PHYSICS
Measuring temperature
including heat and
thermodynamics
David Williams
Abstract
Many items of equipment used in anaesthesia and intensive care rely on the
principles of thermodynamics for their operation. Heat loss from the human
body may result in perioperative hypothermia and increased morbidity. It is
therefore essential to have a sound understanding of the underlying phys-
ical principles. This article outlines thermodynamic concepts which are rele-
vant to clinical practice and includes: heat capacity and latent heat; thermal
effects on solids, liquids, gases and solutions; mechanisms of heat transfer;
and techniques of temperature measurement.
Keywords Anaesthesia; heat; measurement; monitoring; temperature;
thermodynamics
Introduction
Thermodynamics is the study of the relationship between
heat, work and internal energy of a system.
Heat is the energy state of an object due to the kinetic energy
(KE) of its constituent atoms and molecules. Temperature
describes the mean translational KE of the constituent atoms and
molecules of an object, and indicates the thermal potential of one
object relative to another.
The derived SI unit of heat is the joule (J), equal to the energy
expended (i.e. work done) when a force of 1 N is applied through
a distance of 1 m (i.e. 1 J ¼ 1 N m). The unit of heat flow is
therefore J/second or Watts (W). The non-SI unit of heat, calorie
(cal), is defined as the amount of heat needed to raise the
temperature of 1 g of water by 1 C. 1000 calories ¼ 1 kilocalorie
(kcal or Cal). 1 cal ¼ 4.19 J. The British Thermal Unit (BTU) is
the amount of energy required to increase the temperature of 1lb
of water by 1 F; 1 BTU ¼ 1055 J. The SI unit of temperature is
Kelvin (K), but degrees Celsius ( C) and degrees Fahrenheit ( F)
are also used in clinical practice (Figure 1). Temperature
measured in K is directly proportional to the mean KE of the
atoms of the substance, and therefore Kelvin units must be used
for all thermodynamic calculations (e.g. gas laws).
The laws of thermodynamics (summarized by C.P. Snow as:
‘You must play the game’, ‘You can’t win’; ‘You must lose’ and
‘You can’t leave the game’) are:
Zeroth law: if two systems are in thermal equilibrium with
a third system, they are in thermal equilibrium with each other.
David Williams FRCA DipDHM is a Consultant Anaesthetist at the Welsh
Centre for Burns, Swansea, UK. Conflicts of interest: none declared.
ANAESTHESIA AND INTENSIVE CARE MEDICINE 13:3
Learning objectives
After reading this article, you should be able to:
C explain the physical basis of heat and temperature, and the
effects of heat on solids, liquids, gases and solutions
C explain the mechanisms of heat transfer in relation to the cause
and prevention of perioperative heat loss from a patient
C describe different methods of temperature measurement, and
explain how they work
First law: (‘Conservation of energy’): energy can be transformed,
but cannot be created or destroyed.
Second law: entropy (the state of molecular disorder) always
increases or remains constanta e that is, energy always moves
from a higher to lower state (hot to cold), but never in the reverse
direction unless work is done.
Third law: absolute zero is unattainable. At absolute zero,
particles would have no KE (although some residual ‘zero point
energy’ would remain), and would therefore be completely at
rest, exerting zero pressure on their surroundings.
Interactions between heat and matter
The constituent molecules or atoms of a substance in the solid phase
are strongly bound to form a vibrating lattice; in the liquid phase
they are weakly bound by Van der Waal’s forces and are mobile; in
the gas phase they are unbound and move freely and rapidly at
random; and as plasma they are broken up firstly into unbound
atoms, and then into positive and negative ions. Some substances
(e.g. CO2) undergo phase change from solid to gas without passing
through an intermediate liquid phase (sublimation). The triple
point of a substance is the unique combination of pressure and
temperature at which liquid, solid and vapour phases coexist in
stable equilibrium. The boiling point of a liquid is the temperature
at which its vapour pressure is equal to ambient pressure.
As temperature increases, molecular vibration and average
separation of the constituent atoms increase, causing a substance
to undergo thermal expansion (and vice versa) by a degree
which may be calculated if the coefficients of linear (a) and
volumetric (b) expansion for the substance and phase are
known. Glass bulb, metal strip, and Bourdon type thermometers
use this principle to indicate temperature. A bimetallic strip is
made from two bonded dissimilar metals (commonly brass and
‘Invar’; a steel-nickel alloy) which undergo differential thermal
expansion, causing the strip to deflect with change in tempera-
ture. They are used in thermometers, thermostats, contact
breakers and vaporizers.
The specific heat (capacity) (c) (J/kg/K) of a substance is the
amount of energy (Q)(J) required to raise the temperature of
a unit mass (usually 1 kg) by 1 K without a change in phase. The
value of c depends on the substance and its phase. Generally, for
a
“It’s the Second Law of Thermodynamics: Sooner or later everything
turns to s**t!” e Woody Allen, Husbands and Wives (1992).
111 Ó 2012 Elsevier Ltd. All rights reserved.
 PHYSICS

Relationships between temperature scales in common use

Absolute Melting Triple Body temperature Boiling point
zero point point of (approximate) of water
of ice water

0 273.15 273.16 310 373.15

Kelvin (K)1 (1848)
(‘Absolute temperature’)
273.16 divisions

–273.15 0 0.01 36.8 100

Celsius (C)2 (1742)

100 divisions

–459.67 32 32.02 98.2 212

Farenheit (F) (1714)

180 divisions
(Highlights indicate fixed points used for calibration)
Conversion: NB
1
C = K – 273.15 The SI unit for temperature is ‘Kelvin’, not ‘degrees Kelvin’
2
F = (C x 9/5) + 32 ‘Centigrade’ means any scale divided into 100 divisions.
Temperature intervals: 1K = 1C = 1.8F The correct term is ‘degrees Celsius’.

Figure 1

a mass (m) of substance undergoing a temperature change (DT ): phase without a change in temperature; and represents the latent
Q ¼ m$c$DT. (i.e. hidden) energy that is required to break bonds, or is released
The specific latent heat (l ) (J/kg) is the amount of energy by formation of new bonds. The value of l depends on the
added or released as heat when a unit mass of substance changes substance and the phase transition (Figures 2a,b). Q ¼ m$l.

a. Phases and transitions b. A graph of temperature against energy added when 1 g of ice
at –30oC is converted to steam at 120oC
Plasma
120 e
d
Deionization

100
Ionization

IE
Temperature (C)

Steam
c
Water + steam
Gas
Lv b
Va

0 a
po
Co

Water
riz

Ice
nd

Ice
at
en

io

+ water
sa
Deposition

n
Sublimation

tio

–30
n

Ls 0 63 396 815 3075 3115

Liquid
Energy added (J)
g
tin

Energy added:
el

n
M

a = m . cice . ΔT
sio

= 63
Fu

Lf b = m . lf water = 333
Solid c = m . cwater . ΔT = 419
d = m . lv water = 2260
Lf,v,s = latent heat of fusion, vaporization, sublimation e = m . csteam . ΔT = 40
IE = ionization enthalpy Total = 3115

Figure 2

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 PHYSICS

If c and l are not defined in terms of mass, they are called
‘heat capacity’ (C) (J/K) and ‘latent heat’ (L) (J). Defining them
in terms of standard mass (i.e. ‘specific’) allows the properties of
different substances to be compared.
As a liquid evaporates, latent heat of vaporization is drawn
from the remaining liquid and surroundings. Hence for an
anaesthetic vaporizer, the temperature and saturated vapour
pressure of the volatile agent will fall during use, resulting in
a decrease in delivered vapour concentration. Vaporizer design
therefore includes thermostabilization e high-conductivity
materials (e.g. steel, copper) to conduct heat from the
surroundings to the vapourizing chamber, and a large mass (e.g.
metal, water) to act as a heat reservoir; and thermocompensa-
tion e for example a temperature-controlled variable bypass
valve incorporating a bimetallic strip.
Increasing temperature tends to decrease the viscosity (h) of
liquids; increase the viscosity of gases; and decrease the density
(r) of both. Most aqueous solutions undergo an endothermic
reaction (i.e. absorb energy) as they are formed. With increasing
temperature, the solubility of a solid in a liquid generally
increases up to a limit (saturation); however the solubility of
a gas decreases in an aqueous solvent, but increases in an
organic solvent. Dissolved impurities obstruct molecules of
liquid from leaving the liquid phase (evaporation) or forming
bonds (freezing). This has the effect of raising the boiling point
and lowering the freezing point, and depends on the mass of the
impurities present (‘colligative properties’), rather than their
chemical properties.
Thermodynamic processes may be described as adiabatic (or
isocaloric) (no heat transfer to or from the surrounding environ-
ment); isothermal (constant temperature); isobaric (constant
pressure); or isochoric (constant volume). The internal energy of
a system is the sum of its molecular KE (due to molecular trans-
lation, rotation, and vibration) and potential energy (due to inter-
molecular bonds). If work is performed to compress a gas, the
internal energy and therefore the temperature of the gas will
increase. Rapid compression will not allow sufficient time for heat
to be transferred from the gas to the surrounding environment
(adiabatic change), resulting in a sudden increase in temperature of
the gas: however slow compression will allow time for the heat to be
lost to the surroundings (isothermal change) and no increase in gas
temperature will occur. If the valve of an oxygen cylinder is opened
suddenly, the rapid increase in pressure at a valve downstream may
result in adiabatic heating and potential ignition of any flammable
contaminants (e.g. mineral oil) if present. Cylinder valves should
therefore be opened slowly to allow isothermal change to occur.
Conversely, rapid expansion of a gas without the addition of heat
energy from the environment (adiabatic change) will cause

Mechanisms of heat transfer

Mechanism Example: a kettle on Some causes of Some strategies for
a wood-burning stove perioperative heat loss prevention of perioperative
heat loss

Conduction When objects are in physical
contact, direct exchange of
KE between adjacent
vibrating atoms or
molecules occurs.
Convection Bulk flow and diffusion of
fluids (liquids or gases).
Warm fluids decrease in
density and rise, causing
movement of high-energy
molecules.
Radiation Electromagnetic radiation
(e.g. infrared, microwaves).
Does not require a medium
for propagation e heat from
the sun reaches us across
the vacuum of space.
Phase change Release or uptake of latent
heat of fusion or
vaporization when bonds
are made or broken.
The metal case of the stove
gets hot.
Air above the stove and
water in the kettle get hot.
You feel heat on your skin at
a distance from the fire.
If steam from the kettle hits
your skin and condenses to
water, you get scalded by
the heat that is released.
C Cold intravenous fluids
C Irrigation fluid
C Conduction to operating
table
C Air movement in theatre
C Laminar air flow cabinet
C Exposed skin
Latent heat of evaporation
from:
C surgical wounds
C skin prep
C burns
C respiratory tract (esp. if
cold dry gas from
anaesthetic machine)
C Fluid warmer
C Warmed irrigation fluids
C Foam mattress
C Heated mattress
C Forced convection
warming devices
(e.g. Bair HuggerÒ)
C Blankets/drapes
C Radiant heaters
C Blankets/drapes
C Metallized polyester
‘space blanket’ in post-
operative care unit
C Heat and moisture
exchanger (HME)
C Circle breathing system
C Breathing system
humidifier

Table 1

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 PHYSICS

a reduction in internal energy, resulting in cooling (the Joulee
Thomson effect). This is employed in the design of a cryoprobe.
Heat transfer
Thermal transfer can occur by conduction, convection, radia-
tion and phase-change transfer (Table 1). These processes are
responsible for approximately 5%, 30%, 40% and 25% of peri-
operative heat loss respectively.
Thermal conductivity (k) (W/m/K) describes the ability of
a material to transfer heat by conduction. The value of k depends
on the substance and phase; and also increases with average
temperature. High k substances transfer energy rapidly and may
be used in heat sinks to conduct heat away from a site to the
surrounding environment: low k substances are used as thermal
insulation. Gases (except for those with low density such as
hydrogen and helium) generally have low k and are therefore
good insulators, provided that they are not moving and causing
convective loss. Materials incorporating air-filled pockets (e.g.
bubble wrap, foam rubber) are therefore effective insulators
against heat loss by conduction. For a conducting substance of
area (A), thickness (x) and temperature difference (DT ), the rate
of heat transfer (dQ/dt) ¼ k$A$DT/x.
The rate of heat transfer by convection may be predicted by
Newton’s law of cooling, which states that the rate of change of
temperature of an object (dT/dt) is proportional to the difference
between its own instantaneous temperature (Tt) and the ambient
temperature (Tamb); i.e. dQ/dt ¼ h (TtTamb), where (h) is the
heat transfer coefficient (W m2 K). The temperature of an object
which has cooled from initial temperature (T0) over a time period
(t) is therefore given by: Tt ¼ Tamb þ (T0  Tamb) e$ht
Electromagnetic radiation of an appropriate wavelength may
transfer its energy to the electrons which surround an atom and
cause them to move from low to high energy levels, increasing
the kinetic energy of the substance (absorption). The reverse
process may also occur so that heat energy in a substance is
converted to electromagnetic wave energy of a specific wave-
length (emission). Reflection is simply absorption followed by
emission. If the wavelength of the incident radiation does not
correspond to the resonant frequency of the electrons, the waves
pass through the substance (transmission).
Materials emit and absorb radiation equally effectively e
otherwise the second law of thermodynamics would be violated.
Infrared (thermal) radiation (wavelength 0.7e300 mm) is best
emitted and absorbed by matt black rough surfaces, and best
reflected by shiny white smooth surfaces. A black body is an
idealized object which is a perfect absorber and emitter of
thermal radiation. The rate of heat transfer by radiation is
proportional to the fourth power of the temperature difference
(StefaneBoltzmann law).
Dewar (“ThermosÒ”) flasks maintain the temperature of
their contents by using a combination of silvered walls to
reduce radiation, and a vacuum to reduce conduction and
convection.

Methods of temperature measurement

Principle Example

Thermal expansion
C Solid Metal strip thermometer, bimetallic strip
C Liquid Glass bulb thermometer (e.g. mercury, alcohol)
Galilean thermometer (density change of water)
C Gas Dial thermometer (e.g. Bourdon gauge)
Chemical Liquid crystal thermometer: pitch of spiral chiral nematic liquid crystal
changes with temperature, reflecting different wavelengths (colours) of light.
Electrical
C Resistance (R) Resistance temperature device (RTD). Resistance wire (e.g. Pt) in a
Wheatstone bridge. Approx. linear [R with [temperature.
Thermistor (metal oxide semiconductor). May be manufactured with
negative or positive temperature coefficient; i.e. non-linear [ or YR
with [temperature.
C Voltage difference Integrated circuit semiconductor temperature sensor e voltage
difference between junctions of two transistors changes with temperature.
C Thermoelectric Thermocouple e.m.f. is generated by electron flow when a temperature
(PeltiereSeebeckeThomson) effect difference occurs at the junctions of two dissimilar metals, e.g
Cu/CueNi (‘constantan’) or PteRh.
Approx. linear [ in e.m.f. with [temperature.
C Crystal resonance Vibrating quartz crystal: resonant frequency [ w1 KHz/ C
Infrared radiation Tympanic thermometer, Pyrometer.
Output proportional to incident radiation. Sensing elements include:
Photon detector, pyroelectric (charge), thermopile (multiple thermocouples),
bolometer (resistance).

Table 2

ANAESTHESIA AND INTENSIVE CARE MEDICINE 13:3 114 Ó 2012 Elsevier Ltd. All rights reserved.
 PHYSICS

Measurement of heat and temperature

Metabolic heat production can be measured by direct calorimetry, Bonus multiple choice questions (to get you thinking!)
in which food samples are burned in a bomb calorimeter, or by
indirect calorimetry, in which respiratory exchange of O2 and CO2 1. You heat a metal ring with a blowtorch.
is measured. Perioperative monitoring of temperature is indicated As the ring heats up, the hole in the centre:
for patients at risk of hypothermia (especially infants, who have (a) Gets smaller
a high surface area to mass ratio and immature shivering reflex), (b) Gets bigger
pyrexia, malignant hyperpyrexia, autonomic dysfunction, and for (c) Stays the same size
cardiopulmonary bypass; and may be measured by a number of
techniques (Table 2). Perioperative hypothermia is associated with 2. You have a cup of hot, black coffee on a cold winter’s day.
impaired drug metabolism; prolonged postoperative recovery and If you want the coffee to stay hot for longer, you should
hospital stay; and increased morbidity due to coagulopathy, wound add the warm milk:
infection, and myocardial events. A (a) Immediately
(b) After 5 minutes
(c) It makes no difference when the milk is added.
FURTHER READING
Answers
Bloomfield L. How everything works: making physics out of the ordinary.
Hoboken, NJ: Wiley, 2008.
1. (b) The ring expands on heating and so does the hole e this
Chown M. We need to talk about Kelvin: what everyday things tell us
is a useful trick to free up a rusted nut and bolt! A cavity in
about the universe. London: Faber & Faber, 2009.
a material will also expand on heating, as if it were filled
Hill DW. Physics applied to anaesthesia. 3rd edn. London: Butterworths, 1978.
with the same material.
Nelkon M. Principles of physics. 8th edn. London: Longman, 2010.
It is as if you had taken a photograph of the ring and
Serway RA, Jewett JW. Physics for scientists and engineers. 6th edn.
enlarged it on a photocopier.
Belmont CA: Thomson Brooks/Cole, 2004.
Sykes MK, Vickers MD, Hull CJ. Principles of measurement and monitoring
2. (a) The rate of cooling depends on the difference between
in anaesthesia and intensive care. 3rd edn. Oxford: Blackwell Scien-
the temperature of the mixture (milk þ coffee) and ambient
tific, 1991.
temperature (Newton’s law of cooling).
Ward CS. Anaesthetic equipment: physical principles and maintenance.
2nd edn. Eastbourne: Bailliere Tindall, 1985.

ANAESTHESIA AND INTENSIVE CARE MEDICINE 13:3 115 Ó 2012 Elsevier Ltd. All rights reserved.