Spinal anesthesia speeds active postoperative rewarming
ABSTRACT Redistribution of body heat decreases core temperature more during general than regional anesthesia. However, the combination of anesthetic- and sedative-induced inhibition may prevent effective upper-body thermoregulatory responses even during regional anesthesia. The extent to which each type of anesthesia promotes hypothermia thus remains controversial. Accordingly, the authors evaluated intraoperative core hypothermia in patients assigned to receive spinal or general anesthesia. They also tested the hypothesis that the efficacy of active postoperative warming is augmented when spinal anesthesia maintains vasodilation.
Patients undergoing lower abdominal and leg surgery were randomly assigned to receive general anesthesia (isoflurane and nitrous oxide; n = 20) or spinal anesthesia (bupivacaine; n = 20). Fluids were warmed to 37 degrees C and patients were covered with surgical drapes. However, no other active warming was applied during operation. Ambient temperatures were maintained near 20 degrees C. After operation, patients were warmed with a full-length, forced-air cover set to 43 degrees C. Shivering, when observed, was treated with intravenous meperidine.
The mean spinal analgesia level, which was at the sixth thoracic level during surgery, remained at the T12 dermatome after 90 min after operation. Core temperatures did not differ significantly during surgery and decreased to 34.4 +/- 0.5 degrees C and 34.1 +/- 0.4 degrees C, respectively, in patients given spinal and general anesthesia. After operation, however, core temperatures increased significantly faster (1.2 +/- 0.1 degrees C/h vs. 0.7 +/- 0.2 degrees C/h, mean +/- SD; P < 0.001) in patients given spinal anesthesia. Consequently, patients given spinal anesthesia required less time to rewarm to 36.5 degrees C (122 +/- 28 min vs. 199 +/- 28 min; P < 0.001).
Comparable intraoperative hypothermia during general and regional anesthesia presumably resulted because the combination of spinal anesthesia and meperidine administration obliterated effective peripheral and central thermoregulatory control. Vasodilation increased the rate of core rewarming in patients after operation with residual lower-body sympathetic blocks, suggesting that vasoconstriction decreased peripheral-to-core heat transfer after general anesthesia.
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ABSTRACT: Postoperative hypothermia and shivering is a frequent event in patients during cesarean section under spinal anesthesia. We assessed the effect of preoperative warming during cesarean delivery under spinal anesthesia for prevention of hypothermia and shivering. Forty five patients undergoing elective cesarean section were randomly assigned to three groups. Group F received warmed intravenous fluid (40℃). Group A patients were actively warmed by forced air-warming. Group C was the control group. Forced air-warming and warmed fluid was maintained for the 15 min preceding spinal anesthesia. Core temperature (tympanic membrane) and the skin temperature of arm and thigh were measured and shivering was graded simultaneously. The core temperature at 45 min decreased less in Groups F and A than Group C (-0.5℃ ± 0.3℃ vs -0.6℃ ± 0.4℃ vs -0.9℃ ± 0.4℃, respectively; P = 0.004). The arm temperature at 15 min and 30 min exhibited a greater increase in Group A than Group F and Group C (P = 0.001 and P = 0.012, respectively). Leg temperature increased similarly among the three groups. The incidence of shivering was significantly less in Group A and Group F than Group C (20%, 13.3%, and 53.3%, respectively; P = 0.035). Preoperative forced air-warming and warmed fluid prevents hypothermia and shivering in patients undergoing elective cesarean delivery with spinal anesthesia.Korean journal of anesthesiology 05/2012; 62(5):454-60. DOI:10.4097/kjae.2012.62.5.454
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ABSTRACT: Intestinal pseudo-obstruction is defined as a clinical syndrome characterized by impairment of intestinal propulsion, which may resemble intestinal obstruction, in the absence of a mechanical cause. It may involve the small and/or the large bowel, and may present in acute, subacute or chronic forms. We have performed a systematic review of acute pseudo-obstruction, also referred to as Ogilvie's syndrome in the literature, and focused on proposed mechanisms, manifestations and management of post-surgery and critically ill patients who suffer from one or more underlying clinical conditions. The hallmark of the syndrome is massive intestinal distension, which is detected on clinical inspection and plain abdominal radiography. The underlying pathophysiological mechanisms are not fully understood. Therefore, treatment focuses on preventing intestinal perforation, which is associated with an average 21% mortality rate.Baillière' s Best Practice and Research in Clinical Gastroenterology 07/2003; 17(3):427-44. DOI:10.1016/S1521-6918(03)00023-4 · 3.28 Impact Factor
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ABSTRACT: Intrathecal morphine has been used for the relief of postoperative pain following cesarean delivery. We report a case of postoperative hypothermia down to 33.6 degrees C associated with excessive sweating in patient undergoing elective cesarean delivery under spinal bupivacaine anesthesia who received intrathecal morphine for postoperative pain management. A healthy 31-year-old multigravida presented for elective cesarean delivery. Following prehydration with 500 mL hemaccel, she had a subarachnoid block, using hyperbaric bupivacaine 12 mg and morphine 200 microgram, via a 25-gauge Whitacre needle. In the recovery room, 3 hours after induction of spinal anesthesia, the patient's sublingual temperature was 33.6 degrees C and she was noted to be sedated and sweating excessively. During the next 2 hours, the patient was still hypothermic despite active warming. She also complained of severe nausea, vomiting, and moderate pruritus. Following administration of naloxone 400 microgram sedation, vomiting, and pruritus were relieved. Also, the patient experienced excessive shivering, and her body temperature started to increase in association with a concurrent decrease of sweating. The postoperative hypothermia and excessive sweating in our patient may be related to the cephalad spread of the intrathecal morphine within the cerebrospinal fluid (CSF) to reach the level of opioid receptors in the hypothalamus, causing a perturbation of the thermoregulatory center. This effect could be counteracted by administration of naloxone. Intrathecal morphine may cause disruption of thermoregulation resulting in hypothermia associated with excessive sweating.Regional Anesthesia and Pain Medicine 03/2003; 28(2):140-3. DOI:10.1053/rapm.2003.50043 · 2.12 Impact Factor