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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.


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

; sufficient space must be present to allow expeditious access to the patient and emergency equipment to be brought into the room and patient size and weight capacity limits should be established for each NORA location based upon equipment and available resources. All dental office-based anesthesia providers should review this document which is likely to be read and referenced by a variety of state boards and policy makers. Misra S, Singh S, Sarkar S, Behera BK, Jena SS. The effect of prophylactic steroids on shivering in adults undergoing surgery: a

Mark A. Saxen DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 66: Issue 4
Online Publication Date: Jan 01, 2019
Page Range: 235 – 237

adults receiving dexmedetomidine in intensive care sedation studies and 9% of neonates receiving long-term infusions; however, the effects of dexmedetomidine on plasma potassium levels in healthy children have not been studied. Given the increasing popularity of dexmedetomidine in pediatric sedation and anesthesia, this study provides timely information. Kawakami H, Nakajima D, Mihara T, Sato H, Goto T. Effectiveness of Magnesium in Preventing Shivering in Surgical Patients: A Systematic Review and Meta-analysis. Anesth Analg . 2019

Mark A. Saxen DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 66: Issue 3
Online Publication Date: Jan 01, 2019
Page Range: 173 – 176

, Crochetière C. Intravenous dexmedetomidine for the treatment of shivering during caesarean delivery under neuraxial anesthesia: a randomized controlled trial. Can J Anaesth . 2019;66:762–771. Bhakta P, Karim H, Vassallo M. Is an intravenous bolus of dexmedetomidine really a safe and effective option in treating shivering following neuraxial anesthesia? Can J Anaesthesia . In press. doi: 10.1007/s12630-019-01429-1 Lamontagne C, Lesage S, Villeneuve É, Lidzborski E, Derstenfeld A, Crochetière C. In reply: is an intravenous bolus of dexmedetomidine really a safe and

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

appearance of this patient shows slight degree of micrognathia and mandibular retraction, blepharodiastasis, short neck and hypoplastic nose wings. Table 1 Findings of Freeman-Sheldon Syndrome Table 2 Problems of General Anesthesia in Patients with Freeman-Sheldon Syndrome Postoperative Shivering After Prolonged Remifentanil Infusion: A Case Report Hideharu Agata and Toshiya

Bill W. S. Kim DMD, MSc and
 Robert M. Peskin DDS
Article Category: Other
Volume/Issue: Volume 62: Issue 1
Online Publication Date: Jan 01, 2015
Page Range: 25 – 30

histamine, leading to a hypnotic state that is similar to that observed in normal sleep. 3 , 4 Unlike opioids, benzodiazepines, and propofol, dexmedetomidine has been shown not to depress respiration. 2 , 5 Dexmedetomidine has also been associated with reduced overall requirement for opioids, benzodiazepines, and propofol during intravenous sedation. 5 In addition, dexmedetomidine has been shown to potentiate opioids and reduce postoperative shivering. 6 , 7 Dexmedetomidine was initially recognized as an effective sedative in the intensive care unit for

All summaries and comments provided by Mark A Saxen DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 67: Issue 1
Online Publication Date: Jan 01, 2020
Page Range: 60 – 62

. Anesthesia & Analgesia . 2019;129(6):1504–1511. Previously published research has suggested improved recovery scores in patients receiving intraoperative dexmedetomidine infusions; however, the efficacy of dexmedetomidine on coughing and other emergence phenomena is not consistent across studies. This prospective, multicenter, randomized, double-blind, placebo-controlled study sought to determine the optimal dose of intraoperative dexmedetomidine to prevent cough (primary outcome) and improve emergence profiles, as judged by heart rate and the absence of shivering

Atsuki Yamaguchi DDS,
 Yuki Kojima DDS, PhD, and
 Kazuya Hirabayashi MD, MBA
Article Category: Brief Report
Volume/Issue: Volume 70: Issue 2
Online Publication Date: Jun 28, 2023
Page Range: 88 – 90

changes in the patient's vital signs were observed intraoperatively. Upon emerging from general anesthesia, the patient experienced postoperative shivering for a short period, which resolved. Other postoperative complications associated with general anesthesia, such as delirium, nausea, and vomiting, were not observed during recovery. The patient reported no postoperative pain in her right maxilla and neck, and no other analgesics or antiemetics were used postoperatively. DISCUSSION Avoiding or reducing the dose of NSAIDs and opioids

Hirohito Inada DDS,
 Shigeharu Jinno DDS, PhD,
 Hikaru Kohase DDS, PhD,
 Haruhisa Fukayama DDS, PhD, and
 Masahiro Umino DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 52: Issue 1
Online Publication Date: Mar 01, 2005
Page Range: 21 – 23

: 100,000) was used at the surgical sites. The patient's BT ranged between 36.1 and 36.6°C during the operation. Her BP, HR, and SpO 2 were normal and stable intraoperatively. Her intraoperative EtCO 2 and oxygen saturation were within the normal ranges. An electrocardiogram showed no abnormal findings. Her urine was clear during the operation. After the operation, 1.0 mg of atropine sulfate and 2.5 mg of neostigmine were given to reverse the muscle relaxant, and the endotracheal tube was removed. At this time, shivering, tremors, muscle rigidity, excitement

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