Increasing Mean Skin Temperature Linearly Reduces the Core- temperature Thresholds for Vasoconstriction and Shivering in Humans

Cheng, Christi; Matsukawa, Takashi; Sessler, D I; Ozaki, Makoto; Kurz, Andrea; Merrifield, Benjamin; Lin, Henry J.; Olofsson, Pär

doi:10.1097/00000542-199505000-00011

Cited by 210 publications

(112 citation statements)

References 51 publications

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“…Cooling and warming the skin give rise to pleasant or unpleasant sensory experiences depending on prevailing thermoregulatory requirements. Recent observations (12)(13)(14) indicate that the threshold levels of internal temperature at which sweating, cutaneous vasodilation, or shivering are initiated are functions of the skin temperature such that the threshold internal temperature is lowered by elevated skin temperature and raised by cool skin temperature. The impact of the hedonic dimension of thermal sensation suggests that the experience integrates afferent input from the skin and internal thermoreceptors, the latter most probably within the hypothalamus.…”

mentioning

confidence: 99%

Cortical, thalamic, and hypothalamic responses to cooling and warming the skin in awake humans: A positron-emission tomography study

Egan

Johnson

Farrell

et al. 2005

Proc. Natl. Acad. Sci. U.S.A.

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Thermoregulatory mechanisms are remarkably efficient, ensuring minimal temperature variation within the core of the human body under physiological conditions. Diverse afferent and efferent neural pathways contribute to the monitoring of core and skin temperature, generation of heat, and control of thermal exchange with the external environment. We have investigated the cortical, thalamic, and hypothalamic responses to cooling and warming by using positron-emission tomography activation imaging of subjects clad in a water-perfused suit, which enabled rapid change of their skin-surface temperature. Human brain regions that respond to changes in skin temperature have been identified in the somatosensory cortex, insula, anterior cingulate, thalamus, and hypothalamus, with evidence that the hypothalamic response codes for the direction of temperature change. We conclude that signals from thermosensors in the skin providing crucial afferent information to the brain are integrated with signals from central thermosensors, resulting in thermoregulatory responses that maintain core temperature within a remarkably narrow range.functional neuroimaging ͉ hypothalamus ͉ thermoregulation T he integrity of the human body depends on the maintenance of the internal environment at a relatively constant temperature. Thermoregulatory mechanisms are remarkably efficient, ensuring small temperature tolerances within the core of the body under physiological conditions. Diverse afferent and efferent neural pathways contribute to the monitoring of core and skin temperature, generation of heat, and control of thermal exchange with the external environment. The integration of these processes is a function of the central nervous system within a network that has only been partially described in humans.The reflex regulation of body temperature is usually considered in the context of a traditional feedback system, with the detection of small changes in internal temperature leading to appropriate effector responses. In humans, the maintenance of a constant internal temperature depends on vasomotor control of the cutaneous circulation and sudomotor control of sweating and shivering, with nonshivering thermogenesis also contributing in neonates. Heart rate is also considered to be a thermoregulatory effector. Results from experiments in animals and inferences from pathological lesions of the human brain suggest that the preoptic region and hypothalamus play an important role in the control of thermoregulatory mechanisms (see ref. 1 for review). Electrophysiological recordings from the preoptic area have identified cells that respond directly to changes in temperature. Almost all the cells described in these studies increase their level of activity in concert with increases in temperature. Cells responsive to cooling of the hypothalamus have been described only infrequently (2).The capacity of the hypothalamus to integrate cutaneous thermal afferent information in thermoregulatory processes is a matter of debate. Concurrent measurement of the elec...

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mentioning

confidence: 99%

Cortical, thalamic, and hypothalamic responses to cooling and warming the skin in awake humans: A positron-emission tomography study

Egan

Johnson

Farrell

et al. 2005

Proc. Natl. Acad. Sci. U.S.A.

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“…9 Skin counterwarming techniques are thought to be effective because mean skin temperature represents approximately 20% of the total regulatory input. Therefore, every 4ºC increase in mean skin temperature results in a 1ºC decrease in the shivering threshold.…”

Section: Nonpharmacological Methodsmentioning

confidence: 99%

“…Therefore, every 4ºC increase in mean skin temperature results in a 1ºC decrease in the shivering threshold. 9 …”

Section: Nonpharmacological Methodsmentioning

confidence: 99%

“…8 Skin, mucous membrane, and visceral receptors provide thermal input; the mean skin temperature accounts for approximately 20% of the total thermoregulatory input. 9 The spinal cord and brain stem modulate the thermal inputs and integrate afferent information within the hypothalamus. 8 Differences between the set-point temperature and thermoreceptor feedback lead to vasoconstriction, piloerection, and shivering in response to cold.…”

Section: Shiveringmentioning

confidence: 99%

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Optimal Management of Shivering During Therapeutic Hypothermia After Cardiac Arrest

Logan

Sangkachand²,

Funk

2011

Critical Care Nurse

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Both pharmacological and nonpharmacological methods are used to control shivering in therapeutic hypothermia. An evidence-based protocol based on the most current research has been developed for the management of shivering during therapeutic hypothermia. Meperidine is the drug of choice and provides the greatest reduction in the shivering threshold. Other effective pharmacological agents recommended for reducing the threshold include dexmedetomidine, midazolam, fentanyl, and magnesium sulfate. In addition, skin counterwarming techniques, such as use of an air-circulating blanket, are effective nonpharmacological methods for reducing shivering when used in conjunction with medication. As a last resort, neuromuscular blocking agents are considered appropriate therapy for management of refractory shivering.

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“…De fato há uma incidência bem menor de tremor em pacientes em uso de propranolol 34 . Tremor e vasoconstrição são controlados em 30% pela temperatura central e em 20% pela temperatura média da pele 35 . É, portanto, razoável presumir que a hipotermia contribui para tremor e que a normotermia é protetora, na ausência de intervenção cirúrgica 12 .…”

Section: Fisiopatologiaunclassified

Tremores intra e pós-operatório: prevenção e tratamento farmacológico

Albergaria

Lorentz²,

Lima³

2007

Rev. Bras. Anestesiol.

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RESUMOAlbergaria VF, Lorentz MN, Lima FAS -Tremores Intra e Pós-Operatório: Prevenção e Tratamento Farmacológico. JUSTIFICATIVA E OBJETIVOS:Os tremores podem ocorrer como um efeito adverso da intervenção cirúrgica e anestesia. A incidência de tremores pós-operatórios varia entre 6,3% e 66%. Pacientes jovens, sexo masculino, uso de agentes anestésicos halogenados e tempo prolongado de anestesia ou procedimento cirúrgico estão relacionados com tremores. Os tremores são involuntários e apresentam-se como atividade muscular oscilatória com finalidade de aumentar a produção de calor. Tremor pós-operatório é uma desagradável complicação que está relacionada com o aumento de morbidade. O tremor aumenta o metabolismo, resultando em um acréscimo de 200% a 500% no consumo de oxigênio. CONTEÚDO:Discute as causas, a prevenção e o tratamento dos tremores intra-e pós-operatório em pacientes adultos e pediátri-cos submetidos à intervenção cirúrgica sob anestesia geral ou do neuroeixo. CONCLUSÕES:Os tremores são, juntamente com náuseas e vô-mitos, causas de intenso desconforto na sala de recuperação pós-anestésica, além de potencialmente prejudiciais por gerarem aumento da demanda metabólica. Embora a presença de tremores não tenha sido diretamente relacionada com a morbidade cardía-ca, a prevenção tem se tornado tema de debate e de vários artigos científicos. A prevenção e o tratamento de tremores devem ser implementados. Pacientes com reserva cardiopulmorar limitada podem sofrer com acidose láctica, dessaturação venosa mista e hipoxemia.Unitermos: ANESTESIA: Geral, Locorregional; COMPLICAÇÕES: hipotermia, tremor; TREMOR: prevenção, tratamento. SUMMARYAlbergaria VF, Lorentz MN, Lima FAS -Intra-and Postoperative Tremors: Prevention and Pharmacological Treatment. BACKGROUND AND OBJECTIVES:Tremors can be an adverse effect of the surgical intervention and anesthesia. The incidence of postoperative tremors varies from 6.3% to 66%. Young age, male gender, the use of halogenated anesthetics, and prolonged anesthesia or surgical procedure are related with tremors. Tremors are involuntary and present as oscillating muscular activity aiming at increasing heat production. Postoperative tremors are a disagreeable complication related with increased morbidity. Tremors increase the metabolism, resulting in a 200% to 500% increase in oxygen consumption. CONTENTS:The objective of this paper was to discuss the causes, prevention, and treatment of intra-and postoperative tremors in adults and children undergoing general anesthesia or neuroaxis anesthesia for surgical interventions. CONCLUSIONS:Tremors, along with nausea and vomiting, cause severe discomfort in the recovery room, besides being highly prejudicial because they generate an increase in the metabolism. Although the presence of tremors has not been directly related with cardiac morbidity, its prevention has become the subject of discussion and several scientific reports. Prevention and treatment of tremors should be implemented. Patients with limited cardiovascular reserve could devel...

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Increasing Mean Skin Temperature Linearly Reduces the Core- temperature Thresholds for Vasoconstriction and Shivering in Humans

Cited by 210 publications

References 51 publications

Cortical, thalamic, and hypothalamic responses to cooling and warming the skin in awake humans: A positron-emission tomography study

Cortical, thalamic, and hypothalamic responses to cooling and warming the skin in awake humans: A positron-emission tomography study

Optimal Management of Shivering During Therapeutic Hypothermia After Cardiac Arrest

Tremores intra e pós-operatório: prevenção e tratamento farmacológico

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