Journal of Anesthesia

, Volume 33, Issue 1, pp 67–73 | Cite as

What is the predictor of the intraoperative body temperature in abdominal surgery?

  • Ryohei MiyazakiEmail author
  • Sumio Hoka
Original Article



Inadvertent hypothermia is a relatively common intraoperative complication. Few studies have investigated predictors of body temperature change or the effect of the blanket type used with a forced-air warming device during the intraoperative period. We investigated the predictive factors of intraoperative body temperature change in scheduled abdominal surgery.


We retrospectively reviewed the data from 2574 consecutive adult patients who underwent scheduled abdominal surgery in the supine position. Temperature data were collected from anesthesia records. Multiple regression analysis was performed at 60, 120, and 180 min after the surgical incision to identify the factors influencing body temperature change. We conducted nonlinear regression analysis using the equation ΔT = α (eγt—1) + βt, where ΔT represented the change in intraoperative core temperature (°C), t represented the surgical duration (minutes), and α, β, and γ were constants.


The intraoperative core temperature change was explained by the equation ΔT = 0.59 (e− 0.018t − 1) + 0.0043t. Younger age, higher body mass index (BMI), male sex, laparoscopic surgery, and use of an underbody blanket were associated with increased core temperature at 1 or 2 h after surgical incision. Male sex and an underbody blanket remained strong predictive variables even 3 h after surgical incision, whereas BMI had little explanatory power at this timepoint. The difference in the heating effect of an underbody versus an overbody blanket was 0.0012 °C per minute.


The blanket type of the forced-air warmer, age, sex, laparoscopic surgery, and BMI are predictors of intraoperative core temperature change.


Body temperature Forced-air warming Inadvertent hypothermia 



We thank Kelly Zammit, BVSc, from Edanz Group, for editing a draft of this manuscript.


  1. 1.
    Greif R, Laciny S, Rajek A, Doufas AG, Sessler DI. Blood pressure response to thermoregulatory vasoconstriction during isoflurane and desflurane anesthesia. Acta Anaesthesiol Scand. 2003;47:847–52.CrossRefGoogle Scholar
  2. 2.
    Royse CF, Liew DF, Wright CE, Royse AG, Angus JA. Persistent depression of contractility and vasodilation with propofol but not with sevoflurane or desflurane in rabbits. Anesthesiology. 2008;108:87–93.CrossRefGoogle Scholar
  3. 3.
    Chen A, Ashburn MA. Cardiac effects of opioid therapy. Pain Med. 2015;16(Suppl 1):27–31.CrossRefGoogle Scholar
  4. 4.
    Sessler DI, McGuire J, Moayeri A, Hynson J. Isoflurane-induced vasodilation minimally increases cutaneous heat loss. Anesthesiology. 1991;74:226–32.CrossRefGoogle Scholar
  5. 5.
    Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109:318–38.CrossRefGoogle Scholar
  6. 6.
    Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, Beattie C. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997;277:1127–34.CrossRefGoogle Scholar
  7. 7.
    Rajagopalan S, Mascha E, Na J, Sessler DI. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology. 2008;108:71–7.CrossRefGoogle Scholar
  8. 8.
    Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet. 1996;347:289–92.CrossRefGoogle Scholar
  9. 9.
    Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996;334:1209–15.CrossRefGoogle Scholar
  10. 10.
    Zhou J, Poloyac SM. The effect of therapeutic hypothermia on drug metabolism and response. Cellular mechanisms to organ function. Expert Opin Drug Metab Toxicol. 2011;7:803–16.CrossRefGoogle Scholar
  11. 11.
    Sun Z, Honar H, Sessler DI, Dalton JE, Yang D, Panjasawatwong K, Deroee AF, Salmasi V, Saager L, Kurz A. Intraoperative core temperature patterns, transfusion requirement, and hospital duration in patients warmed with forced air. Anesthesiology. 2015;122:276–85.CrossRefGoogle Scholar
  12. 12.
    Han SB, Gwak MS, Choi SJ, Ko JS, Kim GS, Son HJ, Shin JC. Risk factors for inadvertent hypothermia during adult living-donor liver transplantation. Transpl Proc. 2014; 46: 705–8.CrossRefGoogle Scholar
  13. 13.
    Kasai T, Hirose M, Yaegashi K, Matsukawa T, Takamata A, Tanaka Y. Preoperative risk factors of intraoperative hypothermia in major surgery under general anesthesia. Anesth Analg. 2002;95:1381–3. table of contents.CrossRefGoogle Scholar
  14. 14.
    Yang L, Huang CY, Zhou ZB, Wen ZS, Zhang GR, Liu KX, Huang WQ. Risk factors for hypothermia in patients under general anesthesia: is there a drawback of laminar airflow operating rooms? A prospective cohort study. Int J Surg. 2015;21:14–7.CrossRefGoogle Scholar
  15. 15.
    Sessler DI. Temperature regulation and monitoring. In: Miller RD, editor. Miller’s anesthesia. Eighth edition. Philadelphia: Elsevier Health Sciences; 2015. p. 1627.Google Scholar
  16. 16.
    Bräuer A, English MJ, Lorenz N, Steinmetz N, Perl T, Braun U, Weyland W. Comparison of forced-air warming systems with lower body blankets using a copper manikin of the human body. Acta Anaesthesiol Scand. 2003;47:58–64.CrossRefGoogle Scholar
  17. 17.
    Hardy JD, Du Bois EF. Differences between men and women in their response to heat and cold. Proc Natl Acad Sci U S A. 1940;26:389–98.CrossRefGoogle Scholar
  18. 18.
    Bal NC, Maurya SK, Sopariwala DH, Sahoo SK, Gupta SC, Shaikh SA, Pant M, Rowland LA, Bombardier E, Goonasekera SA, Tupling AR, Molkentin JD, Periasamy M. Sarcolipin is a newly identified regulator of muscle-based thermogenesis in mammals. Nat Med. 2012;18:1575–9.CrossRefGoogle Scholar
  19. 19.
    Erdling A, Johansson A. Core temperature–the intraoperative difference between esophageal versus nasopharyngeal temperatures and the impact of prewarming, age, and weight: a randomized clinical trial. AANA J. 2015;83:99–105.Google Scholar
  20. 20.
    Kurz A, Plattner O, Sessler DI, Huemer G, Redl G, Lackner F. The threshold for thermoregulatory vasoconstriction during nitrous oxide/isoflurane anesthesia is lower in elderly than in young patients. Anesthesiology. 1993;79:465–9.CrossRefGoogle Scholar
  21. 21.
    Nguyen NT, Fleming NW, Singh A, Lee SJ, Goldman CD, Wolfe BM. Evaluation of core temperature during laparoscopic and open gastric bypass. Obes Surg. 2001;11:570–5.CrossRefGoogle Scholar
  22. 22.
    Stewart BT, Stitz RW, Tuch MM, Lumley JW. Hypothermia in open and laparoscopic colorectal surgery. Dis Colon Rectum. 1999;42:1292–5.CrossRefGoogle Scholar
  23. 23.
    Song C, Tang B, Campbell PA, Cuschieri A. Thermal spread and heat absorbance differences between open and laparoscopic surgeries during energized dissections by electrosurgical instruments. Surg Endosc. 2009;23:2480–7.CrossRefGoogle Scholar
  24. 24.
    Umenai T, Nakajima Y, Sessler DI, Taniguchi S, Yaku H, Mizobe T. Perioperative amino acid infusion improves recovery and shortens the duration of hospitalization after off-pump coronary artery bypass grafting. Anesth Analg. 2006;103:1386–93.CrossRefGoogle Scholar
  25. 25.
    Inoue S, Shinjo T, Kawaguchi M, Nakajima Y, Furuya H. Amino acid infusions started after development of intraoperative core hypothermia do not affect rewarming but reduce the incidence of postoperative shivering during major abdominal surgery: a randomized trial. J Anesth. 2011;25:850–4.CrossRefGoogle Scholar
  26. 26.
    Morris RH, Wilkey BR. The effects of ambient temperature on patient temperature during surgery not involving body cavities. Anesthesiology. 1970;32:102–7.CrossRefGoogle Scholar
  27. 27.
    Morris RH. Operating room temperature and the anesthetized, paralyzed patient. Arch Surg. 1971;102:95–7.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Operating RoomsKyushu University HospitalFukuokaJapan
  2. 2.Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan

Personalised recommendations