Experimental determination of heat flow parameters during induction of general anesthesia.

Abstract

Alterations in body temperature result from changes in tissue heat content. Heat flow is a complex function of vasomotor status and core, peripheral, and ambient temperatures. Consequently it is difficult to quantify specific mechanisms responsible for observed changes in body heat distribution. Therefore the authors developed two mathematical models that independently express regional tissue heat production and the motion of heat through tissues in terms of measurable quantities. The equilibrium model expresses the effective regional heat transfer coefficient in terms of cutaneous heat flux, skin temperature, and temperature at the center of the extremity. It applies at steady states and provides a ratio of the heat transfer coefficients before and after an intervention. In contrast, the heat flow model provides a time-dependent estimate of the heat transfer coefficient in terms of ambient temperature, skin temperature, and temperature at the center of the extremity. Each model was applied to data acquired in a previous evaluation of heat balance during anesthesia induction. The relation between the ratio of steady state regional heat transfer coefficients calculated using each model was linear. The effective heat transfer coefficient for the forehead (a core site) decreased approximately 20% after induction of anesthesia. In contrast, heat transfer coefficients in the six tested extremity sites more than doubled. Effective heat transfer coefficients can be used to evaluate the thermal effects of various clinical interventions, such as induction of regional anesthesia or administration of vasodilating drugs. The heat transfer coefficient for the forehead presumably decreased because general anesthesia reduces brain perfusion. In contrast, increased heat transfer coefficients in the extremity sites indicate that thermoregulatory and anesthetic-induced vasodilation more than doubles the core-to-peripheral flow of heat. This flow of heat causes redistribution hypothermia, which is usually the major cause of core hypothermia during anesthesia.