Chapter 12 Body temperature management during anesthesia

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Chapter 12Body temperature management during
anesthesia
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Temperature drop during operation ??Reasonslt
36? 1. Age (1)older - thermoregulation
function is lower (2)premature?neonatus?infant -
thermoregulatory center is imperfect
2. Influence of operative procedure (1)cold
disinfectant solution and rinse solution
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Temperature drop during operation (2)large dose
of cold blood transfusion and
infusing fluid 3. room temperature 4.
anesthetic action (1)field block
anaesthesia (2)general anaesthesia 5.
insufficient heat production
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Temperature drop during operation ??Heat
preservation 1. Evaluation of Preoperative and
Preheating 2. Body surface heating 3.
Warming the infused fluid
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Perioperative Fervescence ??Reasons
1. Patients state 2. Temperature
and humidity of operating room is
high 3. Influence of anesthesia
4. Surgery factors 5. Malignant
hyperthermia
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Perioperative Fervescence ??Prevention and
Cure 1. Continuous monitoring of
body temperature 2. Correctly select
anticholinergic agent 3. Suitable temperature
and humidity of operating room
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Perioperative Fervescence 4. Avoid
hypoxia and carbon dioxide
accumulation 5. Avoid iatrogenic
fervescence 6. Reduce the temperature by
physical method
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Artificial hypothermia
Relation between body temperature and metabolic
rate body temperature(?) metabolic
rate() 36.8
100
31.8 7580
30.0
6070 26.8
50
20.0
25 16.8
20 15.0
15
6.8
6
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Artificial hypothermia ??Indications 1.
Operation on vessels of heart (1)Cardiosurgery (2
)Operation on major vessels (3)Safe time limit
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Artificial hypothermia
Safe time limit of different body temperature
body temperature circulation blocking
time (?)
(min) 3230?
89
3028?
1015 2818?
1545 lt18?
4560
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Artificial hypothermia 2. Neurosurgery
3. Others (1)Operation on liver and
kidney (2)Large wound and operation
which is bleeding a lot (3)Control the
hyperpyrexia (4)Cerebral resuscitation
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Artificial hypothermia Time limit of circulation
blocking of major organ at different temperature
(min)
37? 2832? 25?
Brain 3
8 14 15 Spinal cord
30 45
Kidney 30 40 60
Liver 20 60
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Artificial hypothermia ??Cooling?Rewarming?M
onitoring and Announcements
(?)Anesthetic Management 1. Three main
points (1)Avoid cold degense reflex
(2)Ccompletely muscle relaxation
(3)Vasodilatation of peripheral vessel is well
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Artificial hypothermia 2. Anesthetic
Management (1)preanesthetic medication (2)inducti
on (3)maintenance (4)low dose of chlorpromazine
before cooling0.250.5 mg/kg?prevent
shiver and
vasospasm
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Artificial hypothermia (?)Method of reduce the
temperature 1. Surface cooling (1)icewater
bath or ice crumbs (2)ice bag?ice-cap (3)ectother
mic blanket
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Artificial hypothermia 2. Body cavity
cooling 3. Blood cooling using extracorporeal
circulation 4. Extracorporeal circulation
Surface cooling 5. Infusing cold fluid
intravenously(46?)
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Artificial hypothermia (?)Rewarming 1.
Surface rewarminghot water bottle?
electric
blanket?
ectothermic blanket 2. Body cavity
rewarming 3. Hematogenous rewarming using
extracorporeal circulation
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Artificial hypothermia (?)Monitoring 1.
Body temperature (1)nasopharyngeal temperature
(2)esophageal temperature (3)rectal temperature
(4)blood temperature 2. Circulatory
monitoringECG?BP?CVP 3. Othersurine
volume?electrolyte?
blood gas?haemorheology
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Artificial hypothermia ??Announcements 1.
Avoid cold degense reflex 2. Avoid frostbite 3.
When surface rewarming (1)Avoid burn (2)Prevent
hypotension and arhythmia (3)Prevent responsive
hyperpyrexia 4. Prevent hypoxia and metabolic
acidosis 5. Prevent ventricular fibrillation
and brain damage
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Artificial hypothermia ??Complications 1. Cold
degense reflex 2. Arhythmiaventricular
fibrillation (1)Critical temperature2628? (2)Evo
ked reasons ? unbalance between sympathetic
nerve and pneumogastric nerve ?
acid-base imbalance ? electrolyte
disturbances
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Artificial hypothermia (3)Management 3.
Tissue damageCooling - Frostbite
Warming - Burn 4.
Gastrointestinal hemorrhageintestinal
arterial
embolism 5. Acidosis