Peri-operative hyperthermia
If prolonged or ≥ 39°C this is a clinical emergency: permanent organ dysfunction and death can result. Treatment depends on the aetiology. Distinguish early between: excessive heating (most common), inadequate dissipation of metabolic heat, excessive heat production, actively maintained fever.
COMMON
Excessive insulation, high ambient temperature, external warming devices, especially infants and children (most common)
Surgical devices, e.g. HIFU, diathermy, radiotherapy
Prolonged epidural anaesthesia
Sepsis (→ 3-14) e.g. during manipulation of a urological device
Blood transfusion
Allergic reaction / anaphylaxis (→ 3-1)
Drug induced:
Neuroleptic malignant syndrome (e.g. haloperidol and other antipsychotics)
Malignant hyperthermia crisis (late sign) (→ 3-8)
Serotonin syndrome (cocaine, amphetamine, phencyclidine, MDMA)
Anticholinergic syndrome (tricyclic antidepressants, antipsychotics, antihistamines)
Sympathomimetic syndrome (cocaine, MDMA, amphetamines)
Toxic:
Radiologic contrast neurotoxicity
Alcohol withdrawal
Endocrine:
Thyrotoxicosis
Phaeochromocytoma
Neurologic:
Meningitis
Intracranial blood
Hypoxic encephalopathy
Traumatic brain injury
Chlorpromazine (Largactil) 25–50 mg i.m. 6–8 hourly. Caution in elderly.