The effect of ephedrine on intraoperative hypothermia

Youn Yi Jo, Ji Young Kim, Joon-Sik Kim, Youngjun Kwon, Cheung Soo Shin, Youn Yi Jo, Ji Young Kim, Joon-Sik Kim, Youngjun Kwon, Cheung Soo Shin

Abstract

Background: Prevention of intraoperative hypothermia has become a standard of operative care. Since ephedrine has a thermogenic effect and it is frequently used to treat hypotension during anesthesia, this study was designed to determine the effect of ephedrine on intraoperative hypothermia of patients who are undergoing spine surgery.

Methods: Twenty-four patients were randomly divided to receive an ephedrine (the ephedrine group, n = 12) or normal saline (the control group, n = 12) infusion for 2 h. The esophageal temperature (the core temperature), the index finger temperature (the peripheral temperature) and the hemodynamic variables such as the mean blood pressure and heart rate were measured every 15 minutes after the intubation.

Results: At the end of the study period, the esophageal temperature and hemodynamic variables were significantly decreased in the control group, whereas those in the ephedrine group were stably maintained. The index finger temperature was significantly lower in the ephedrine group compared to that in the control group, suggesting the prevention of core-to-peripheral redistribution of the heat as the cause of temperature maintenance.

Conclusions: An intraoperative infusion of ephedrine minimized the decrease of the core temperature and it stably maintained the hemodynamic variables during spine surgery with the patient under general anesthesia.

Keywords: Anesthesia; General; Hypothermia; Temperature.

Figures

Fig. 1
Fig. 1
Change in the esophageal and index finger temperatures. The data is expressed as means ± SEs. Preop: before induction of general anesthesia, Intu: immediately after intubation, T10-115: 10 to 115 minutes after the start of ephedrine infusion. *P < 0.05 compared to the value at Tintu.
Fig. 2
Fig. 2
Change in the heart rate and mean blood pressure. The data is expressed as means ± SEs. Preop: before induction of general anesthesia, Intu: immediately after intubation, T10-115: 10 to 115 minutes after the start of the ephedrine infusion. *P < 0.05 compared to the value at Tpreop.

References

    1. Rajagopalan S, Mascha E, Na J, Sessler DI. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology. 2008;108:71–77.
    1. Heier T, Caldwell JE, Sessler DI, Miller RD. Mild operative hypothermia increases duration of action and spontaneous recovery of vecuronium blockade during nitrous oxide-isoflurane anesthesia in humans. Anesthesiology. 1991;74:815–819.
    1. Carli F, Emery PW, Freemantle CAJ. Effect of preoperative normothermia on postoperative protein metabolism in elderly patients undergoing hip arthroplasty. Br J Anaesth. 1989;63:276–282.
    1. Sessler DI, Rubenstein EH, Moayeri A. Physiological responses to mild perianesthetic hypothermia in humans. Anesthesiology. 1991;75:594–610.
    1. Goto T, Matsukawa T, Sessler DI, Uezono S, Ishiguro Y, Ozaki M, et al. Thermoregulatory thresholds for vasoconstriction in patients anesthetized with various 1-minimum alveolar concentration combinations of xenon, nitrous oxide, and isoflurane. Anesthesiology. 1999;91:626–632.
    1. Kasai T, Nakajima Y, Matsukawa T, Ueno H, Sunaguchi M, Mizobe T. Effect of preoperative amino acid infusion on thermoregulatory response during spinal anaesthesia. Br J Anaesth. 2003;90:58–61.
    1. Sahin A, Aypar U. Effect of amino acid solutions on intraoperative hypothermia and postoperative shivering. Comparison of two anesthetic regimens. Acta Anaesthesiol Scand. 2002;46:64–67.
    1. Diepvens K, Westerterp KR, Westerterp-Plantenga MS. Obesity and thermogensis related to the consumption of caffeine, ephedrine, capsaicin, and green tea. Am J Physiol Regul Integr Comp Physiol. 2007;292:R77–R85.
    1. Kinoshita T, Suzuki M, Shimada Y, Ogawa R. Effect of low-dose ketamine on redistribution hypothermia during spinal anesthesia sedated by propofol. J Nippon Med Sch. 2004;71:92–98.
    1. Dulloo AG. Ephedrine, xanthhines and prostaglandin-inhibitors: actions and interactions in the stimulation of thermogenesis. Int J Obes Relat Metab Disord. 1993;17:S35–S40.
    1. Dulloo AG, Seydoux J, Girardier L. Potentiation of the thermogenic antiobesity effects of ephedrine by dietary methylxanthines: adenosine antagonism or phosphodiesterase inhibition. Metabolism. 1992;41:1233–1241.
    1. Bukowiecki L, Jahjah L, Follea N. Ephedrine, a potential slimming drug, directly stimulates thermogenesis in brown adipocytes via beta-adrenoreceptors. Int J Obes. 1982;6:343–350.
    1. Dulloo AG, Seydoux J, Girardier L. Peripheral mechanisms of thermogenesis induced by ephedrine and caffeine in brown adipose tissue. Int J Obes. 1991;15:317–326.
    1. Kamitani K, Higuchi A, Nohara A, Takagi M, Tokutake M, Horikawa H, et al. Effect of amino acid solution on intraoperative core temperature the influence of anesthetics. Masui. 2005;54:1258–1262.
    1. Flynn MD, Sandeman DD, Mawson DM, Shore AC, Tooke JE. Cylclical hypothermia: successful treatment with ephedrine. J R Soc Med. 1991;84:752–753.
    1. Im UJ, Lee DJ, Kim MC, Lee JS, Lee SJ. Difference in Core temperature in response to propofol-remifentanil anesthesia and sevoflurane-remifentanil anesthesia. Korean J Anesthesiol. 2009;57:704–708.
    1. Nakasuji M, Nakamura M, Imanaka N, Tanaka M, Nomura M, Suh SH. Intraoperative high-dose remifentanil increases post-anaesthetic shivering. Br J Anaesth. 2010;105:162–167.
    1. Muldoon S, Sambuughin N, Voelkel M, Bunger R, Grocott H, Sulzer C. Malignant hyperthermia, thermoregulation, and perioperative hypothermia. 1st ed. China: McGraw-Hill Companies, Inc.; 2008. pp. 1986–1989.
    1. Gajraj NM, Victory RA, Pace NA, Van Elstraete AC, Wallace DH. Comparison of an ephedrine infusion with crystalloid administration for prevention of hypotension during spinal anesthesia. Anesth Analg. 1993;76:1023–1026.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit