxis, and
deep tissues
The interthreshold range
0.2° C.
Efferent Sweating
Responses Vasoconstriction &
Shivering
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SHIVERNING THERMOGENESIS NON SHIVERNING THERMOGENESIS
 (Sweating - Post ganglionic- Cholinergic blocked by
Capillary AV Shunt Nerve block and Atropine)

Vasoconstriction increases
Mean Arterial Pressure
Approximately 15mm Hg
Nonshivering thermogenesis Most consistently used autonomic effector
increases metabolic heat mechanism. Prevents convection and
radiation loss of metabolic heat.
production (measured as whole-
body oxygen consumption)
without producing mechanical
work
Decreased muscle mass, neuromuscular diseases, and
Muscle relaxants affects shivering
 Combination of increased sweating
thresholds and reduced
vasoconstriction thresholds increases

In General the interthreshold range approximately

2° C to 4° C.

Anaesthesia Poikilothermic within this temperature

range,
Non-Shivering Thermogenesis (NST) does not
Sweating is the best preserved major thermoregulatory
occur in anesthetized
defense during anesthesia.
adults(Volatile) .
Not only is the threshold onlyslightly increased, but the
Wheras in Infants - gain and maximum intensity remain normal.
Isoflurane - Vasoconstriction
Propofol- NST)
HEAT TRANSFER - Stefan - Boltzman Law (4th power of
difference in absolute temperature)

Radiation & Convection, << conduction, evaporation.

Convection - Air currents 20cm/sec Laminar flow.

Avoided by Surgical draping.

Foam pad (an excellent thermal insulator) covering most

operating room tables - prevents conduction.

Infants and pre term - thin skin - Transcutaneous Evaporation.

Evaporation inside surgical wounds may contribute

substantially
First 2- 4 hrs - Redistribution Hypothermia.
(heat loss exceeding metabolic heat production).

After 3 to 4 hours of anesthesia, core temperature usually

reaches a plateau and remains virtually constant for the
duration of surgery.
(heat production equaling heat loss)

Plateau phase is associated with Peripheral

thermoregulatory vasoconstriction triggered by core
temperatures
of 33° C to 35° C.

Peripheral tissue temperature, in contrast, continues to

decrease because it is no longer being supplied with
sufficient heat from the core

In NEURAXIAL
Anaesthesia
Epidural and spinal anesthesia each
decrease the thresholds triggering
vasoconstriction and shivering.
(Above the level of the block)
Approximately 0.6° C
Autonomic thermoregulation is impaired
during Regional anesthesia, and the result
typically is intraoperative core
hypothermia.
This hypothermia often is not consciously
perceived by patients, but nonetheless
triggers shivering.
Paradox: A hypothermic patient who denies
feeling cold.
Devices to measure
Sites of temperature monitoring
 When to do? For which group of patients?
High risk patients include:

• Children and elderly

• Pre-operative temperature <360 C

• Combined general and regional anaesthesia

• Major or intermediate surgery

• Prolonged surgery

• Patients at risk of cardiovascular complications

• ASA 3-5 patients.

What to do for such group of patients?
Preoperative:

Keep the patient comfortably warm (36.5-37.5 0C) by providing sheets/warm clothes and by maintaining higher ambient temperature. If
temperature is below 36 degree C commence forced air warming unless immediate surgery is imperative.

Intraoperative:

Maintain ambient temperature above 21 degree C. Cover the patient adequately with either sheets or cotton roll or any other passive
insulating material. This traps air under the insulation material and may prevent heat loss by up to 30%.

Use warmed irrigation fluids.

Connect a blood and fluid warmer if large amounts of fluid and blood product use are anticipated.

Warm and humidify Inspired gases may be warmed by using a heat and moisture exchange device.

Postoperative

May be necessary for vascular surgery patients and cardiopulmonary surgeries

Fluid warming devices
Adverse effects of hypothermia
CONSEQUENCES OF HYPOTHERMIA
Increased perioperative blood loss/coagulopathy

• Longer post anaesthetic recovery due to altered drug metabolism

• Postoperative shivering and increased oxygen consumption

• Thermal discomfort

• Cardiac events including myocardial ischaemia, arrhythmias

• Delayed wound healing

• Increased rates of surgical wound infection

• Longer hospital stay

So only hypothermia in anaesthesia?

Preoperative Fever, Sepsis etc etc

Differential Diagnosis
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The normal core temperature range of adult patients is
between 36.5 C and 37.5 C and hypothermia
can be defined as core body temperature less than 36 C.

Inadvertent perioperative hypothermia is a common but preventable

complication.

Regular measurement and recording of temperature is the key to prompt

identification and its management.