AJP - Endocrinology and Metabolism, Vol 263, Issue 3 E441-E447, Copyright © 1992 by American Physiological Society
Thermogenesis after surgery: effect of perioperative heat conservation and epidural anesthesia
F. Carli, J. Webster, P. Nandi, I. A. MacDonald, J. Pearson and R. Mehta
Department of Anaesthesia, Northwick Park Hospital, Medical Research Council Clinical Research Centre, Harrow, Middlesex, United Kingdom.
Body temperature, respiratory gas exchange, and plasma catecholamines were
determined before and after surgery in three groups [control (C), warmed
(W), and epidural (E) who received local anesthetic at T4-S5 dermatomes
during and for 24 h after surgery] of patients undergoing colonic surgery
under general anesthesia. At the end of surgery, group W were nursed in an
ambient temperature of 28-30 degrees C, whereas the others were at 20-23
degrees C for a period of 24 h. Core (Tc) and dorsal hand temperature
decreased during surgery in both C and E (P less than 0.05) but not in W.
After surgery, Tc increased similarly in C and E and by a smaller amount in
W. Plasma catecholamine concentrations increased significantly in C and W
but not in E (P less than 0.001), with the greatest response occurring in
C. Postoperative oxygen consumption and carbon dioxide production exceeded
preoperative values (P less than 0.01) in C but not in W or E. After
surgery, plasma albumin fell and C-reactive protein increased similarly in
all three groups. Thus body heat conservation or epidural blockade
attenuates or abolishes the rise in plasma catecholamines and oxygen
consumption postoperatively but does not prevent the increase in Tc or the
acute phase protein response.
