title: Epidural anesthesia impairs both central and peripheral thermoregulatory control during general anesthesia.
abstract: BACKGROUND
  The authors tested the hypotheses that: (1) the vasoconstriction threshold during combined epidural/general anesthesia is less than that during general anesthesia alone; and (2) after vasoconstriction, core cooling rates during combined epidural/general anesthesia are greater than those during general anesthesia alone. Vasoconstriction thresholds and heat balance were evaluated under controlled circumstances in volunteers, whereas the clinical importance of intraoperative thermoregulatory vasoconstriction was evaluated in patients.
  
  
  METHODS
  Five volunteers were each evaluated twice. On one of the randomly ordered days, epidural anesthesia (approximately T9 dermatomal level) was induced and maintained with 2-chloroprocaine. On both study days, general anesthesia was induced and maintained with isoflurane (0.7% end-tidal concentration), and core hypothermia was induced by surface cooling and continued for at least 1 h after fingertip vasoconstriction was observed. Patients undergoing colorectal surgery were randomly assigned to combined epidural/enflurane anesthesia (n = 13) or enflurane alone (n = 13). In appropriate patients, epidural anesthesia was maintained by an infusion of bupivacaine. The core temperature that triggered fingertip vasoconstriction identified the threshold.
  
  
  RESULTS
  In the volunteers, the vasoconstriction threshold was 36.0 +/- 0.2 degrees C during isoflurane anesthesia alone, but significantly less, 35.1 +/- 0.7 degrees C, during combined epidural/isoflurane anesthesia. Cutaneous heat loss and the rates of core cooling were similar 30 min before vasoconstriction with and without epidural anesthesia. In the 30 min after vasoconstriction, heat loss decreased 33 +/- 13 W when the volunteers were given isoflurane alone, but only 8 +/- 16 W during combined epidural/isoflurane anesthesia. Similarly, the core cooling rates in the 30 min after vasoconstriction were significantly greater during combined epidural/isoflurane anesthesia (0.8 +/- 0.2 degrees C/h) than during isoflurane alone (0.2 +/- 0.1 degrees C/h). In the patients, end-tidal enflurane concentrations were slightly, but significantly, less in the patients given combined epidural/enflurane anesthesia (0.6 +/- 0.2% vs. 0.8 +/- 0.2%). Nonetheless, the vasoconstriction threshold was 34.5 +/- 0.6 degrees C in the epidural/enflurane group, which was significantly less than that in the other patients, 35.6 +/- 0.8 degrees C. When the study ended after 3 h of anesthesia, patients given combined epidural/enflurane anesthesia were 1.2 degrees C more hypothermic than those given general anesthesia alone. The rate of core cooling during the last hour of the study was 0.4 +/- 0.2 degrees C/h during combined epidural/enflurane anesthesia, but only 0.1 +/- 0.3 degrees C/h during enflurane alone.
  
  
  CONCLUSIONS
  These data indicate that epidural anesthesia reduces the vasoconstriction threshold during general anesthesia. Furthermore, the markedly reduced rate of core cooling during general anesthesia alone illustrates the importance of leg vasoconstriction in maintaining core temperature.
authors.affiliation: Service d'Anesthesiologie, Centre Hospitalier Universitaire de Liege, Domaine Universitaire du Sart Tilman.
authors.forename: J
authors.initials: J
authors.lastname: Joris
authors.forename: M
authors.initials: M
authors.lastname: Ozaki
authors.forename: D I
authors.initials: DI
authors.lastname: Sessler
authors.forename: A F
authors.initials: AF
authors.lastname: Hardy
authors.forename: M
authors.initials: M
authors.lastname: Lamy
authors.forename: J
authors.initials: J
authors.lastname: McGuire
authors.forename: D
authors.initials: D
authors.lastname: Blanchard
authors.forename: M
authors.initials: M
authors.lastname: Schroeder
authors.forename: A
authors.initials: A
authors.lastname: Moayeri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000779:Anesthetics, Local; D001833:Body Temperature Regulation / Q000502:physiology*; D002648:Child; D005260:Female; D006801:Humans; D007530:Isoflurane; D008297:Male; D008875:Middle Aged; D011343:Procaine / Q000031:analogs & derivatives; D012016:Reference Values; D013514:Surgical Procedures, Operative; D014661:Vasoconstriction / Q000502:physiology*
chemical_list: D000779:Anesthetics, Local; D011343:Procaine; C004616:chloroprocaine; D007530:Isoflurane