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Heat balance and anaesthetic implications in the elderly 

Heat balance and anaesthetic implications in the elderly
Chapter:
Heat balance and anaesthetic implications in the elderly
Author(s):

Amjad Maniar

and Kwong Fah Koh

DOI:
10.1093/med/9780199604999.003.0034
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date: 20 August 2019

This chapter reviews the topic of heat balance in the elderly surgical patient. It begins with a thorough résumé of the normal physiology of temperature control. The variations affecting elderly patients are then discussed, including their thermal tolerance, structural changes in the skin, changes in perception, and reduced muscle mass. Medication effects and those of coexisting illnesses are then reviewed. The three phases of heat loss under general anaesthesia are described followed by those due to regional anaesthesia. The implications of hypothermia are then explored in detail, including shivering, neurological protection, effects on the cardiovascular and respiratory systems, coagulation, immune responses, and drug metabolism. Warming strategies and equipment are reviewed including the use of thermal insulators, active warming devices, warming of intravenous fluids, airway gas humidification, and the practice of prewarming.

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