Temperature regulation

 Body temp. should be kept within the

normal range because any deviation can
affect metabolic function & enzymatic
activity
 Body temp. is controlled by balancing heat
production against heat loss
Temperature regulation

 Core temp. Temp. of deep tissues of body.

Remains constant( ± 0.6 ºC) , except when
person develops febrile illness[ average:
36.6- 37ºC]
 Skin temp. in contrast to core temp. rises &
falls with the temp. of surrounding.
Estimated range of body (core) temp.
in normal people
 HEAT PRODUCTION
1.BASAL METABOLIC RATE of all cells in body
The BMR can increase by the effect of :
- Catecholamines ( adr. & noradr.)
- Thyroxine
- Growth hormone
- Testosterone
2.FOOD INTAKE (Thermogenic effect of food)
Extra metabolism needed for digestion , absorption & storage of
food

3. Muscle contraction
-Exercise (20 x BMR)
-Shivering (5 x BMR)
HEAT LOSS
 Blood vessels are distributed profusely
beneath the skin.
 A high rate of skin blood flow causes heat
to be conducted from the core to the skin.
 While decreasing blood flow decreases heat
conduction
 Vasodilatation & vasoconstriction are
controlled by sympathetic N.S.
Skin circulation
Effect of changes in environmental temp. on
heat conductance from body core to skin
surface
HEAT LOSS

 Heat loss from skin surface is by:

 1. Conduction : to clothes, chair
 2. Convection: to air, water
 3. Radiation: Infrared heat rays ( wave
length= 5-20 micrometer)
 4. Evaporation: for each 1 gm water
evaporated 0.58 cal of heat is lost
Heat loss
Water evaporation
 Even if a person is not sweating , water still
evaporates insensibly from skin & lungs at
a rate of about 600- 700 ml/day.
 This accounts for a continual heat loss of
16-19 cal/ hour.
 This amount can increase by sweating
 Evaporation is a necessary cooling
mechanism at very high air temp.
Heat loss

 Conduction & radiation continues as long

as skin temp. is higher than surrounding
temp.
 When surrounding temp. is higher than skin
temp. evaporation occur
 Clothing decrease heat loss by conduction
& convection.
 SKIN HYPOTHALAMUS

Preoptic Area

W Sweating
Set Vasodilation
Warm W
Receptors
point Vasoconstriction
W C Shivering
Cold
Receptors
Temperature regulation

 Threshold for
sweating&vasodilatation:37ºC
 Threshold for vasoconstriction: 36.8º C
 Threshold for nonshivering
thermogenesis:36ºC
 Threshold for shivering: 35.5º C
Normal thermoregulation
 Afferent input: cold signal-Aδ fiber
warm signal-C fiber
 Each contribute 20% of the total thermal input:
hypothalamus
other parts of brain
skin surface
spinal cord
deep abdominal and thoracic tissues
Normal thermoregulation

 Primary thermoregulatory control center

-hypothalamus
 Control of autonomic responses is 80%

determined by thermal input from core

structures
 In contrast, behavior response may depend
more on skin temperature
Temp.regulating mechanisms

 When temp. regulating areas in

hypothalamus are stimulated, reflex &
semireflex thermoregulatory responses are
activated.
 Responses include: autonomic, somatic,
endocrine & behavioral changes
Temperature regulation
 Reflex responses activated by cold are
controlled from posterior hypothalamus
 Those activated by warmth are controlled
primarily from anterior hypothalamus.
 Serotonin may be released in response to
cold
 Noradrenaline may be released in central
neurons in response to heat
Temperature regulation

 Exposure to heat causes:

 1. Increased heat loss
 2. Decreased heat production
 Exposure to cold causes:
 1. Decreased heat loss
 2. Increased heat production
Normal thermoregulation
 Major responses against heat:
1. sweating
2.cutaneous vasodilation
 Major responses against cold:
1.cutaneous vasoconstriction
2.nonshivering thermogenesis
3.shivering
Normal thermoregulation

 Vasoconstriction occurs in AV shunts

located primarily in fingers and toes,
mediated by α-adrenergic symp. nerve.
 Nonshivering thermogenesis is important in
infants,but not in adults (brown fat)
 Shivering is an involuntary muscle activity
that increase metabolic rate 2-3 times
Effect of changes in int.head temp. on the rate of
evaporative heat loss from body. Skin temp
determines set point of sweating
Fffect of changes in int.head temp. on the rate
of heat production
Skin temp. determines set point of shivering
FEVER
FEVER = an abnormally high body temperature
PYROGEN = a fever producing substance

PYROGEN WBC
bacterial toxins, leukocytes,
viruses, pollen, + monocytes = Cytokines
proteins, dust (Endogenous pyrogen)

act on preoptic area

Prostaglandins Aspirin

RAISES THE “SET POINT”

Effect of changing the set-point of
hypothalamic temp. controller
Body temp. under different
conditions
LIMITS TO
TEMPERATURE REGULATION
Heat Exhaustion: Inadequate water/salt replacement
Body temperature may be normal
Symptoms: cerebral dysfunction
nausea
fatigue
Vasodilaton causing fatigue or fainting

Heat Stroke: Temperature regulation lost

Symptoms: high body temperature
NO sweating
dizziness or
loss of consciousness
Body temperature MUST be lowered!
Hypothermia during general
anesthesia
 Inadvertent hypothermia during general
anesthesia is by far the most common
perioperative thermal disturbance(due to impaired
thermoregulation and cold environment)

 Heat transferred from p`t to environment:

radiation > convection >>conduction &
evaporation
Perioperative hypothermia
 The human thermoregulatory system usually
maintains core body temperature within 0.2℃ of 37℃
 Perioperative hypothermia is common because of the
inhibition of thermoregulation induced by
anesthesia and the patient`s exposure to cool
environment
 Hypothermia complication:
shivering,prolonged drug effect,coagulopathy,
surgical wound infection,morbid cardiac event
Thermoregulation during general
anesthesia
 General anesthesia removes a p`t ability to regulate
body temperature through behavior, so that
autonomic defenses alone are available to respond to
changes in temperature
 Anesthetics inhibit thermoregulation in a dose-
dependent manner and inhibit vasoconstriction and
shivering about 2-3 times as they restrict sweating
 Interthreshold range is increased from 0.2 to
4℃ (20 times), so anesthetized p`t are poikilothermic
with body temperatures determined by the
environment
Thermoregulation during general
anesthesia
 The gain and maximal response intensity of sweating
and vasodilation are well preserved when volatile
anesthetics is given
 However volatile anesthetics reduces the gain of AV-
shunt vasoconstriction,without altering the
maximal response intensity
 Nonshivering thermogenesis dosen`t occur in
anesthetized adults
 General anesthesia decreases the shivering threshold
far more than the vasoconstriction threshold
Patterns of intraoperative hypothermia

Phase I: 38

Initial rapid decrease 37

36
Phase II :
Slow linear reduction 35

34
Phase III:
Thermal plateau 33
0 1 2 3 4 5 6
Patterns of intraoperative hypothermia

• Initial rapid decrease

 heat redistribution
 decreases 0.5-1.5℃ during 1st hr
 Tonic thermoregulatory vasoconstriction that
maintains a temperature gradient between the core and
periphery of 2-4℃ is broken
 The loss of heat from the body to environment is little
 Heat redistribution decreases core temperature, but
mean body temperature and body heat content
remain unchanged
Patterns of intraoperative hypothermia

2. Slow linear reduction

 decreases in a slow linear fashion for 2-3hrs
 Simply because heat loss >metabolic heat
production
 90% heat loss through skin surface by
radiation and convection
Patterns of intraoperative hypothermia

3. Thermal plateau
 After 3-5 hrs,core temperature stops decreasing
 It may simply reflect a steady state that
heat loss=heat production in well-warmed p`t
 If a p`t is sufficiently hypothermic,plateau phase
means activation of vasoconstriction to reestablish
the normal core-to-peripheral temperature gradient
 Temperature plateau due to vasoconstriction is not a
thermal steady state and body heat content
continues to decrease even though temperature
remains constant
 Regional Anesthesia

 Regional anesthesia impairs both central

and peripheral thermoregulation
 Hypothermia is common in patients given
spinal or epidural anesthetics
 Thermoregulation
 All thermoregulatory responses are neurally
mediated
 Spinal and epidural anesthetics disrupt nerve
conduction to more than half the body
 The peripheral inhibition of thermoregulatory
defense is a major cause of hypothermia during
RA
 Undetected hypothermia

 The core temperature is rarely monitored by

medical personnel during spinal and
epidural anesthesia
 Patients usually do not feel cold
 Treating and Preventing
Intraoperative Hypothermia
Preventing redistribution hypothermia
 The initial reduction in core temperature is
difficult to treat because it result from
redistribution of heat
 Prevent by skin-surface warming
 Peripheral heat content ↑
→ Temperature gradient ↓
→ Redistribution of heat ↓
 Intravenous fluids

 1L of IV fluids at ambient temperature or 1

unit of refrigerated blood decreases the
mean body temperature 0.25 ℃
 Heating fluids to near 37 ℃ helps prevent
hypothermia and is appropriate if large
volumes are being given
 Cutaneous Warming

 The skin is the predominant source of heat

loss during surgery, mostly by radiation and
convection
 Evaporation from large surgical incisions
may be important
 An ambient temp. above 25℃ is frequently
required, but this is uncomfortable for
gowned surgeons
 Conclusions
 Temperatures throughout the body are
integrated by a thermoregulatory system
 General anesthesia produces marked, dose-
dependent inhibition of thermoregulation to
increase the interthreshold range by roughly
20-fold
 Regional anesthesia produce both peripheral
and central inhibition
 The combination of anesthetic-induced
thermoregulatory impairment and exposure to cold
operating rooms makes most surgical patients
hypothermic
 The hypothermia initially results from a
redistribution of body heat and then from an excess
of heat loss
 Perioperative hypothermia is associated with
adverse outcomes, including cardiac events,
coagulopathy, wound infections……
 Unless hypothermia is specially indicated, the
intraoperative core temperature should be above 36
℃