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GENERAL ARTICLES

Less Core Hypothermia when Anesthesia Is Induced with Inhaled Sevoflurane Than with Intravenous Propofol

Takehiko Ikeda, MD^*, Daniel I. Sessler, MD^,,§,||, Mutsuhito Kikura, MD^*, Tomiei Kazama, MD^*, Kazuyuki Ikeda, MD, FRCA^*, and Shigehito Sato, MD^*

*Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan; Outcomes Research^TM Group and Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California; §Ludwig Boltzmann Institute for Clinical Anesthesia and Intensive Care; and ||Department of Anesthesia and General Intensive Care, University of Vienna, Vienna, Austria

Address correspondence and reprint requests to Dr. Takehiko Ikeda, Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 3600 Handa-cho, Hamamatsu 431-3192, Japan. Address e-mail to tikeda{at}hama-med .ac.jp.

Hypothermia after the induction of anesthesia results initially from core-to-peripheral redistribution of body heat. Sevoflurane and propofol both inhibit central thermoregulatory control, thus causing vasodilation. Propofol differs from sevoflurane in producing substantial peripheral vasodilation. This vasodilation is likely to facilitate core-to-peripheral redistribution of heat. Once heat is dissipated from the core, it cannot be recovered. We therefore tested the hypothesis that the induction of anesthesia with IV propofol causes more core hypothermia than induction with inhaled sevoflurane. We studied patients undergoing minor oral surgery randomly assigned to anesthetic induction with either 2.5 mg/kg propofol (n = 10) or inhalation of 5% sevoflurane (n = 10). Anesthesia in both groups was subsequently maintained with sevoflurane and 60% nitrous oxide in oxygen. Calf minus toe skin temperature gradients <0°C were considered indicative of significant vasodilation. Ambient temperature and end-tidal concentrations of maintenance sevoflurane were comparable in each group. Patients in both groups were vasodilated throughout most of the surgery. Nonetheless, core temperatures in patients who received propofol were significantly lower than those in patients who received inhaled sevoflurane. These data support our hypothesis that even a brief period of vasodilation causes substantial redistribution hypothermia that persists throughout surgery.

Implications: Core temperatures in patients who received IV propofol were consistently lower than those in patients who received inhaled sevoflurane, although anesthesia was subsequently maintained with sevoflurane in nitrous oxide in both groups. This suggests that even a brief period of propofol-induced vasodilation during anesthetic induction causes substantial redistribution hypothermia that persists throughout surgery.

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