Arkiliç C F, Akça O, Taguchi A, Sessler D I, Kurz A
Department of Anesthesiology, Washington University, St. Louis, MO 63110, USA.
Anesth Analg. 2000 Sep;91(3):662-6. doi: 10.1097/00000539-200009000-00031.
Temperature monitoring and thermal management are rare during spinal or epidural anesthesia because clinicians apparently restrict monitoring to patients with an expected risk of hypothermia. This implies that anesthesiologists can predict patient thermal status without monitoring core temperature. We therefore, tested the hypotheses that during neuraxial anesthesia: 1) amount of core hypothermia depends on the magnitude and duration of surgery; 2) temperature monitoring and thermal management are used selectively in patients at high risk of hypothermia; and 3) anesthesiologists can estimate patient thermal status. We evaluated thermal status on arrival in the recovery room along with intraoperative thermal management and monitoring in 120 patients. Anesthesiologists were asked if their patients were hypothermic (<36 degrees C). There was no correlation between the magnitude or duration of surgery and initial postoperative core temperature in unwarmed patients. Temperature monitoring and thermal management were not used selectively in high-risk patients. Initial postoperative tympanic membrane temperatures were <36 degrees C in 77% of patients and <35 degrees C in 22%. Body temperature was monitored intraoperatively in 27% of the patients and forced-air warming was used in 31%. Anesthesiologists failed to accurately estimate whether their patients were hypothermic. Our results suggest that temperature monitoring and management during neuraxial anesthesia is currently inadequate.
In this observational study, we evaluated core temperatures and intraoperative thermal management in patients undergoing spinal or epidural anesthesia. Hypothermia was common, however, rarely detected either by temperature monitoring or estimates by anesthesiologists. In addition, it was not treated with active warming. Consequently, temperature monitoring and management have to be done during neuraxial anesthesia.
在脊髓或硬膜外麻醉期间，体温监测和热管理很少见，因为临床医生显然将监测局限于预期有体温过低风险的患者。这意味着麻醉医生可以在不监测核心体温的情况下预测患者的热状态。因此，我们检验了以下假设：在神经轴麻醉期间：1）核心体温过低的程度取决于手术的规模和持续时间；2）在体温过低高风险患者中选择性地使用体温监测和热管理；3）麻醉医生可以估计患者的热状态。我们评估了120例患者在进入恢复室时的热状态以及术中的热管理和监测情况。询问麻醉医生其患者是否体温过低（<36摄氏度）。在未保暖的患者中，手术规模或持续时间与术后初始核心体温之间没有相关性。在高风险患者中未选择性地使用体温监测和热管理。术后初始鼓膜温度在77%的患者中<36摄氏度，在22%的患者中<35摄氏度。27%的患者术中进行了体温监测，31%的患者使用了强制空气加温。麻醉医生未能准确估计其患者是否体温过低。我们的结果表明，目前神经轴麻醉期间的体温监测和管理不足。
在这项观察性研究中，我们评估了接受脊髓或硬膜外麻醉患者的核心体温和术中热管理情况。体温过低很常见，然而，很少通过体温监测或麻醉医生的估计被检测到。此外，未进行主动加温治疗。因此，在神经轴麻醉期间必须进行体温监测和管理。
