체온조절과 수술후 저체온 : A review = Thermoregulation and intraoperative hypothermia

다국어 초록 (Multilingual Abstract)

The human body needs to maintain a core temperature between 36℃ to 38℃(96.8℉to 100.4℉) to carry on cellular metabolism essential for life: below 36℃(96.8℉) hypothermia occurs.
General anesthesia decreases core body temperature by depressing hypothalamic thermoregulating centers. Skeletal muscle relaxants and CNS depressants also abolish shivering and eliminate motor activity: thus the body lose its natural ability to increase heat production and become poikilothermic.
Ulnder spinal anesthesia patients lose heat distal to the level of block because of vasodilatation of blocked segments.
Other contributors of intraoperative heat loss are cold stress of the OR, exposed sedated patients, unwarmed fluid therapy, cold surgical preparation solutions, open body cavities and blood loss during operation.
All of these combined to make inadvertent intraoperative hypothermia, one of the most complication of modern surgical practice under anesthesia.
The adverse effects of the hypothermia are cardiac arrhythmia, decreased oxygen availability, metabolic acidosis, hyperglycemia, depressed CNS and coma so on.
Because of little can be done to increase heat production in the anesthetized patient, most efforts to prevent hypothermia should be directed at reducing heat loss.
Keeping the patient covered as much as possible while in the OR should considered routine. If the large volume of Ⅳ fluids are predicted, a fluid warmer should be used. During transfusion blood warmer should be used.
Warming blanket(fluid filled circulating blanket) or electric blanket can be placed under the patient on the operating table. However its placement and efficacy is limited by the patients, patient's operative position.
Heated and humidified anesthetic gases also help to maintain the body temperature. Radiant heat devices (Radiant heat lamp, heat cradle and Infrared lamp) are useful for patients who experinced post operative shivering. Radiant heat control shivering by increasing cutaneous thermal input to the hypothalamic temperature regulating center. Vigorous skin surface warming prevents shivering and provides a feeling of thermal comfort even when the patient remains markedly hypothermic.
The OR nurse should establish protocols and be instrumental in maintaining the body temperatures within the normal range.

목차 (Table of Contents)

• Ⅰ. 서론
• Ⅱ. 체온조절과 열이동
• 1. 체온조절 체제
• 2. 열이동 기전
• A. 행동
• B. 생리적 반응
• 1) 열획득
• 2) 열소실
• C. 환경과의 열교환
• 3. 체온측정
• Ⅲ. 수술후 저체온의 발생과 영향
• 1. 수술후 저체온 발생 요인
• 2. 수술후 저체온의 영향
• Ⅳ. 수술후 저체온의 관리
• 1. 마취동안의 저체온의 예방
• 2. 전율의 관리
• Ⅴ. 요약
• 참고문헌
• 영문초록