The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia: A randomized clinical trial

Steven Mark Frank, M. S. Higgins, M. J. Breslow, L. A. Fleisher, R. B. Gorman, J. V. Sitzmann, H. Raff, C. Beattie

Research output: Contribution to journalArticle

Abstract

Background: Unintended hypothermia occurs frequently during surgery and may have adverse effects on the cardiovascular system. Although the mechanisms responsible for the cardiovascular manifestations of hypothermia are unclear, it is possible that they are sympathetically mediated. In this prospective study, relationships between body temperature, the neuroendocrine response, and hemodynamic changes in the perioperative period were examined. Methods: Seventy-four elderly patients, undergoing abdominal, thoracic, or lower extremity vascular surgical procedures, were randomly assigned to either 'routine care' (n = 37) or 'forced-air warming' (n = 37) groups. Throughout the intra-operative and early postoperative periods, the routine care group received standard thermal care, and the forced-air warming group received forced-air skin-surface warming. Core temperature, forearm minus fingertip skin-surface temperature gradient, and plasma concentrations of epinephrine, norepinephrine, and cortisol were measured throughout the pertoperative period, and the two groups were compared. In addition, heart rate and arterial blood pressure were compared between groups. Results: The routine care and forced-air warming groups did not differ with regard to age, sex, type of surgical procedures, anesthetic techniques, or postoperative analgesia. Mean core temperature was lower in the routine care group on admission to the postanesthetic care unit (routine care, 35.3 ± 0.1Γ; forced-air warming, 36.7 ± 0.1Γ; P = 0.0001) and remained lower during the early postoperative period. Forearm minus fingertip skin-surface temperature gradient (an index of peripheral vasoconstriction) was greater in the routine care group in the early postoperative period. The mean norepinephrine concentration (pcg/ml) was greater in the routine care group immediately after surgery (480 ± 70 vs. 330 ± 30, P = 0.02) and at 60 min (530 ± 50 vs. 340 ± 30, P = 0.002) and 180 min (500 ± 80 vs. 320 ± 30, P = 0.004) postoperatively. Mean epinephrine concentrations were not significantly different between groups. Mean cortisol concentrations were increased in both groups during the early postoperative period (P <0.01), but the differences between groups were not significant. Systolic, mean, and diastolic arterial blood pressures were significantly higher in the routine care group. Conclusions: Compared with patients in the forced-air warming group, patients receiving routine thermal care had lower core temperatures, a greater degree of peripheral vasoconstriction, higher norepinephrine concentrations, and higher arterial blood pressures in the early postoperative period. These findings suggest a possible mechanism for hypothermia-related cardiovascular morbidity in the perioperative period.

Original languageEnglish (US)
Pages (from-to)83-93
Number of pages11
JournalAnesthesiology
Volume82
Issue number1
DOIs
StatePublished - 1995

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Hypothermia
Catecholamines
Hydrocortisone
Postoperative Period
Randomized Controlled Trials
Hemodynamics
Air
Norepinephrine
Arterial Pressure
Perioperative Period
Skin Temperature
Vasoconstriction
Forearm
Epinephrine
Temperature
Vascular Surgical Procedures
Hot Temperature
Cardiovascular System
Body Temperature
Analgesia

Keywords

  • Hormones: cortisol
  • Hypothermia: perioperative
  • Sympathetic nervous system, catecholamines: epinephrine; norepinephrine
  • Thermoregulation: vasoconstriction

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia : A randomized clinical trial. / Frank, Steven Mark; Higgins, M. S.; Breslow, M. J.; Fleisher, L. A.; Gorman, R. B.; Sitzmann, J. V.; Raff, H.; Beattie, C.

In: Anesthesiology, Vol. 82, No. 1, 1995, p. 83-93.

Research output: Contribution to journalArticle

Frank, SM, Higgins, MS, Breslow, MJ, Fleisher, LA, Gorman, RB, Sitzmann, JV, Raff, H & Beattie, C 1995, 'The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia: A randomized clinical trial', Anesthesiology, vol. 82, no. 1, pp. 83-93. https://doi.org/10.1097/00000542-199501000-00012
Frank, Steven Mark ; Higgins, M. S. ; Breslow, M. J. ; Fleisher, L. A. ; Gorman, R. B. ; Sitzmann, J. V. ; Raff, H. ; Beattie, C. / The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia : A randomized clinical trial. In: Anesthesiology. 1995 ; Vol. 82, No. 1. pp. 83-93.
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title = "The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia: A randomized clinical trial",
abstract = "Background: Unintended hypothermia occurs frequently during surgery and may have adverse effects on the cardiovascular system. Although the mechanisms responsible for the cardiovascular manifestations of hypothermia are unclear, it is possible that they are sympathetically mediated. In this prospective study, relationships between body temperature, the neuroendocrine response, and hemodynamic changes in the perioperative period were examined. Methods: Seventy-four elderly patients, undergoing abdominal, thoracic, or lower extremity vascular surgical procedures, were randomly assigned to either 'routine care' (n = 37) or 'forced-air warming' (n = 37) groups. Throughout the intra-operative and early postoperative periods, the routine care group received standard thermal care, and the forced-air warming group received forced-air skin-surface warming. Core temperature, forearm minus fingertip skin-surface temperature gradient, and plasma concentrations of epinephrine, norepinephrine, and cortisol were measured throughout the pertoperative period, and the two groups were compared. In addition, heart rate and arterial blood pressure were compared between groups. Results: The routine care and forced-air warming groups did not differ with regard to age, sex, type of surgical procedures, anesthetic techniques, or postoperative analgesia. Mean core temperature was lower in the routine care group on admission to the postanesthetic care unit (routine care, 35.3 ± 0.1Γ; forced-air warming, 36.7 ± 0.1Γ; P = 0.0001) and remained lower during the early postoperative period. Forearm minus fingertip skin-surface temperature gradient (an index of peripheral vasoconstriction) was greater in the routine care group in the early postoperative period. The mean norepinephrine concentration (pcg/ml) was greater in the routine care group immediately after surgery (480 ± 70 vs. 330 ± 30, P = 0.02) and at 60 min (530 ± 50 vs. 340 ± 30, P = 0.002) and 180 min (500 ± 80 vs. 320 ± 30, P = 0.004) postoperatively. Mean epinephrine concentrations were not significantly different between groups. Mean cortisol concentrations were increased in both groups during the early postoperative period (P <0.01), but the differences between groups were not significant. Systolic, mean, and diastolic arterial blood pressures were significantly higher in the routine care group. Conclusions: Compared with patients in the forced-air warming group, patients receiving routine thermal care had lower core temperatures, a greater degree of peripheral vasoconstriction, higher norepinephrine concentrations, and higher arterial blood pressures in the early postoperative period. These findings suggest a possible mechanism for hypothermia-related cardiovascular morbidity in the perioperative period.",
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T1 - The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia

T2 - A randomized clinical trial

AU - Frank, Steven Mark

AU - Higgins, M. S.

AU - Breslow, M. J.

AU - Fleisher, L. A.

AU - Gorman, R. B.

AU - Sitzmann, J. V.

AU - Raff, H.

AU - Beattie, C.

PY - 1995

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N2 - Background: Unintended hypothermia occurs frequently during surgery and may have adverse effects on the cardiovascular system. Although the mechanisms responsible for the cardiovascular manifestations of hypothermia are unclear, it is possible that they are sympathetically mediated. In this prospective study, relationships between body temperature, the neuroendocrine response, and hemodynamic changes in the perioperative period were examined. Methods: Seventy-four elderly patients, undergoing abdominal, thoracic, or lower extremity vascular surgical procedures, were randomly assigned to either 'routine care' (n = 37) or 'forced-air warming' (n = 37) groups. Throughout the intra-operative and early postoperative periods, the routine care group received standard thermal care, and the forced-air warming group received forced-air skin-surface warming. Core temperature, forearm minus fingertip skin-surface temperature gradient, and plasma concentrations of epinephrine, norepinephrine, and cortisol were measured throughout the pertoperative period, and the two groups were compared. In addition, heart rate and arterial blood pressure were compared between groups. Results: The routine care and forced-air warming groups did not differ with regard to age, sex, type of surgical procedures, anesthetic techniques, or postoperative analgesia. Mean core temperature was lower in the routine care group on admission to the postanesthetic care unit (routine care, 35.3 ± 0.1Γ; forced-air warming, 36.7 ± 0.1Γ; P = 0.0001) and remained lower during the early postoperative period. Forearm minus fingertip skin-surface temperature gradient (an index of peripheral vasoconstriction) was greater in the routine care group in the early postoperative period. The mean norepinephrine concentration (pcg/ml) was greater in the routine care group immediately after surgery (480 ± 70 vs. 330 ± 30, P = 0.02) and at 60 min (530 ± 50 vs. 340 ± 30, P = 0.002) and 180 min (500 ± 80 vs. 320 ± 30, P = 0.004) postoperatively. Mean epinephrine concentrations were not significantly different between groups. Mean cortisol concentrations were increased in both groups during the early postoperative period (P <0.01), but the differences between groups were not significant. Systolic, mean, and diastolic arterial blood pressures were significantly higher in the routine care group. Conclusions: Compared with patients in the forced-air warming group, patients receiving routine thermal care had lower core temperatures, a greater degree of peripheral vasoconstriction, higher norepinephrine concentrations, and higher arterial blood pressures in the early postoperative period. These findings suggest a possible mechanism for hypothermia-related cardiovascular morbidity in the perioperative period.

AB - Background: Unintended hypothermia occurs frequently during surgery and may have adverse effects on the cardiovascular system. Although the mechanisms responsible for the cardiovascular manifestations of hypothermia are unclear, it is possible that they are sympathetically mediated. In this prospective study, relationships between body temperature, the neuroendocrine response, and hemodynamic changes in the perioperative period were examined. Methods: Seventy-four elderly patients, undergoing abdominal, thoracic, or lower extremity vascular surgical procedures, were randomly assigned to either 'routine care' (n = 37) or 'forced-air warming' (n = 37) groups. Throughout the intra-operative and early postoperative periods, the routine care group received standard thermal care, and the forced-air warming group received forced-air skin-surface warming. Core temperature, forearm minus fingertip skin-surface temperature gradient, and plasma concentrations of epinephrine, norepinephrine, and cortisol were measured throughout the pertoperative period, and the two groups were compared. In addition, heart rate and arterial blood pressure were compared between groups. Results: The routine care and forced-air warming groups did not differ with regard to age, sex, type of surgical procedures, anesthetic techniques, or postoperative analgesia. Mean core temperature was lower in the routine care group on admission to the postanesthetic care unit (routine care, 35.3 ± 0.1Γ; forced-air warming, 36.7 ± 0.1Γ; P = 0.0001) and remained lower during the early postoperative period. Forearm minus fingertip skin-surface temperature gradient (an index of peripheral vasoconstriction) was greater in the routine care group in the early postoperative period. The mean norepinephrine concentration (pcg/ml) was greater in the routine care group immediately after surgery (480 ± 70 vs. 330 ± 30, P = 0.02) and at 60 min (530 ± 50 vs. 340 ± 30, P = 0.002) and 180 min (500 ± 80 vs. 320 ± 30, P = 0.004) postoperatively. Mean epinephrine concentrations were not significantly different between groups. Mean cortisol concentrations were increased in both groups during the early postoperative period (P <0.01), but the differences between groups were not significant. Systolic, mean, and diastolic arterial blood pressures were significantly higher in the routine care group. Conclusions: Compared with patients in the forced-air warming group, patients receiving routine thermal care had lower core temperatures, a greater degree of peripheral vasoconstriction, higher norepinephrine concentrations, and higher arterial blood pressures in the early postoperative period. These findings suggest a possible mechanism for hypothermia-related cardiovascular morbidity in the perioperative period.

KW - Hormones: cortisol

KW - Hypothermia: perioperative

KW - Sympathetic nervous system, catecholamines: epinephrine; norepinephrine

KW - Thermoregulation: vasoconstriction

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