Applied physics in anesthesia

Dr Sachana KC
1st year Resident
Department of Anesthesia
Overview

• Heat, thermal conductivity in the body.

• Methods of heat conservation and loss from
the body.
• Temperature and methods of temperature
measurement.
• Thermistor and thermocouples.
Heat Vs Temperature
Heat
• Energy form,total sum of
kinetic energy of molecules
• Calorimeter
• joules
Temperature
• Temperature is a
numerical measure of how
hot or cold
• Measure of the average
kinetic energy of molecules
• Thermometer
• Celsius, Fahrenheit, Kelvin
Interconversion
• C/5 = {F-32}/9
C= (F-32)X 0.555

• C= K-273.15
• Inc. in 1 0C ~ 1
.8 0F
Normal body temperature
• 37+/- 0.5 0 C
• Regular circadian fluctuation of 0.5–0.7 °C
• Lowest early morning/ highest evening
• Mid-cycle fluctuation in women
• Less precise in children may normally have a
temp. 0.50C above the normal for adults
Contd…

• The anus (rectum/rectal), vagina, or in the ear

(otic) is about 37+/- 0.5 °C
• Temperature in the mouth (oral) is about
36.8 °C (98.2 °F)
• Axillary temp is about 36.5 °C (97.7 °F)
 Core Vs Periphery
CORE PERIPHERY

• major thoracic and • limbs and skin and

abdominal organs & subcutaneous
Brain tissue
• holds two-thirds of • About one-third
the body heat • varies
content widely.depending on
• Maintained within a the environment
narrow temp. range • usually 30-32°C.
(36.6 to 37.4°C)
This 5-7°C difference between core and peripheral body temperature is maintained by
vasoconstriction in the blood vessels
Thermoregulation

• Preoptic nucleus of anterior hypothalamus.

• Afferents-
• Thermoreceptors in skin, deep tissues, spinal cord.
• Also contains heat sensitive neurons and receives
additional thermal input from extra hypothalamic
areas.
Temp. control

• Ant/posterior • Skin and deep receptors

Hypothalamus spinal abdominal viscera ,
cord in/around large vessels

• Warm receptors>> cold • Cold receptors>> heat

Transmission

Cold signals – Via Aδ

fibres
Warm signal – C
fibres
 HEAT
• GAIN
Vasoconstriction (sympathetic activity) <36.5 0C
- enhances insulation

• Chemical thermogenesis
-Non shivering in neonates
-effect of thyroid hormone on BMR

• Shivering (<36.50C)
-4-6fold increase in heat production
• Muscular exercise

• Piloerection
 Nonshivering Thermogenesis

• Metabolic process located primarily in brown

adipose tissue and controlled by the activity of the
sympathetic nervous supply
• All the energy of metabolism is dispersed as
heat without any ATP.
• Adrenaline and Noradrenaline stimulate
uncoupled oxidative phosphorylation
• Conversion of T4 to T3 inside brown fat cells. T3
-↑cellular metabolic rate
Thermal conductivity
• Property of a material to conduct heat
• Watts per meter kelvin

• Thermal Conductivity = heat × distance / (area ×

temperature gradient

• Thermal capacity: Necessary amount of energy

needed to increase temperature by 1 kelvin

• Fat: very low thermal conductivity and thermal capacity

• Muscles and skin: higher thermal conductivity

Heat loss
Physical mechanisms:

• Radiation(40%)
• Convection (30%)
• Evaporation (20%)
• Respiration 10% (8% humidification &
2% heating of air)
• Conduction
Radiation
• Major type of heat loss (40%)

• Warm object emits energy in the form of

infrared radiation. Infrared radiation allows
heat transfer independent of intervening air.

• Examples- Space blankets, Radiant warmers.

Convection
• 2nd most important factor (30%)

• Conducting heat loss to air greatly facilitated

by air movement is called Convection.

• Depends upon air temperature and velocity.

Evaporation
• accounts for 20% of heat loss
• Evaporation of 1g water removes about 0.6
Kcal. Of heat
• Insensible loss (600ml/d even without sweating)
• Increased by sweating
• In infants higher fraction of heat loss by
transpiration of water through thin skin( in
preterms heat loss can be 1/5th of metabolic heat
production)
• Heat loss from respiratory system
• Exposure of surgical wounds potentiates heat loss
Conduction
• Directly proportional to the temperature
difference to adjacent surfaces and the
strength of the thermal insulation separating
them.
• <5%
• By direct contact with cooler object.
• Example- reduction in core temperature after
administering I.V fluids is due to conduction.
Sweating
• Sympathetic cholinergic fibers
• prevented by nerve block or administration
of atropine
• only mechanism by which the body can
dissipate heat in an environment exceeding
core temperature
• 0.6 kcal dissipated per gram
of evaporated sweat
Intra-operative heat loss
• Cold irrigating fluids

• Cold IV fluids

• Evaporative heat losses

- dryanesthetic gases
- body cavity exposure

• Exposure
- cold OT
- shed clothes, cold table, cold skin prep
Contd…

• Anesthetic drugs
1. Volatiles
- depress threshold
for
thermoregulation
2-3°C
- promote
vasodilatation
- muscle relaxation
-impede shivering

2. Opioids
- potent
sympatholytics -
depress threshold -
volatiles
Contd…

5. Vasodilators
- promote heat loss.

• Regional anesthesia
- hypothalamic thermoregulation intact
-heat loss enhanced by vasodilatation and
impaired shivering below the level of the
block.
General
Anesthesia
decline in body temp. occurs in three phases
•

Phase Upto 1st hour. 1-

1.5 0C
Core to periphery
redistribution

I
due to
Rapid fall vasodilation

Phase 2-3 hours. ↓BMR

II Slower decline Loss >

production

Phase After 3-5 hrs Loss =

production

III Plateau vasoconstriction

Heat loss during GA
Hypothermia Considerations in
anesthesia
• Widens interthreshold range from 0.4 - 3°C
• ↓ Drug metabolism
-DOA vecuronium is more than doubled in patients
with a core temp.
-<35°C.
• ↑Solubility of inhaled anesthetic agents
-↓ MAC of 5% for every 10 decrease in core temp.
• Delayed awakening
• Left shift of the hemoglobin–oxygen saturation
curve
Contd…
• ↓ BMR
• Reversible coagulopathy (platelet dysfunction)
• Poor wound healing
• Cardiac arrhythmias and ischemia
• Impaired renal function
• Postoperative protein catabolism and stress
response
• CNS dysfunction
MEDICAL CONDITIONS PREDISPOSING
TO HYPOTHERMIA
• Skin loss - burns, severe exfoliating dermatoses

• Autonomic neuropathy - para/quadriplegia,

diabetes, uremia

• Acute alcohol intoxication

• Endocrinopathies - myxoedema, adrenal insufficiency

• Sickle cell diseases - hypothermia can precipitate a

crisis.
SPECIAL CONSIDERATIONS
Neonates and infants

• Increased surface area to volume ratio

• Thin skin with minimal insulating fat

• Less effective efferent responses to cold temperatures

• Infants <3 months cannot shiver

Temperature

• Heat is a form of energy that can be

transferred from a hotter substance to a colder
substance, energy being in the form of the
kinetic energy of the molecules of the
substance.
• Temperature is the thermal state of a
substance which determines whether it will
give heat to another substance or receive heat
from it.
Contd…

• Temperature scales- SI unit- Kelvin (K)-

fraction 1/273.16 of the thermodynamic
temperature of the triple point of water.

Temperature (K) = Temperature (°C) +

273.15
Contd…

• Body temp is determined by the relationship

between heat production and heat dissipation.
• Normal core body temp – 36 to 37.5 degree C.

• Lowest in morning –due to 10-15% decrease in

BMI during sleep.
• Highest – in evening.
Monitoring recommendations
• Core body temperature should be measured in
GA >30 minutes.
• During regional anesthesia when changes in
body temperature are intended, anticipated, or
suspected.
• Unless hypothermia is specifically indicated
(e.g., for protection against ischemia), effort
should be made to maintain intraoperative core
temperature higher than 36°C.
ASA recommendation
• “Every patient receiving anesthesia shall
have temperature monitored when clinically
significant changes in body temperature are
intended, anticipated or suspected.”

• For office-based sedation, regional anesthesia,

or general anesthesia, the ASA also requires that
“the body temperature of pediatric patient
shall be measured continuously
Methods of measuring temperature
• Non – electrical technique

• Electrical technique

• Infrared ear and tympanic membrane

thermometers
Non electric thermometers
• Mercury thermometer
• Based on “ change in volume with temperature”
• Reliable
• Disadvantage – difficult to introduce in some
orifices since it is rigid,risk of breakage also.
• Alchohol is used sometime instead of mercury-
cheaper and more suitable for very low
temperature
Dial thermometers : Bimetallic strip

• Two dissimilar metals

fixed together in a coil
Unequal Metal expansion
leads to coil tightening
and movement of level
clock-wise
Bourdon gauge

• A device measure
pressure which is
attached to sensing
element containing a
small tube of mercury
or a volatile fluid
• With temperature ,
volume or pressure
changes in the sensing
element which is
recorded on bourdon
gauge and is calibrated
in units of temperature.
Electrical technique
• Resistance thermometer
• The thermistor
• The thermocouple
Resistance thermometer
• Based on the fact that the electrical resistance
of a metal increases linearly with increased
temperature.
• Consists of of : platinum wire resistor , a
battery to supply current and ammeter to
measure resistance.
• Insensitive
Thermistor

• A small bead of metal oxide, the electrical resistance of which

falls exponentially as the temperature rises. Often also used with
a wheatstone bridge.
• Used clinically in anesthetized pt- nasal temp,oesophagus temp
• Cheaper
Contd...

Figure : The graph contrasts the changes of

resistance with temperature for a
platinum resistance thermometer and a
thermistor.
Thermocouple
• Based on Seebeck’s effect
• At junction of 2 different
metal ( copper and
constantan) small
voltage is
developed,magnitude of
which is dependent on
the temp. of the junction
• Reference junction
should be kept at
constant temperature
• Used in clinical
hyperthermia
Infrared ear and tympanic membrane
thermometer
• Based on emission of electromagnetic radiation by
objects and the intensity of radiation and the wavelength
depend on the temperature of the object.

• At body temperature object primarily emits Infrared

radiation

• The sensor is kept in ear canal or near ear drum , which

senses the radiation and converts it into electric signal
References

• Basic Physics and Measurement in Anesthesia

4th ed. by P.D. Davis
Thank You !!!