title: Temperature monitoring and management during neuraxial anesthesia: an observational study.
abstract: Temperature monitoring and thermal management are rare during spinal or epidural anesthesia because clinicians apparently restrict monitoring to patients with an expected risk of hypothermia. This implies that anesthesiologists can predict patient thermal status without monitoring core temperature. We therefore, tested the hypotheses that during neuraxial anesthesia: 1) amount of core hypothermia depends on the magnitude and duration of surgery; 2) temperature monitoring and thermal management are used selectively in patients at high risk of hypothermia; and 3) anesthesiologists can estimate patient thermal status. We evaluated thermal status on arrival in the recovery room along with intraoperative thermal management and monitoring in 120 patients. Anesthesiologists were asked if their patients were hypothermic (<36 degrees C). There was no correlation between the magnitude or duration of surgery and initial postoperative core temperature in unwarmed patients. Temperature monitoring and thermal management were not used selectively in high-risk patients. Initial postoperative tympanic membrane temperatures were <36 degrees C in 77% of patients and <35 degrees C in 22%. Body temperature was monitored intraoperatively in 27% of the patients and forced-air warming was used in 31%. Anesthesiologists failed to accurately estimate whether their patients were hypothermic. Our results suggest that temperature monitoring and management during neuraxial anesthesia is currently inadequate.
  
  
  CONCLUSIONS
  In this observational study, we evaluated core temperatures and intraoperative thermal management in patients undergoing spinal or epidural anesthesia. Hypothermia was common, however, rarely detected either by temperature monitoring or estimates by anesthesiologists. In addition, it was not treated with active warming. Consequently, temperature monitoring and management have to be done during neuraxial anesthesia.
authors.affiliation: Department of Anesthesiology, Washington University, St. Louis, MO 63110, USA.
authors.forename: C F
authors.initials: CF
authors.lastname: Arkiliç
authors.forename: O
authors.initials: O
authors.lastname: Akça
authors.forename: A
authors.initials: A
authors.lastname: Taguchi
authors.forename: D I
authors.initials: DI
authors.lastname: Sessler
authors.forename: A
authors.initials: A
authors.lastname: Kurz
mesh_terms: D000368:Aged; D000758:Anesthesia; D000767:Anesthesia, Epidural; D000775:Anesthesia, Spinal; D001831:Body Temperature / Q000502:physiology*; D006801:Humans; D007035:Hypothermia / Q000503:physiopathology*; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative