Reduction in the Shivering Threshold Is Proportional to Spinal Block Height

1996 ◽  
Vol 84 (6) ◽  
pp. 1327-1331 ◽  
Author(s):  
Kate Leslie ◽  
Daniel I Sessler
Keyword(s):  
Skin Temperature ◽  
Spinal Anesthesia ◽  
Skin Surface ◽  
Intravenous Fluid ◽  
Upper Body ◽  
Spinal Block ◽  
Cooling Rates ◽  
Ambient Temperatures ◽  
Ringer’S Solution ◽  
Lactated Ringer's Solution

Background Hypothermia is nearly as common, and may be as severe, during spinal and epidural anesthesia as during general anesthesia. The authors have proposed that thermoregulatory failure results when regional anesthesia increases apparent leg skin temperature to a level far exceeding actual leg skin temperature. Extensive dermatomal blocks will alter thermal input to the hypothalamus from a greater skin-surface area more than less extensive ones and thus might be expected to impair central thermoregulatory control more. Accordingly, they tested the hypothesis that reduction in the shivering threshold is directly related to the number of dermatomes blocked during spinal anesthesia. Methods Eleven men, aged 62 +/- 6 yr (mean +/- SD), undergoing urologic surgery were studied. Ice-cold lactated Ringer's solution was administered intravenously before spinal blockade and the shivering threshold (triggering core temperature) was established. Spinal anesthesia then was induced using a randomly assigned dose of 0.5% bupivacaine (2-4 ml). Again, sufficient cold lactated Ringer's solution was given to induce shivering. Tympanic membrane, ambient and skin temperatures were measured, and extent of block was defined by loss of temperature discrimination. Presence of shivering was evaluated by a blinded observer. Mean upper-body skin and ambient temperatures, cooling rates and intravenous fluid volumes at the two thresholds were compared using paired, two-tailed t tests (P < 0.05). Linear regression defined the relationship between reduction in shivering threshold and the number of dermatomes blocked. Results There were no significant differences between mean upper-body skin and ambient temperatures, cooling rates or intravenous fluid volumes at the control and spinal shivering thresholds. Spinal anesthesia reduced the shivering threshold in direct relation to the number of dermatomes blocked: delta threshold = 0.74 - 0.06 (dermatomes blocked); r2 = 0.58, P < 0.006. Conclusions Extensive spinal blockade impairs central thermoregulatory control more than less extensive blockade. Clinicians can thus anticipate more core hypothermia during extensive than during restricted spinal blockade.

Increasing Mean Skin Temperature Linearly Reduces the Core- temperature Thresholds for Vasoconstriction and Shivering in Humans 

1995 ◽  
Vol 82 (5) ◽  
pp. 1160-1168 ◽  
Author(s):  
Christi Cheng ◽  
Takashi Matsukawa ◽  
Daniel I. Sessler ◽  
Ozaki Makoto ◽  
Andrea Kurz ◽  
...  
Keyword(s):  
Skin Temperature ◽  
Core Temperature ◽  
Central Venous ◽  
Men And Women ◽  
Ringer’S Solution ◽  
The Core ◽  
Temperature Thresholds ◽  
Venous Infusion ◽  
Lactated Ringer's Solution ◽  
Skin Temperatures

Background The contribution of mean skin temperature to the thresholds for sweating and active precapillary vasodilation has been evaluated in numerous human studies. In contrast, the contribution of skin temperature to the control of cold responses such as arteriovenous shunt vasoconstriction and shivering is less well established. Accordingly, the authors tested the hypothesis that mean skin and core temperatures are linearly related at the vasoconstriction and shivering thresholds in men. Because the relation between skin and core temperatures might vary by gender, the cutaneous contribution to thermoregulatory control also was determined in women. Methods In the first portion of the study, six men participated on 5 randomly ordered days, during which mean skin temperatures were maintained near 31, 34, 35, 36, and 37 degrees C. Core hypothermia was induced by central venous infusion of cold lactated Ringer's solution sufficient to induce peripheral vasoconstriction and shivering. The core-temperature thresholds were then plotted against skin temperature and a linear regression fit to the values. The relative skin and core contributions to the control of each response were calculated from the slopes of the regression equations. In the second portion of the study, six women participated on three randomly ordered days, during which mean skin temperatures were maintained near 31, 35, and 37 degrees C. At each designated skin temperature, core hypothermia sufficient to induce peripheral vasoconstriction and/or shivering was again induced by central venous infusion of cold lactated Ringer's solution. The cutaneous contributions to control of each response were then calculated from the skin- and core-temperature pairs at the vasoconstriction and shivering thresholds. Results There was a linear relation between mean skin and core temperatures at the response thresholds in the men: r = 0.90 +/- 0.06 for vasoconstriction and r = 0.94 +/- 0.07 for shivering. Skin temperature contributed 20 +/- 6% to vasoconstriction and 19 +/- 8% to shivering. Skin temperature in the women contributed to 18 +/- 4% to vasoconstriction and 18 +/- 7% to shivering, values not differing significantly from those in men. There was no apparent correlation between the cutaneous contributions to vasoconstriction and shivering in individual volunteers. Conclusions These data indicate that skin and core temperatures contribute linearly to the control of vasoconstriction and shivering in men and that the cutaneous contributions average approximately 20% in both men and women. The same coefficients thus can be used to compensate for experimental skin temperature manipulations in men and women. However, the cutaneous contributions to each response vary among volunteers; furthermore, the contributions to the two responses vary within volunteers.

Effects of Crystalloid and Colloid Preload on Blood Volume in the Parturient Undergoing Spinal Anesthesia for Elective Cesarean Section 

1999 ◽  
Vol 91 (6) ◽  
pp. 1571-1571 ◽  
Author(s):  
Hiroshi Ueyama ◽  
Yan-Ling He ◽  
Hironobu Tanigami ◽  
Takashi Mashimo ◽  
Ikuto Yoshiya
Keyword(s):  
Cardiac Output ◽  
Cesarean Section ◽  
Indocyanine Green ◽  
Spinal Anesthesia ◽  
Blood Volume ◽  
Elective Cesarean Section ◽  
Colloid Solution ◽  
Ringer’S Solution ◽  
Elective Cesarean ◽  
Lactated Ringer's Solution

Background The role of crystalloid preloading to prevent hypotension associated with spinal anesthesia in parturients during cesarean section has been challenged. Direct measurement of blood volume should provide insight regarding the volume-expanding effects. The aim of the current study was to clarify the effects of volume preload with either crystalloid or colloid solution on the changes in blood volume of parturients undergoing spinal anesthesia for cesarean section. Methods Thirty-six healthy parturients scheduled for elective cesarean section during spinal anesthesia were allocated randomly to one of three groups receiving 1.5 l lactated Ringer's solution (LR; n = 12), 0.5 l hydroxyethylstarch solution, 6% (0.5 l HES; n = 12), and 1.0 l hydroxyethylstarch solution, 6% (1.0 l HES; n = 12), respectively. Blood volume and cardiac output were measured before and after volume preloading with indocyanine green (ICG), and the indocyanine green blood concentrations were monitored by noninvasive pulse spectrophotometry. Results After volume preload, the blood volume significantly increased in all three groups (P < 0.01). The volume of infused solution remaining in the vascular space in the LR, 0.5-l HES, and 1.0-l HES groups were 0.43+/-0.20 l, 0.54+/-0.14 l, and 1.03+/-0.21 l, respectively, corresponding to 28% of lactated Ringer's solution and 100% of hydroxyethylstarch solution infused. Significant increases in cardiac output were observed in the 0.5-l and 1.0-l HES groups (P < 0.01). A significant correlation between the percentage increase in blood volume and that of cardiac output was observed by volume preloading (r2 = 0.838; P < 0.001). The incidence of hypotension was 75% for the LR group, 58% for the 0.5-l HES group, and 17% for the 1.0-l HES group, respectively. Conclusions The incidence of hypotension developed in the 1.0-l HES group was significantly lower than that in the LR and 0.5-l HES groups, showing that greater volume expansion results in less hypotension. This result indicates that the augmentation of blood volume with preloading, regardless of the fluid used, must be large enough to result in a significant increase in cardiac output for effective prevention of hypotension.

Role of skin temperature in the control of sweating

1979 ◽  
Vol 47 (3) ◽  
pp. 591-597 ◽  
Author(s):  
T. V. McCaffrey ◽  
R. D. Wurster ◽  
H. K. Jacobs ◽  
D. E. Euler ◽  
G. S. Geis
Keyword(s):  
Steady State ◽  
Ambient Temperature ◽  
Skin Temperature ◽  
Upper Body ◽  
Lower Body ◽  
Sweating Rate ◽  
Ambient Temperatures ◽  
Rate Versus ◽  
Male Subjects

In five male subjects tympanic membrane temperature (Tty), rectal temperature, skin temperatures at 12 sites were simultaneously recorded. Local sweating rate was measured at six sites using resistance hygrometry. After steady-state sweating was established, the lower body was heated at ambient temperatures of 50, 60, 70, and 80 degrees C or cooled at an ambient temperature of 29 degrees C while the upper body remained at a constant ambient temperature. During lower body heating or cooling, Tty was maintained constant by the drinking of cold (10 degrees C) or warm (45 degrees C) water. Sweating rate on both upper and lower body surfaces was proportional to lower body skin temperature. The regression coefficients for sweating rate versus mean lower body skin temperature varied from 0.03 to 0.09 mg/cm2.min. degrees C between subjects, but were not significantly different from each other (P greater than 0.05). This study demonstrates an influence of cutaneous thermoreceptors on sweating rate under steady-state conditions.

Spinal Anesthesia Speeds Active Postoperative Rewarming 

1997 ◽  
Vol 87 (5) ◽  
pp. 1050-1054 ◽  
Author(s):  
Peter Szmuk ◽  
Tiberiu Ezri ◽  
Daniel I. Sessler ◽  
Arnold Stein ◽  
Daniel Geva
Keyword(s):  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Regional Anesthesia ◽  
Upper Body ◽  
Ambient Temperatures ◽  
Thoracic Level ◽  
The Mean ◽  
Forced Air ◽  
To Receive ◽  
Body Heat

Background 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. Methods 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. Results 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). Conclusions 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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