Purpose To describe a case of persistent hypothermia following spinal anesthesia with intrathecal morphine. Clinical features Following elective right total knee arthroplasty under spinal anesthesia with isobaric 0.5% bupivacaine 11 mg, fentanyl 15 lg, and preservative-free morphine 150 lg, a 57-yr-old female (93.5 kg, 151 cm) developed postoperative hypothermia with a nadir rectal temperature of 33.6°C four hours after surgery. At times, her temperature could not be measured by tympanic, temporal arterial, oral, axillary, or rectal routes. In spite of the low temperature, the patient complained of feeling hot and was diaphoretic without shivering. With the exception of her temperature, her vital signs were normal postoperatively, and aside from hyperglycemia, complete blood count, electrolytes, thyroid-stimulating hormone, serum cortisol, troponin, and twelve-lead electrocardiogram were normal. Her temperature did not respond to warming efforts with a forced-air warming blanket, infusion of warmed intravenous crystalloid, and hourly bladder irrigation with warm saline through an indwelling urinary catheter. Normothermia returned after she received a small dose of sublingual lorazepam eight hours after surgery. The remainder of her postoperative stay was uneventful. Conclusion Patients undergoing spinal anesthesia with intrathecal morphine may develop postoperative hypothermia that is resistant to warming measures. This complication may be treated successfully with lorazepam.
RésuméObjectif De´crire un cas d'hypothermie persistante apre`s anesthe´sie me´dullaire avec administration intrathe´cale de morphine. Caractéristiques cliniques Apre`s arthroplastie totale programme´e du genou droit sous anesthe´sie me´dullaire utilisant de la bupivacaı¨ne 0,5 % isobare 11 mg, du fentanyl 15 lg et de la morphine 150 lg sans agent de conservation, une femme aˆge´e de 57 ans (93,5 kg, 151 cm) a pre´sente´une hypothermie postope´ratoire avec une tempe´rature rectale descendant jusqu'a`33,6°C quatre heures apre`s l'ope´ration. Par moment, sa tempe´rature n'a pas pu eˆtre mesure´e par voie tympanique, orale, axillaire, ou rectale, ou par le biais de l'arte`re temporale. En de´pit de cette tempe´rature basse, la patiente s'est plainte d'une sensation de chaleur et pre´sentait une diaphore`se sans frissonnement. A`l'exception de sa tempe´rature, ses signes vitaux postope´ratoires e´taient normaux et hormis une hyperglyce´mie, la formule sanguine comple`te, les e´lectrolytes, l'hormone thyre´otrope, le cortisol se´rique, la troponine et un e´lectrocardiogramme a`12 de´rivations e´taient normaux. Sa tempe´rature n'a pas re´agi aux efforts de re´chauffement avec une couverture chauffante aÀ uthor contributions Kenneth Ryan conducted the literature review, wrote the first draft of the case report, and contributed to the revisions of the manuscript. James Price was involved in the care of the patient and contributed extensively to the revisions of the manuscript. Brian Warriner was involved in the care of the patient and contr...