lly precedes the first andsecond laws of thermodynamics, thezeroth lawof

thermodynamicswas previously taken forgranted but is a necessary for the

precedinglaws. It states: if two systems are at the sametime in
thermal equilibrium with a thirdsystem, they are in thermal
equilibrium witheach other. The zeroth law allows temperatureto be
defined; the �triple point� is the onlypoint at which all three states
can exist at thesame temperature and pressure.Another law that relates
temperature and itstransmission is the Stefan � Boltzmann law.This refers
to the concept of a black body, i.e.an ideal object that emits an
equal amount ofinfrared energy as that given to it; so the hotteran object gets
the more energy it emits as infra-red energy. The total emissive power
(E)isproportional to the fourth power of the body�sabsolute temperature
(T):E�1sATwheresis Stefan�s constant, 5.67#1028Wm22K24,Athe area, and1the
emissive effi-ciency, which is close to 1 for a blackenedsurface and
very small for a well-silvered one.Note that for a hot body in
surroundings oftemperatureT0, thenetenergy loss per secondwill
be:1sA(T42T04).In general, the energy in a gas molecule isdirectly
proportional to the absolute tempera-ture. As the temperature increases,
the kineticenergy per molecule increases. This conceptlinks temperature,
energy, and the ideal gasequation. Boltzmann demonstrated that
theaverage kinetic energy of the molecules of agas was directly comparable
with the measuredpressure. From the Gay � Lussac law, it isknown that
pressure is directly proportional totemperature and therefore the kinetic
energy ofthe molecules is related directly to the tempera-ture of the gas.Three
temperature scales are recognized,those of: Centigrade (Celsius),
Fahrenheit, andKelvin, which is the SI unit for temperature.Key pointsHeat and
temperature areinter-related but not thesame.Temperature is measured inKelvin one
of seven base SIunits.Temperature can bemeasured by electrical andnon-electrical
means.Hypothermia is detrimentalto patients in numerousways.Understanding
temperaturemeasurement is relativelysimple and easy to apply topatient
management.Gavin Sullivan MB BCh FRCASpecialist RegistrarWrexham Maelor
HospitalUKCampbell Edmondson FRCAConsultant Anaesthetics and IntensiveCareWrexham
Maelor HospitalCroesnewydd RoadWrexham LL13 7TDUKTel:�44 01978 725955Fax:�44
01978725932E-mail: CAMPBELL.EDMONDSON@new-tr.wales.nhs.uk(for
correspondence)104doi:10.1093/bjaceaccp/mkn014Continuing Education in Anaesthesia,
Critical Care & Pain | Volume 8 Number 3 2008&The Board of Management and Trustees
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FahrenheitFahrenheit (1714) used the mercury thermometer to develop
thistemperature scale. The zero point was set using a mixture of sodiumchloride and
ice. According to this scale, water boiled at 2128F, icemelted at 328F, and body
temperature was assumed to be 1008F.CentigradeAnders Celsius developed the
first precise scale in 1742. He used�degree� as the unit of temperature.
All of his standards for com-parison to make his markings (on his scale)
were based on theproperties of water: 1008C for the boiling point and
08C for themelting point of ice.Kelvin (absolute temperature scale)This
temperature scale was designed by Lord Kelvin (WilliamThompson, 182421907),
a British inventor and scientist. Kelvinis a temperature scale that is
designed so that zero Kelvin isdefined as absolute zero (at absolute zero, a
hypothetical tempera-ture, all molecular movement stops�all actual
temperatures areabove absolute zero) and the size of one unit is the
same as thesize of 18C. Thetriple pointis the temperature and pressure
atwhich the solid, liquid, and gas phase of a substance exist in equi-librium. The
Kelvin is defined as being a unit of absolute tempera-ture equal to 1/273.16 of
the absolute temperature of the triplepoint of water (273.16 K at 611.2 Pa).
This scale uses the absolutezero,2273.168C. The boiling point of water
according to thisscale is 3738K. The Kelvin is the SI unit of
temperature.Relationship between heat and temperatureThe interrelationship between
heat and temperature is intrinsicallyassociated with the change in state from
solid to liquid to gas andthere are several important concepts related to this.The
first concept is that of latent heat; this refers to the energy(or heat) required
to change the state of a substance without chang-ing its temperature. To understand
this concept, see Figure 1. If Awere, for example, a block of ice, as you added
heat to the systemthe temperature of the ice would rise. However, at a
certain pointB, the temperature of the ice would remain constant as all
theenergy being given to the system is used to break the
crystallinebonds of ice to produce water molecules in a less bound
statethereby creating a liquid, i.e. water. Further energy given to
thesystem causes a further rise in temperature until reaching 1008C.At
this point, the temperature reaches a plateau as all the energy isbeing used to
break the bonds between water molecules to form agas, i.e. steam. It can be
seen from the graph that much moreenergy is required to convert a
liquid to a gas than a solid to aliquid (i.e. comparing length D to B).Two
terms therefore arise from these concepts.(i)Latent heat of fusion (or
crystallization): The energy given outor taken in when a substance changes state
from solid to liquidor from liquid to solid with no temperature change in
thesystem. This process is reversible, i.e. when converting fromliquid to
solid, energy is released from the system.(ii)Latent heat of vaporization:This
is the energy given out ortaken in when a substance changes state from liquid
to gas orfrom gas to liquid with no temperature change in the
system.Similarly, this is a reversible process as noted above.Also related to the
above is the specific latent heat of vaporizationor fusion. This refers to the
energy required to change the tempera-ture of a unit mass, usually a kilogram of a
substance by 18Cataspecified temperature. The amount of energy required is
higher atlower temperatures and lower at higher temperatures. A body at
ahigher temperature already has a lot of energy and will thereforerequire
less to reach a latent heat point.A special circumstance arises with gas systems.
If a gas is com-pressed (work carried out upon it), it will usually lead
to anincrease in the energy (i.e. heat) of its molecules. If done
slowlyenough, the temperature rise expected with increased heat does notoccur as
the energy is lost to the surroundings; this is an isothermalchange. If the gas
is compressed suddenly, there is not enoughtime for the heat to be lost
to the surroundings and the energy isheld within the system and the
temperature can rise suddenly. Theconverse is true, i.e. a gas allowed to expand
rapidly will cool. Asthe decreased pressure leads to loss of energy of
molecules withreduced heat, these are known as adiabatic changes. A
clinicalexample of this concept is seen in the cryoprobe where
rapidexpansion of CO2leads to cooling.Clinical applicationThese physical principles
are important in that heat in patients, andsubsequently their temperature, has
a bearing on their anaestheticmanagement and their postoperative recovery.
Several studies haveshown that hypothermic patients (i.e. core
temperature,368C)have potentially severe physiological disturbances. A
temperatureof 368C is the standard being used by the National Institute
ofClinical Excellence guidance, below which is termed inadvertentFig 1The
concept of latent heat. See text for explanation.Heat and temperatureContinuing
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perioperative hypothermia. Patients undergoing anaesthesia havetheir physical
and behavioural responses to cold abolished.Mechanisms of heat lossLoss of heat is
from five main mechanisms: radiation, convection,conduction, evaporation, and
respiration.Radiation (40%)Heat can also be transferred without the presence
of a medium.This occurs by the process of radiation. Thermal radiation
is aform of electromagnetic radiation similar to light. It travels
instraight lines, can be reflected, and its intensity obeys the
inversesquare law. A silica prism, demonstrating that it has a longer wave-length
that visible light, can refract it (it is therefore often knownas infrared
radiation). The amount of radiation emitted by a bodydepends on its
temperature and the quality (e.g. colour) of itssurface (Stefan � Boltzmann
law). The wavelength of the brightestpart of the emission spectrum
decreases with increasingtemperature.Convection (30%)Convection refers to
the movement of molecules away from awarm object as a consequence of
their reduced density as theygain heat and expand. This creates
convection currents, whichtransfer heat away from the object. If the
temperature of a givengas or fluid rises, the volume must increase by the same
factor; ifthe volume increases, then density decreases and therefore convec-tion
currents are generated. Forced convection occurs when themotion of the fluid
is maintained by some external agency such asa fan or pump. The rate of heat flow
is given by:Q�hADTwhereAis the area of the body andDTthe temperature
differencebetween body and fluid. However,hdepends on many factors, e.g.shape and
orientation of surface, density, viscosity, specific heat,and thermal
conductivity of fluid, and whether fluid flow islaminar or turbulent.
For a given body and fluid, Newton�s law ofcooling applies, i.e. rate of heat loss
is proportional to the tempera-ture difference (DT), providedDTis small and
forced convectionapplies.Conduction (5%)Conduction of heat occurs between two
objects in direct contactwhere a temperature gradient exists between them. The
formula forheat conduction is given by:QTime�Thermal
conductivity#Area#�Thot#Tcold�ThicknesswhereQis the rate of heat flow andTthe
temperature of the twoobjects.Evaporation (15%)Evaporation refers to latent heat
losses, i.e. when a liquid convertsto a gas, it needs to gain energy to do
so and this energy in theform of heat is taken from the patient.Respiration
(10%)Respiration is a form of evaporative heat loss.Heat loss during
anaesthesiaBoth general and regional anaesthesia have been shown to
reducecore body temperatures with losses of 0.5 � 18C within the firsthour
due to redistribution of heat from the core to the periphery,and a
further loss of 0.38Ch21thereafter. It should be noted that a1000 ml bag of fluid
at room temperature could reduce body temp-erature by 0.58C. Volatile anaesthetic
agents lower the thermoregu-latory threshold so that the body�s
thermoregulatory mechanismsare not triggered until lower temperatures. Metabolic
productio