Does covering a child on induction impact body temp? Dr. Trivedi

Puja Trivedi, DO
 PGY-3 Resident at RCRMC who will do a Cardiac Anesthesia Fellowship at USC upon graduation

Does the covering of children during induction of anesthesia have an effect on body temperature at the end of surgery?

Due to anesthesia induced impairment of thermoregulation as well as the cold environment of the operating room, surgical patients are prone to disturbances of his/her body temperature. Hypothermia under anesthesia follows a characteristic pattern of a large drop in core temperature due to core to peripheral heat redistribution. This is followed by a slow linear regression as more body heat is lost than generated. A plateau ensues as a thermal steady state is reached. A benefit of hypothermia has been exploited in the care of patients who have suffered a catastrophic myocardial and traumatic brain injury. Complications of hypothermia are more devastating and include coagulopathy secondary to cold induced platelet dysfunction, delayed wound healing, myocardial infarction, hypermetabolism secondary to shivering, a catecholamine surge resulting in tachycardia and hypertension due to discomfort and longer recovery time. 

Neonatal and pediatric patients are especially vulnerable in developing hypothermia due to an immature thermoregulatory system and greater heat loss due to an increased surface area to body weight ratio.  Shukry et al from the Children’s Hospital of Oklahoma City investigated the effect of covering children during induction of anesthesia and end of surgery core body temperatures, measured at the temporal artery and rectally. 50 healthy (ASA 1 or 2) children ranging from the age of 6 months to 3.5 years undergoing simple urologic procedures were selected. The majority of urological patients received caudal blocks which the author estimates can take anywhere from 10-20 minutes. They were either covered with a blanket during induction or remained uncovered, but both groups were re warmed using a forced air blanket at 43 degrees after the blue drapes were placed. Shukry et al found no change in core temperature at the end of the surgical procedure between patients covered with a blanket during anesthesia induction and those that were not. Limitations include small sample size and a higher than normal ambient operating room temperature which has a greater influence on the patient’s body temperature.