Unusual excessive sweating and hypothermia during hysterectomy under general anesthesia -A case report-

Hyuckgoo Kim, Daelim Jee, Haemi Lee
2015 Anesthesia and Pain Medicine  
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. A 78-year-old female patient was undergone general anesthesia for total abdominal hysterectomy with bilateral salpingo-oopherectomy. Arterial blood pressure dropped 20 minutes after beginning of
more » ... after beginning of the surgery when uterine manipulation was started. From then, excessive sweating was found in the face and whole body and core temperature decreased to 34.3 o C. Sweating and low body temperature were sustained despite of various aggressive warming efforts. Anticholinergic medication immediately put an end to an hour of excessive sweating and prevented further body temperature decline. Several possibilities of excessive sweating were discussed in this case: uterine manipulation during the light plane of general anesthesia, age related autonomic changes, use of intraoperative opioid and antihypertensive medications. (Anesth Pain Med 2015; 10: 321-324) Patients seldom sweat during general anesthesia. Although excessive draping may cause thermal sweating, this is rare in operating rooms (OR) with air conditioning systems. Surgery under general anesthesia usually induces a decrease in body temperature (BT) through a low OR temperature, evaporation from the surgical fields, the administration of unheated fluids, and heat loss due to vasodilation. Patients may respond to hypothermia with vasoconstriction and shivering and to hyperthermia with active vasodilatation and sweating. In the awakened state, the BT is strictly maintained within a 0.2 o C temperature range by vasoconstriction and sweating [1,2]. During general anesthesia, however, this range becomes wider due to an increased sweating threshold and a decreased vasoconstriction threshold. These mechanisms involve hypothalamus, which is considered as the main temperature regulating center of thermal sweating. However, we experienced generalized sweating with hypothermia, which does not indicate a consequence of thermoregulatory abnormality. This report describes a case of prolonged excessive cold sweating and hypothermia during the hysterectomy under general anesthesia with several possible explanations. CASE REPORT A 78-year-old female patient (151 cm, 70.6 kg) with endometrial cancer was scheduled for a total abdominal hysterectomy with bilateral salpingo-oopherectomy. Her past medical history included hypertension which had been well controlled with medication (lecardipine and thiazide) for 5 years. No other metabolic diseases were found, and the preoperative physical examination, hematologic tests, chest X-ray, and electrocardiogram showed nothing unusual. No premedication was given. In the OR, routine anesthetic monitoring devices, including noninvasive blood pressure (BP), pulse oximeter, electrocardiogram, and entropy monitors, were attached to the patient. The temperature in the OR was regulated by a central air conditioning system, which maintained the temperature at approximately 21-23 o C with an indoor thermometer. At that time, the patient felt a cold sensation and shivered mildly. The
doi:10.17085/apm.2015.10.4.321 fatcat:q2beycahlnblhjjslkeuvz6xxu