1、Temperature drop Temperature drop during operationduring operation一、一、Reasons：36 1.Age：（1）older-thermoregulation function is lower（2）premature、neonatus、infant-thermoregulatory center is imperfect 2.Influence of operative procedure：（1）cold disinfectant solution and rinse solutionTemperature drop Temp
2、erature drop during operationduring operation（2）large dose of cold blood transfusion and infusing fluid 3.room temperature：4.anesthetic action：（1）field block anaesthesia（2）general anaesthesia 5.insufficient heat production：Temperature drop Temperature drop during operationduring operation二、二、Heat pr
3、eservation：1.Evaluation of Preoperative and Preheating 2.Body surface heating 3.Warming the infused fluidPerioperative FervescencePerioperative Fervescence 一、一、Reasons：1.Patient s state 2.Temperature and humidity of operating room is high 3.Influence of anesthesia 4.Surgery factors 5.Malignant hyper
4、thermiaPerioperative FervescencePerioperative Fervescence 二、二、Prevention and Cure：1.Continuous monitoring of body temperature 2.Correctly select anticholinergic agent 3.Suitable temperature and humidity of operating roomPerioperative FervescencePerioperative Fervescence 4.Avoid hypoxia and carbon di
5、oxide accumulation 5.Avoid iatrogenic fervescence 6.Reduce the temperature by physical methodRelation between body temperature and metabolic ratebody temperature（）metabolic rate（%）36.8 100 31.8 7580 30.0 6070 26.8 50 20.0 25 16.8 20 15.0 15 6.8 6Artificial hypothermiaArtificial hypothermiaArtificial
6、 hypothermiaArtificial hypothermia 一、一、Indications：1.Operation on vessels of heart：（1）Cardiosurgery（2）Operation on major vessels（3）Safe time limitArtificial hypothermiaArtificial hypothermiaSafe time limit of different body temperature body temperature circulation blocking time （）（min）3230 89 3028 1
7、015 2818 1545 18 4560Artificial hypothermiaArtificial hypothermia 2.Neurosurgery：3.Others：（1）Operation on liver and kidney（2）Large wound and operation which is bleeding a lot（3）Control the hyperpyrexia（4）Cerebral resuscitationArtificial hypothermiaArtificial hypothermiaTime limit of circulation bloc
8、king of major organ at different temperature（min）37 2832 25 Brain 3 8 14 15 Spinal cord 30 45 Kidney 30 40 60 Liver 20 60Artificial hypothermiaArtificial hypothermia 二、二、Cooling、Rewarming、Monitoring and Announcements：（一）（一）Anesthetic Management 1.Three main points：（1）Avoid cold degense reflex；（2）Cco
9、mpletely muscle relaxation；（3）Vasodilatation of peripheral vessel is wellArtificial hypothermiaArtificial hypothermia 2.Anesthetic Management：（1）preanesthetic medication（2）induction（3）maintenance（4）low dose of chlorpromazine before cooling：0.250.5 mg/kgprevent shiver and vasospasmArtificial hypother
10、miaArtificial hypothermia（二）（二）Method of reduce the temperature 1.Surface cooling：（1）icewater bath or ice crumbs（2）ice bag、ice-cap（3）ectothermic blanketArtificial hypothermiaArtificial hypothermia 2.Body cavity cooling3.Blood cooling using extracorporeal circulation4.Extracorporeal circulation+Surfa
11、ce cooling5.Infusing cold fluid intravenously（46）Artificial hypothermiaArtificial hypothermia（三）（三）Rewarming 1.Surface rewarming：hot water bottle、electric blanket、ectothermic blanket 2.Body cavity rewarming：3.Hematogenous rewarming using extracorporeal circulationArtificial hypothermiaArtificial hyp
12、othermia（四）（四）Monitoring：1.Body temperature：（1）nasopharyngeal temperature（2）esophageal temperature（3）rectal temperature（4）blood temperature 2.Circulatory monitoring：ECG、BP、CVP 3.Others：urine volume、electrolyte、blood gas、haemorheologyArtificial hypothermiaArtificial hypothermia 三、三、Announcements 1.Av
13、oid cold degense reflex 2.Avoid frostbite 3.When surface rewarming：（1）Avoid burn（2）Prevent hypotension and arhythmia（3）Prevent responsive hyperpyrexia 4.Prevent hypoxia and metabolic acidosis 5.Prevent ventricular fibrillation and brain damageArtificial hypothermiaArtificial hypothermia 四、四、Complica
14、tions 1.Cold degense reflex 2.Arhythmia：ventricular fibrillation（1）Critical temperature：2628（2）Evoked reasons：unbalance between sympathetic nerve and pneumogastric nerve acid-base imbalance electrolyte disturbancesArtificial hypothermiaArtificial hypothermia（3）Management 3.Tissue damage：Cooling-Frostbite Warming-Burn 4.Gastrointestinal hemorrhage：intestinal arterial embolism 5.Acidosis
