Medicine:Postanesthetic shivering
| Postanesthetic shivering | |
|---|---|
| Specialty | Anesthesia |
Postanesthetic shivering (PAS) is shivering after anesthesia.[1]
Description and treatment
Postanesthetic shivering is one of the leading causes of discomfort in patients recovering from general anesthesia. It usually results due to the anesthetic inhibiting the body's thermoregulatory capability, although cutaneous vasodilation (triggered by post-operative pain) may also be a causative factor. First-line treatment consists of warming the patient; more persistent/severe cases may be treated with medications such as tramadol, pethidine, clonidine, and nefopam, which work by reducing the shivering threshold temperature and reducing the patient's level of discomfort. As these medications may react and/or synergize with the anesthetic agents employed during the surgery, their use is generally avoided when possible.[2] The anesthetic ketamine can also be used to manage postanesthetic shivering.[3]
Intensity
The intensity of PAS may be graded using the scale described by Crossley and Mahajan:
- 0 = no shivering;
- 1 = no visible muscle activity but piloerection, peripheral vasoconstriction, or both are present (other causes excluded);
- 2 = muscular activity in only one muscle group;
- 3 = moderate muscular activity in more than one muscle group but no generalized shaking;
- 4 = violent muscular activity that involves the whole body.
References
- ↑ English W (2002). "Post-operative shivering, causes, prevention and treatment (letter)". Update in Anaesthesia 1 (3). http://www.nda.ox.ac.uk/wfsa/html/u15/u1503_01.htm. Retrieved 8 September 2010.
- ↑ Alfonsi, P (2001). "Postanaesthetic shivering: epidemiology, pathophysiology, and approaches to prevention and management.". Drugs 61 (15): 2193–205. doi:10.2165/00003495-200161150-00004. PMID 11772130.
- ↑ Zhou, Y; Mannan, A; Han, Y; Liu, H; Guan, HL; Gao, X; Dai, MS; Cao, JL (30 December 2019). "Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: a systematic review and meta analysis.". BMC Anesthesiology 19 (1): 245. doi:10.1186/s12871-019-0910-8. PMID 31888509.
Further reading
- "The intensity of postoperative shivering is unrelated to axillary temperature". Anaesthesia 49 (3): 205–7. March 1994. doi:10.1111/j.1365-2044.1994.tb03422.x. PMID 8147511.
- "Thermoregulation, mild perioperative hypothermia and postanaesthetic shivering". Br J Anaesth 84 (5): 615–28. May 2000. doi:10.1093/bja/84.5.615. PMID 10844839.
- Alfonsi P (May 2003). "Postanaesthetic shivering. Epidemiology, pathophysiology and approaches to prevention and management". Minerva Anestesiol 69 (5): 438–42. PMID 12768180. http://www.minervamedica.it/index2.t?show=R02Y2003N05A0438.
- "Pharmacological treatment of postoperative shivering: a quantitative systematic review of randomized controlled trials". Anesth. Analg. 94 (2): 453–60. February 2002. doi:10.1213/00000539-200202000-00043. PMID 11812718. http://www.anesthesia-analgesia.org/cgi/content/full/94/2/453.
- "Single-dose parenteral pharmacological interventions for the prevention of postoperative shivering: a quantitative systematic review of randomized controlled trials". Anesth. Analg. 99 (3): 718–27. September 2004. doi:10.1213/01.ANE.0000130589.00098.CD. PMID 15333401. http://www.anesthesia-analgesia.org/cgi/content/full/99/3/718.
- "Independent risk factors for postoperative shivering". Anesth. Analg. 101 (6): 1849–57. December 2005. doi:10.1213/01.ANE.0000184128.41795.FE. PMID 16301273. http://www.anesthesia-analgesia.org/content/101/6/1849.long.
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