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Thermoregulation: Physiological and Clinical Considerations during Sedation and General Anesthesia
Marcos Díaz DDS and
 Daniel E. Becker DDS
Article Category: Research Article
Volume/Issue: Volume 57: Issue 1
Online Publication Date: Jan 01, 2010
DOI: 10.2344/0003-3006-57.1.25
Page Range: 25 – 33

INTRODUCTION Hypothermia during anesthesia is the most common perioperative thermal disturbance. 1 It is not uncommon for patients to become cold and exhibit uncontrollable episodes of shaking and shivering. These events are both troubling and perplexing to the anesthesia provider. The purposes of this article are to review the processes of heat loss and thermoregulation and to use this information to properly care for patients during sedation and general anesthesia. Although malignant hyperthermia is a relatively rare occurrence, we will

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Marcos Díaz and
 Daniel E. Becker
Figure 1
Figure 1

Hypothalamic thermoregulation. Temperature inputs to the hypothalamus are integrated and compared with threshold temperatures that trigger appropriate thermoregulatory responses. Normally these responses are initiated at as little as 0.1°C above and below normal body temperature of 37°C (98.6°F). Therefore the difference between temperatures that initiate sweating versus those initiating vasoconstriction is only 0.2°C. This is defined as the interthreshold range and represents the narrow range at which the body does not initiate thermoregulatory efforts. Most general anesthetics depress hypothalamic responses, widening this interthreshold range to as much as 4°C. Therefore patients are less able to adjust to temperature changes that occur during treatment.


Ruri Teshima DDS,
 Akiko Nishimura DDS, PhD,
 Akira Hara DDS,
 Yuhei Ubukata DDS,
 Sayaka Chizuwa DDS,
 Mone Wakatsuki DDS, and
 Takehiko Iijima DDS, PhD
Article Category: Brief Report
Volume/Issue: Volume 69: Issue 3
Online Publication Date: Oct 06, 2022
Page Range: 38 – 39

temperatures at 3 different locations to avoid perioperative redistribution hypothermia and triggering of a FCAS/CAPS episode. CASE REPORT A 13-year-old female patient (height 162 cm; weight 42 kg; body mass index 16 kg/m 2 ) with FCAS/CAPS was scheduled to undergo the extraction of an impacted tooth (mandibular right second premolar) under general anesthesia. She had been treated with canakinumab (interleukin [IL]-1 inhibitor) every 2 months during the winter, and her symptoms were well controlled with no other systemic disease or comorbidities

Steven Ganzberg DMD, MS
Article Category: Research Article
Volume/Issue: Volume 62: Issue 3
Online Publication Date: Jan 01, 2015
Page Range: 89 – 90

temperature taken pre-operatively? Certainly, if the patient appears febrile or exhibits signs of significant oral infection, this is reasonable. Intra-operative and postoperative hypothermia is a concern but will pre-operative temperature evaluation change the anesthesia plan? For those patients who are administered agents that could precipitate malignant hyperthermia, intra-operative temperature monitoring is essential and currently required. Again, this requirement for pre-operative temperature taken directly from the Joint Commission is not applicable to the dental

Mark A. Saxen DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 70: Issue 3
Online Publication Date: Oct 18, 2023
Page Range: 154 – 155

, 0.67; 95% CI, 0.52–0.87; P = .002; I 2 = 78%) and hydrocortisone (RR, 0.51; 95% CI, 0.32–0.80; P = .003; I 2 = 58%) were effective in shivering prophylaxis. Factors like the dose and timing of administration of steroids or the type of anesthesia were not found to be significant. Patient satisfaction and QoR were higher in the dexamethasone groups versus placebo. No increased risk of adverse events of steroids was noted versus placebo or controls. Comment: Perioperative shivering is a complex compensatory response to hypothermia. Antishivering drugs

Nikolaos Dabarakis DDS, PhD,
 Anastasios Tsirlis DDS, PhD,
 Nikolaos Parisis DDS, PhD, and
 Dimitrios Tsoukalas DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 53: Issue 3
Online Publication Date: Jan 01, 2006
Page Range: 91 – 94

nerve block. In Strichartz , G. R. ed . Handbook of Experimental Pharmacology. Volume 81: Local Anesthetics . New York, NY Springer-Verlag . 1987 . 95 – 164 . 8 Popovic , V. and P. Popovic . Hypothermia in Biology and Medicine . New York, NY Grune Stratton . 1974 . 98 – 109 . 9 Swenson , R. P. and G. S. Oxford . Modification of sodium channel gating by long chain alcohols. Ionic and gating current

Toru Yamamoto DDS, PhD,
 Noriko Miyazawa MD, PhD,
 Shinichi Yamamoto MD, PhD, and
 Hiroshi Kawahara DDS, PhD
Article Category: Case Report
Volume/Issue: Volume 64: Issue 4
Online Publication Date: Jan 01, 2017
Page Range: 235 – 239

Perioperative management is challenging in patients with mitochondrial encephalomyopathy ( Table ). Acidosis due to hypermetabolism is considered a potential problem, and hypermetabolism can develop owing to increased stress associated with shivering from hypothermia, perioperative pain, or preoperative anxiety. Therefore, we were careful to maintain the patient's temperature and keep his pain levels low. Because lactate metabolism is impaired in patients with MELAS, infusion solutions containing sodium lactate should be avoided, as the metabolic conversion of lactic acid to

Article Category: Research Article
Volume/Issue: Volume 56: Issue 1
Online Publication Date: Jan 01, 2009
Page Range: 23 – 32

. Duration of anesthesia lasted for 12 hours and 45 minutes. The continuous remifentanil infusion rate during the operation was 0.1–0.5 µg/kg/min and the cumulative dose was 13.5 mg. The minimum core temperature during operation was 35.5°C, and was 36.8°C at extubation. The patient received 100 µg fentanyl intravenuously 7 minutes before the end of surgery and the endotracheal tube was removed 5 minutes after the end of surgery. However, approximately one minute following extubation, the patient started shivering without signs of hypothermia or postoperative pain. Although

Asako Eriguchi DDS, PhD,
 Nobuyuki Matsuura DDS, PhD,
 Yoshihiko Koukita DDS, PhD, and
 Tatsuya Ichinohe DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 68: Issue 1
Online Publication Date: Apr 07, 2021
Page Range: 10 – 18

local anesthetics containing epinephrine administered in other situations, such as in the elderly, diabetics, patients taking beta-blocking or parasympatholytic agents, or those with hypovolemia and/or hypothermia. We have not investigated whether similar results would be obtained with different methods of anesthesia or in patients with different backgrounds, which illustrates potential areas for further investigation. CONCLUSION In conclusion, there was no difference in the degree of cardiovascular stimulation caused by exogenous

Regina A. E. Dowdy DDS,
 Shadee. T. Mansour DDS,
 James H. Cottle DDS,
 Hannah R. Mabe DDS,
 Harry B. Weprin DMD,
 Leigh E. Yarborough DMD,
 Gregory M. Ness DDS,
 Todd M. Jacobs DMD, and
 Bryant W. Cornelius DDS, MBA, MPH
Article Category: Case Report
Volume/Issue: Volume 68: Issue 1
Online Publication Date: Apr 07, 2021
Page Range: 38 – 44

hypothermia, thrombus, and tension pneumothorax were ruled out upon admission to the hospital emergency department. However, the cardiac arrest occurring in this case was most likely multifactorial. 1 – 4 Hypovolemia was a likely causative factor, as the patient had been NPO for more than 15 hours, excluding his morning medications taken with a small sip of water. Medication overdose was another potential cause, specifically propranolol and guanfacine, as the patient had a history of serotonin syndrome attributed to overmedication for behavioral problems by his caregiver

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