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Hauttemperaturerhöhungen bei Spinalanästhesie

Prädiktiver Wert als Vorhersagewahrscheinlichkeit einer chirurgischen Toleranz

Increase in skin surface temperature in spinal anesthesia

Predictive value for probability of surgical tolerance

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Zusammenfassung

Hintergrund

Während einer Spinalanästhesie verursacht die dabei entstehende sympathische Blockade eine Gefäßerweiterung der Kapillaren mit einem höheren Blutfluss, der zu einem Anstieg der lokalen Hauttemperatur führt.

Material und Methoden

Elf chirurgische Patienten einer Universitätsklinik mit Eingriffen der unteren Extremität in beidseitiger Spinalanästhesie wurden untersucht. Zum Einsatz kam ein digitales Mehrkanal-Hautoberflächen-Thermometer, das kontinuierlich vor, während und 45 min nach der Spinalanästhesie die Hauttemperatur an 8 definierten Messpunkten aufzeichnete. Gleichzeitig wurde an diesen Messpunkten ein neurologischer „Pin-prick“-Test als Maß der chirurgischen Toleranz in den betreffenden Dermatomen durchgeführt.

Ergebnisse

Die Korrelation mit dem Auftreten einer chirurgischen Toleranz zeigte für die untere Extremität die sichere Vorhersagewahrscheinlichkeit einer Analgesie. Mit 95%iger Vorhersagewahrscheinlichkeit konnte bei einer definierten Differenztemperatur von 1,05°C für die untere Extremität (Fuß, Knie, Leiste) eine sichere Analgesie vorhergesagt werden (n = 11).

Schlussfolgerung

Damit eignet sich die Messung der Hauttemperaturerhöhung nach Spinalanästhesie als Parameter einer chirurgischen Toleranz. Diese Untersuchungsmethode wird weiterer Forschungsgegenstand sein und in größeren Untersuchungen bestätigt werden müssen.

Abstract

Background

Spinal anesthesia causes sympathetic blockade which leads to changes in the local temperature of the skin surface due to hyperemia.

Materials and methods

These changes in skin temperature were used in a newly developed method for estimating the level of analgesia. A total of 11 patients who were scheduled for surgical procedures of the lower extremities with symmetrical spinal anesthesia were included in the clinical study. By means of an electronic digital multi-channel body temperature measurement device with eight high precision temperature sensors placed on defined dermatomes, patient skin temperature was continuously measured at 2 s intervals and documented before, during and for 45 min after spinal anesthesia. Simultaneously, a neurological pin-prick test was carried on at regular intervals every 2 min on the defined dermatomes to calculate the correlation between the effects of analgesia and corresponding changes in skin temperature.

Results

The analyzed correlations showed that there is a minimum of 1.05°C temperature difference before and after spinal anesthesia especially on the lower extremities (foot, knee, inguinal) of patient dermatomes. The collected data of varying temperature differences were systematically evaluated using statistical software which led to a deeper understanding of the interdependency between temperature differences at different dermatomes. These interdependencies of temperature differences were used to develop a systematic analgesia level measurement algorithm. The algorithm calculates the skin temperature differences at specified dermatomes to find the accurate level of analgesia and also to find the forward and reverse progresses of analgesia. The developed mathematical method shows that it is possible to predict the level of analgesia up to an accuracy of 95% after spinal anesthesia.

Conclusions

Therefore, it can be concluded that systematic processing of skin temperature data, collected at defined dermatomes can be used as a promising parameter for predicting surgical tolerance. The objective is to improve this experimental method with an extended patient population study.

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Danksagung

Die Autoren bedanken sich sehr herzlich bei Herrn Dr. Reinhard Vonthein, Zentrum für Klinische Studien, Universität Lübeck, für die Hilfe bei der statistischen Auswertung der Studiendaten.

Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: Drittmittelförderung DMWi (EXIST II) und Beschäftigungsverhältnis GP Medical Instruments GmbH.

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Authors and Affiliations

  1. Chirurgisches Forschungslabor, Klinik für Chirurgie, UKSH Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    A. Penno, M. Arumugam, G. Antweiler, T. Laubert, J. Habermann & H.-P. Bruch

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  1. A. Penno
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  2. M. Arumugam
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  3. G. Antweiler
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  4. T. Laubert
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  5. J. Habermann
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  6. H.-P. Bruch
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Corresponding author

Correspondence to A. Penno.

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Penno, A., Arumugam, M., Antweiler, G. et al. Hauttemperaturerhöhungen bei Spinalanästhesie. Anaesthesist 61, 770–776 (2012). https://doi.org/10.1007/s00101-012-2076-3

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  • DOI: https://doi.org/10.1007/s00101-012-2076-3

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