Hyperthermic conditions in neurosurgical patient Academic Article uri icon

abstract

  • hypothalamus. Heat-sensitive neurons in this area increase their rate of firing during artificial heating. Receptors in the skin, spinal cord, abdominal viscera, and central veins primarily detect cold and provide feedback to the hypothalamus signaling an increase in heat production. The hypothalamus maintains body temperature at 37.1 C (98.78 F). Stimuli that be-gin to change the core temperature result in drastic changes in heat loss or production. Even a mild elevation in brain temperature may be detrimental to the hypoxic, ischemic and in-jured brain. Hyperthermic states may be caused by a wide variety of clinical disorders which are divided into two major groups: 1) Controlled hyperthermia – resulting from a deviation of thermoregulatory set points and thresholds, 2) AbstractThermoregulation during anesthesia – gen-eral or regional – is often significantly impaired. Any shifts from a body core temperature of 36.6°c±0.2°c results in either hyperthermia or hypothermia, caus-ing pathophysiologic reactions. Hyperthermic disorders are very dangerously and critical for patients. Hyperthermia is caused by a variety of clinical states. It is important to differenti-ate controlled and uncontrolled hyperthermia and evaluate the underlying cause. In this paper we dis-cuss most frequently pathologic state, monitoring of hyperthermic disorders and adequate clinical man-agement. Temperature control occurs by feedback mech-anisms operating through the preoptic area of the Table 1 lists major causes of hyperthermia.Increased heat production• Metabolic rate • Fever • Heat stroke • Thyrotoxicosis, thyroid storm• Pheochro-mocytoma• Drugs: amphetamines, hallucinogens• Malignant hyperthermia• Neuroleptic malignant syndromeImpaired heat loss• High ambient temperature and humidity• Excessive heating• Cardiovascular disease • Hypokalemia• Dehydration• Old age• Skin disease• Cystic fibrosisSurgical and Medical conditions• Hypothalamic bleeding • Fourth ventricle bleeding• CNS lesions • Hemispherectomy• Infection causes • Meningitis• Encephalitis• Cerebral abscess• Subdural Emphysema• Medullar abscess• SepsisDrugs• Anticholinergics• Monoamine oxidase inhibitors• Serotonin releasers • Serotonin reuptake inhibitors • Amphetamines • Ecstasy• LSD• Tricyclic antidepres-sants • Analgesics• Antihistamines• Phenothiazines• Butyrophenones • Thiothixenes• Barbiturates• Anti-Parkinsonian agents • Diuretics• Beta-blockers• alcohol

publication date

  • January 1, 2011