Yoo Jae Hwa, Sung Tae-Yun, Oh Chung-Sik
Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Myunggok Medical Research Institute, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.
Anesth Pain Med (Seoul). 2025 Jul;20(3):189-199. doi: 10.17085/apm.25294. Epub 2025 Jul 31.
Aging adversely impacts thermoregulatory function, thereby increasing the risk of intraoperative hypothermia. Age-associated alterations-including diminished thermal perception, impaired autonomic responsiveness, reduced thermogenic capacity due to sarcopenia, and decreased cardiovascular adaptability, exacerbate the vulnerability to hypothermia. Concomitant comorbidities and polypharmacy further compromise thermal homeostasis in geriatric patients. Anesthetic agents compound this risk by lowering the thresholds for vasoconstriction and shivering and attenuating the magnitude of thermal responses. Consequently, geriatric populations are predisposed to significant perioperative temperature decline, particularly in cooler operating room (OR) environments. Intraoperative hypothermia is associated with an increased incidence of adverse outcomes, including increased cardiac events, surgical site infections, coagulopathy, protracted pharmacodynamic effects, extended recovery, and hospitalization duration. Although recent investigations suggest a diminished incidence of hypothermia due to minimally invasive surgical techniques and enhanced temperature management protocols, the intrinsic susceptibility of the aged thermoregulatory system persists. Effective temperature management requires precise core temperature monitoring and maintains appropriate OR temperatures. Furthermore, the implementation of multimodal warming strategies, including passive insulation, active warming modalities, warming of intravenous fluids, and prewarming before anesthesia induction, is critical. Therefore, a comprehensive and proactive thermal management approach is essential in mitigating hypothermia-related risks and optimizing perioperative outcomes in the geriatric patients.
衰老对体温调节功能产生不利影响，从而增加术中体温过低的风险。与年龄相关的改变，包括热感觉减退、自主反应受损、肌肉减少症导致的产热能力降低以及心血管适应性下降，加剧了对体温过低的易感性。同时存在的合并症和多种药物治疗进一步损害了老年患者的热稳态。麻醉药物通过降低血管收缩和寒战阈值以及减弱热反应幅度来增加这种风险。因此，老年人群在围手术期容易出现明显的体温下降，尤其是在较冷的手术室环境中。术中体温过低与不良结局的发生率增加相关，包括心脏事件增加、手术部位感染、凝血功能障碍、药效学作用延长、恢复时间延长和住院时间延长。尽管最近的研究表明，由于微创手术技术和强化体温管理方案，体温过低的发生率有所降低，但老年体温调节系统的内在易感性仍然存在。有效的体温管理需要精确的核心体温监测并维持合适的手术室温度。此外，实施多模式升温策略，包括被动保温、主动升温方式、静脉输液加温以及麻醉诱导前预加温，至关重要。因此，全面且积极主动的热管理方法对于降低老年患者体温过低相关风险并优化围手术期结局至关重要。
