Thermoregulatory Thresholds during Epidural and Spinal Anesthesia

Ozaki, Makoto; Kurz, Andrea; Sessler, Daniel I.; Lenhardt, Rainer; Schroeder, Mark E.; Moayeri, Azita; Noyes, Katherine M.; Rotheneder, E.

doi:10.1097/00000542-199408000-00004

Cited by 193 publications

(88 citation statements)

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“…Redistribution of body heat has been reported [8]. The compensatory responses to hypothermia such as shivering and vasoconstriction might be blunted in spinal anaesthesia [9]. There might also be a decreased thermal input from the skin surface because of sensory block.…”

Section: Discussionmentioning

confidence: 98%

A randomised double‐blind controlled study evaluating the hypothermic effect of 150 μg morphine during spinal anaesthesia for Caesarean section

et al. 2005

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SummaryWe studied the hypothermic effect of adding 150 lg morphine during spinal anaesthesia in 60 parturients scheduled for elective caesarean section. All the parturients received intrathecal injection of a solution containing 150 lg morphine or normal saline in addition to 10-12 mg hyperbaric bupivacaine 0.5%. In both groups, a significant decrease in body temperature was noted. There was no difference in the area under the curve for temperature against time for the two groups; however, the maximum decrease in temperature from baseline was significantly larger after morphine than after saline injection (mean (SD) 1.11 (0.61)°C vs 0.76 (0.39)°C, respectively; p = 0.01) and the time to nadir temperature was significantly longer (59.5 (17.6) min vs 50.4 (15.9) min, respectively; p = 0.047). The lowest temperature observed in the morphine group was 34.3°C. We conclude that intrathecal injection of 150 lg morphine intensified the intra-operative hypothermic effect of bupivacaine spinal anaesthesia for caesarean section. Intra-operative hypothermia has been reported in parturients receiving spinal anaesthesia [1]. For parturients undergoing caesarean section, bupivacaine is a commonly used agent for providing spinal anaesthesia. When morphine is used in addition to local anaesthetics, it prolongs the duration of analgesia and provides postoperative pain relief [2]. Severe hypothermia has been reported when a large dose of morphine was used in spinal anaesthesia [3]. Although hypothermia associated with smaller doses of morphine has been reported sporadically [4,5], it is not known whether a very small dose of morphine (150 lg) would also intensify spinal anaesthesia-induced hypothermia. This randomised double-blind controlled study was performed to evaluate the effect of adding 150 lg of morphine to bupivacaine on body temperature in parturients during elective caesarean section under spinal anaesthesia. MethodsWe included 60 term pregnant women (ASA physical status 1-2) scheduled for elective caesarean section after informed consent. This study was approved by the institutional reviewing board. The individuals were assigned to receive either morphine or saline by a computer-generated randomisation table. The assignments were blinded to both the parturients and the anaesthetists who performed the spinal injection and measured the body temperature. After the parturients were transferred to the operating room, regular noninvasive blood pressure was recorded every 3 min. Lead-II configuration of the ECG and pulse oximetry were continuously displayed. Body temperatures were recorded from the same ear with an infrared tympanic thermometer (Welch Allyn 9000, accuracy ± 0.2°F). The room temperature was kept constant at 24°C. The parturients were prehydrated with 1000 ml Hartmann's solution, which was prewarmed to 37°C. After hydration, the baseline body temperature was obtained. A 27-G Quincke spinal needle was introduced into the subarachnoid space at the L2-3 or L3-4 interspace in the lateral decubitus position, and 10-...

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Section: Discussionmentioning

confidence: 98%

A randomised double‐blind controlled study evaluating the hypothermic effect of 150 μg morphine during spinal anaesthesia for Caesarean section

et al. 2005

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“…We thought this was also unlikely to have affected our comparison as it has been shown that vasoconstriction, shivering thresholds and thermoregulatory processing are very' similar during extradural and subarachnoid anesthesia. 26 We have not performed a direct comparison between tramadol and meperidine. However, tramadol does have advantages over meperidine in that it is not a controlled drug and it causes less respiratory depression and sedation than other opioids at equivalent dosages) 2,13 Patients receiving meperidine iv for control of shivering during extradural anesthesia were more drowsy at two and five minutes after injection, although there was no difference in level of consciousness at later intervals.…”

Section: Discussionmentioning

confidence: 99%

Control of shivering under regional anesthesia in obstetric patients with tramadol

Chan

Tong

et al. 1999

Can J Anesth/J Can Anesth

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Control of shivering under regional anesthesia in obstetric patients with tramadolPurpose: Tramadol in a dose of I mg'kg -~ iv is effective in the treatment of shivering after general anesthesia. The current study aimed to investigate (I) whether tramadol was equally effective for shivering under regional anesthesia in obstetric patients and (2) whether effective treatment could be achieved with lower doses. Methods: In a randomised, double-blind study, 36 obstetric patients who shivered during Cesarean section under regional anesthesia and who requested anti-shivering treatment were allocated to one of three groups for iv treatment: Group T0.5 received tramadol 0.5 mg'kg -l (n= 12), Group T0.25 tramadol 0.25 mg'kg -I (n--13) and Group NS normal saline 0.05 mlkg -l (n= I I). Treatment efficacy was evaluated subjectively by the parturient as no improvement, slight improvement, or marked improvement. The attending anesthesiologist who was blinded also independently noted the time elapsed from treatment to the time shivering subsided. Side effects such as nausea, vomiting or sedation and Apgar scores of the newborn were also noted. l~sults: Eighty percent of parturients in Group T0.5 and 92% in Group T0.25 were judged by observers to have shivering controlled compared with 27% in Group NS (P < 0.00 I). The response rates of Group T0.5 and Group T0.25 were not different. There was no increased incidence of side effects in the treatment groups. Conclusion: We conclude that tramadol iv was effective in the treatment of intraoperative shivering during regional anesthesia for Cesarean section. There was no demonstrable difference in response rate or incidence of side effects between the two doses of 0.5 mg.kg-' and 0.25 mg-kg -J.Objecdf : Le tramadol en dose de I mg-kg-' iv est efficace pour le traitement des frissons apr& l'anesth~sie gEnErale. La pr&ente Etude veut analyser (I) si le tramadol est Egalement efficace contre les frissons sous anesth&ie obst&ricale rEgionale et (2) si le traitement efficace peut se faire avec de plus faibles doses. M&hodc : Dans une Etude randomisEe et ~ double insu, 36 parturientes atteintes de frissons pendant la cEsarienne sous anesth&ie rEgionale ont ErE rEparties en trois groupes pour recevoir un traitement de tramadol iv : le Groupe T0,5 en a re~u 0,5 mg-kg-' (n = 12), le Groupe T0,25 en a re~u 0,25 mg.kg-' (n = 13) et le Groupe SN a eu 0,05 ml.kg-' de solution saline normale (n = I I). ['efficacitE du traitement a EtE Evalu& subjectivement par les parturientes : aucune amelioration, IEg&e amelioration ou importante amelioration. De son c6tE, l'anesthEsiologiste traitant, observateur impartial, a not~ le temps &oul~ entre le traitement et la fin des frissons. On a aussi enregistrE les effets secondaires comme les nausEes, les vomissements ou la s~dation et les indices d'Apgar du nouveau-n& REsultats : Quatre-vingt pour cent des parturientes du Groupe T0,5 et 92 % de celles du Groupe T0,2S ont bEnEficiE du traitement des frissons selon les observateurs, mais 27 96 seulement des patie...

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“…22 Even so, patients undergoing neuraxial anesthesia are just as likely or even more likely to become hypothermic [23][24][25] than patients undergoing general anesthesia, and they most likely suffer similar hypothermia-related complications. Thus, a noninvasive device that can accurately represent core temperature will help the clinician determine a course of thermal management.…”

Section: -3mentioning

confidence: 99%

The accuracy of a disposable noninvasive core thermometer

Kimberger

Saager

Egan

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Perioperative hypothermia is still a common occurrence, and it can be difficult to measure a patient's core temperature accurately, especially during regional anesthesia, with placement of a laryngeal mask airway device, or postoperatively. We evaluated a new disposable double-sensor thermometer and compared the resulting temperatures with those of a distal esophageal thermometer and a bladder thermometer in patients undergoing general and regional anesthesia, respectively. Furthermore, we compared the accuracy of the thermometer between regional and general anesthesia, since forehead microcirculation might differ between the two types of anesthesia. Methods We assessed core temperature in 36 general anesthesia patients and 20 patients having regional anesthesia for orthopedic surgery. The temperatures obtained using the double-sensor thermometer were compared with those obtained with the distal esophageal thermometer in the general anesthesia population and those obtained with the bladder thermometer in regional anesthesia patients. Results In our general anesthesia patients, 90% (95% confidence interval [CI] 85 to 95) of all double-sensor values were within 0.5°C of esophageal temperatures. The average difference (bias) between the esophageal and double-sensor temperatures was -0.01°C. In patients undergoing regional anesthesia 89% (95% CI 80 to 97) of all double-sensor values were within 0.5°C of bladder temperatures. The average difference (bias) between the bladder and double-sensor temperatures was -0.

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Thermoregulatory Thresholds during Epidural and Spinal Anesthesia

Cited by 193 publications

References 0 publications

A randomised double‐blind controlled study evaluating the hypothermic effect of 150 μg morphine during spinal anaesthesia for Caesarean section

A randomised double‐blind controlled study evaluating the hypothermic effect of 150 μg morphine during spinal anaesthesia for Caesarean section

Control of shivering under regional anesthesia in obstetric patients with tramadol

The accuracy of a disposable noninvasive core thermometer

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