[The thermoregulatory threshold during surgery with propofol-nitrous oxide anaesthesia]

Abstract

Background: Thermoregulatory responses are thought to be drastically suppressed by general anesthesia. In previous studies, it was shown that halothane, isoflurane and fentanyl-N2O combination decrease the threshold of vasoconstriction in general anesthesia. Propofol is a recently introduced intravenous anesthetic. The thermoregulatory threshold of its administration during surgery has not been quantified.

Materials: Fourteen unpremedicated ASA class I patients were anesthetized with N2O (67%) and propofol (2 mg/kg in bolus followed by 6 mg/kg/h infusion) during elective surgery of free flap. Patients were randomly assigned either to receive additional warming (n = 5) or standard (n = 9) management. Significant vasoconstriction was prospectively defined as the temperature gradient between forearm surface and finger-tip surface is > or = 4 degrees C, and the thermoregulatory threshold was defined as the esophageal temperature (core temperature) at a point where the skin temperature gradient between two tested zones exceeds 4 degrees C.

Results: Vasoconstriction did not occur in patients who received additional warming and they remained in nearly normothermia. The average minimum core temperature was 36.3 +/- 0.4 degrees C. In patients who underwent standard management the core temperature ranged from 32.8 to 34.6 degrees C (33.6 +/- 0.7 degrees C), signifying significant vasoconstriction.

Conclusions: General anesthesia with propofol/N2O during surgery drastically inhibits thermoregulatory vasoconstriction. This effect should also be noted during long-term use of propofol (e.g. ICU-sedation).