Can a Neonate Shiver ? — A perioperative Diagnostic Dilemma and a Short Literature Review

Background: Neonates often show involuntary movements peri-operatively which are difficult to diagnose. Neonatal Shivering albeit very rare, may confuse the anaesthesiologist by presenting as Seizures. Case : A Neonate was scheduled for the repair of Lumbar Meningomyelocele in our Operating Room. At the end of an uneventful Surgery, we noticed jittery movements during recovery from Anaesthesia. Differentiating these movements from Neonatal Shivering, Motor Automatisms and Physiological New-born Behaviour was a challenge. The immediate venous blood gas analysis was within normal limits and no apparent cause could be found. Suspecting accidental Hypothermia, Immediate rewarming was initiated and after Consulting Paediatric Neurology intravenous Levetiracetam was given. There were no further similar episodes. Conclusion : Shivering-like episodes in Neonates during the peri-operative period need to be carefully evaluated to allay parental anxiety, avoid inappropriate treatment and prevent any further complications

Intravenous Dexmedetomidine For The Management Of Shivering Post Sub Arachnoid Blockade For Conduction Of Caesarean Delivery: A Randomised Controlled Trial

Background:About 52% of patients who undergo Cesarean delivery under spinal or epidural anesthesia will experience shivering, which may interfere with the monitoring of vital signs. Recent studies have shown that dexmedetomidine could potentially help to mitigate shivering associated with anesthesia. In accordance with them we decided to investigate the capability of dexmedetomidine, an alpha 2-adrenergic agonist, in reducing the duration of shivering associated with spinal anesthesia during Cesarean delivery. Material And Methods:Forty parturient going through Cesarean delivery under spinal anesthesia and experiencing shivering were included in this randomized, double-blind, prospective trial. After delivery, the intervention group (n = 20) was administered a single intravenous bolus of dexmedetomidine (20 microgram) while the control group (n =20) was given normal saline. Randomization and allocation were based on a computer-generated list. The primary outcome parameter was the time required for an observable reduction in shivering after the intervention. Result:Eighty patients were recruited, 40 of whom presented with shivering and underwent randomization. Our study recorded that dexmedetomidine alleviated the mean duration of shivering after a single intravenous bolus to 2.2 (2.07) min after dexmedetomidine from 18.9 (12.72) min after saline (95% confidence interval [CI],). The effect of dexmedetomidine was sustained 15 min after the bolus was administered, and shivering had completely stopped in 90% of the patients in the intervention group vs. 22.6% in the control group. No adverse effects were recorded. Conclusion:Our study found that a single intravenous bolus of dexmedetomidine reduced the duration of shivering for up to 15 min during Cesarean delivery under spinal anesthesia when compared against a placebo.

Effect of electroacupuncture on laparoscope postoperative shivering in patients undergoing general anesthesia / 中国针灸

OBJECTIVE@#To observe the effect of electroacupuncture (EA) on laparoscope postoperative shivering in patients undergoing general anesthesia and explore its effect mechanism.@*METHODS@#A total of 80 patients with elective laparoscopic resection of intestinal tumor under general anesthesia were randomly divided into an EA group and a tramadol group, 40 cases in each group. Thirty min prior to the end of the operation, in the EA group, EA was exerted at Neimadian and Zusanli (ST 36), with disperse-dense wave, 2 Hz/100 Hz in frequency, 1 mA in intensity, and lasting 30 min. In the tramadol group, tramadol hydrochloride injection was dropped intravenously, 1 mg/kg. The conditions of shivering, dizziness, nausea, vomiting and agitation were observed in the post-anesthesia care unit (PACU). Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were observed before treatment (T0), at the moment of extubation (T1), in 3 min of extubation (T2) and 1 h after operation (T3). Using ELISA, at T0 and T3, the expression levels of interleukin 6 (IL-6) and 5-hydroxytryptamine (5-HT) in plasma were detected separately. Choking and agitation were recorded during extubation.@*RESULTS@#① In the EA group, the incidence of shivering, dizziness, nausea, vomiting and agitation in the PACU was lower than that in the tramadol group (P<0.05). ②Compared with T0, HR, SBP and DBP were increased at T1 and T2 in the tramadol group (P<0.05). HR, SBP and DBP in the EA group were lower than the tramadol group at T1 and T2 (P<0.05). ③Compared with T0, the expression levels of IL-6 and 5-HT in plasma were increased at T3 in the tramadol group (P<0.05). The expression levels of IL-6 and 5-HT in the EA group were lower than the tramadol group at T3 (P<0.05). ④The incidence of choking and agitation during exudation in the EA group was lower than that in the tramadol group (P<0.05).@*CONCLUSION@#Electroacupuncture can reduce the incidence of laparoscopic postoperative shivering under general anesthesia. The potential mechanism mays related to the modulation of the expression levels of IL-6 and 5-HT caused by surgical trauma.

Research progress in the mechanism and prevention of shivering during cesarean section / 中国医师杂志

The perioperative shivering, as one of the adverse reactions during cesarean sections, has many bad influences on the parturients and the neonates. Several studies have already explored in the evaluation methods, risk factors, possible mechanisms, and effective prevention measures for the occurrence of perioperative shivering during cesarean sections. This article will make a review on the basis of literature, hoping to provide a reference for the prevention and treatment of shivering during the perioperative period of cesarean section.

Effect of esketamine on prevention and treatment of shivering after epidural anesthesia during cesarean section / 中国医师进修杂志

Objective:To observe the efficacy and safety of different doses of esketamine in the prevention and treatment of shivering after epidural anesthesia during cesarean section.Methods:Ninety women with American Society of Anesthesiologists grade Ⅰ to Ⅱ who underwent cesarean section from February to April 2021 in Dalian Women and Children′s Medical Center (Group) were divided into three groups by random digits table method: 0.9% sodium chloride group (group C, 30 cases); 0.25 mg/kg esketamine group (K1 group, 30 cases); esketamine 0.50 mg/kg group (K2 group, 30 cases). After epidural anesthesia, each group was given the drugs in the trial plan intravenously. General condition, shivering, sedation, Apgar score, psychiatric symptoms, nausea and vomiting were observed and recorded.Results:Finally, 81 cases were completed, including 27 cases in group C, 28 cases in group K1, and 26 cases in group K2. Shivering assessment: there was no grade 2/3 shivering in K1 group and K2 group, but the incidence of grade 2/3 shivering in C group was 25.93% (7/27) and 70.37% (19/27) the difference was statistically significant ( P<0.05). Sedation assessment: in the groups of K1 and K2, incidences of mild/moderate sedation were 92.86% (26/28)/7.14% (2/28) and 3.85% (1/26)/96.15% (25/26), respectively, obviously higher than those of group C, the differences were statistically significant ( P<0.01); there were no significant differences in the incidences of maternal mental symptoms, nausea and vomiting, and Apgar score of newborns among the three groups ( P>0.05). Conclusions:0.25 and 0.50 mg/kg esketamine are effective in preventing and treating shivering after cesarean section with epidural anesthesia without obvious adverse reactions.

Comparative Assessment of Clonidine and Tramadol on Post-Spinal Anaesthesia Shivering among Patients with Lower Abdominal and Lower Limb Surgeries: A Randomized Controlled Trial

Introduction: Spinal anaesthesia is commonly used as asafe anaesthetic technique for both elective and emergencyoperations. Shivering is known to be a frequent complicationreported in 40 to 70% of the patients undergoing surgery inregional anaesthesia. Hence, the aim of the present studywas to compare the efficacy of clonidine, and α2-agonistwith that of tramadol, a non-opioid analgesic for control ofshivering after spinal anaesthesia in patients undergoing lowerabdominal and lower limb surgeries.Material and methods: The present study was a randomizedcontrolled trial which was conducted among 60 patients agedbetween 18 to 70 years, who were scheduled for abdominal andlower limb surgeries and who developed shivering followingspinal anaesthesia. These 60 patients of ASA grade I and IIwhich were selected randomly after taking informed andwritten consent from their relatives. Once patient developedshivering, they were randomly allocated into two groupsnamed as Group C and Group T.Results: Patients who developed shivering grade 3 or 4 wereincluded in study. There was no significant difference betweenboth the groups regarding shivering grade. Out of 30 patientsin Group C, shivering subsided in 29(96.7%) patients. Whilein group T, shivering subsided in 26(86.7%) patients out of30. There was significant difference in both groups for controlof shivering (p= 0.0001) which proved that the rate of successafter clonidine was more than that of tramadol.Conclusion: Both clonidine (75 μg) and tramadol (0.5 mg/kg) can effectively treat patients with post-spinal anaesthesiashivering, but tramadol took longer time for completecessation of shivering than clonidine.

Effect of Self-warming Blankets on Intravascular Hypothermia for Severe Traumatic Brain Injury / 中国康复理论与实践

Objective:To investigate the effect of constant temperature blankets on intravascular hypothermia for severe traumatic brain injury (sTBI). Methods:A total of 112 inpatients with sTBI from January, 2013 to December, 2018 were reviewed. They were divided into control group (n = 58) and observation group (n = 54) according to whether a self-warming blanket was used. They were assessed with Bedside Shivering Assessment Scale (BSAS). Their dosages of anti-shivering medicine, coagulation and intracranial pressure were recorded. The scores of Glasgow Outcome Scale Extended (GOSE) and the mortality one, six and twelve months after discharge were observed. Results:The incidence and severity were less in the observation group than in the control group (χ2 = 16.212, P < 0.01). The dosage of anti-shivering medicine was less in the observation group than in the control group (t > 1.269, P < 0.05). The hypercoagulation relieved significantly six hours after hypothermia in the observation group, and it was stable twelve hours after hypothermia. For the control group, the hypercoagulation relieved significantly twelve hours after hypothermia, and it was stable 24 hours after hypothermia. The intracranial pressure decreased more in the observation group than in the control group. The GOSE score and the mortality were less in the observation group than in the control group (t > 1.168, P < 0.05) one, six and twelve months after discharge. Conclusion:Application of self-warming blankets in intravascular hypothermia for sTBI may relieve shivering, hypercoagulation and intracranial pressure, to improve the outcome of patients.

Control of Shivering with Prophylactic Ketamine During Subarachnoid Block: A Placebo-Controlled Randomised Double- Blind Study

Introduction: Shivering is a common and challenging sideeffect of anaesthesia and may result in different degrees ofperioperative hypothermia. Hence, the aim of the study was tocompare the efficacy of ketamine to prevent shivering duringsubarachnoid block inpatient undergoing elective surgery.Material and Methods: We conducted a prospectiverandomized, double-blind placebo-controlled trial with totalof 90 ASA I and II patients of either sex between the agesof 18 – 60 years undergoing elective infra- umbilical surgeryunder subarachnoid blocks. Random allocation of patientswas done into Group1: ketamine at dose of 0.5 mg /kg (n=30),Group2: ketamine at dose of 0.25 mg /kg (n=30), Group3:saline (n=30).Results: The study groups were comparable at the baseline.After spinal anaesthesia and concomitant administration ofthe study drug, shivering was observed only in 10% of patientwith score 1 in Group 1 and Group 2. Whereas in placebogroup 50% patients suffered different degrees of shivering andrequired treatment (p<0.05). After drug injection % of patienthad higher sedation score (3 or 2) which was significantlyhigher in Group 1 (3%) than Groups 2 and 3 (0%) (P=0.002).Only 3.3% patients of group1 experienced hallucination andrest of the patients in any group had no hallucination (P value=0.045)Conclusion: Ketamine at a dose of 0.5 mg /kg had similareffects as that of ketamine at dose of 0.25 mg /kg whencompared to placebo group. However, ketamine at dose of 0.5mg /kg caused higher effects of sedation and hallucination.

To Evaluate the Effectiveness of Magnesium Sulphate as an Agent to induce Hypotensive Anaesthesia in Lumbar Spine Surgery. A Prospective Randomized, Placebo-Control Study

Introduction: This randomized placebo controlled study wasdesigned to evaluate the effectiveness of magnesium sulphateas an agent to induce hypotensive anaesthesia in lumbar spinesurgery.Material and Methods: The study included 100 patients ofboth sexes who were equally distributed in two groups, theGroup Mg(Magnesium sulphate group) and Group C (controlgroup). The Magnesium group received magnesium sulphate40mg/kg administered as a slow IV bolus over a period of 10minutes before induction and 15mg/kg/hr by continuous IVinfusion during surgery. The same volume of isotonic salinewas administered to the control group. Surgical time, heartrate and mean arterial blood pressure was measured.Results: In the magnesium group there was reduction insurgical time (103.54 mins vs 117.34 mins), although theanaesthestic time was 9 minutes longer in the Magnesiumgroup denoting a longer emergence time. The mean arterialpressure and heart rate were significantly reduced inMagnesium group(p<0.005). Postoperative shivering was alsoless in Magnesium group.Conclusion: Magnesium infusion resulted in a steady andsmooth reduction in mean blood pressure and reduced heartrate, with no episodes of severe hypotension. Furthermoremagnesium causes reduction in duration of surgical time andpostoperative shivering

A Prospective And Randomized Double Blind Study To Compare The Effectiveness Of Prophylactic Granisetron Versus Pethidine For The Prevention Of Postoperative Shivering In Patients Undergoing Elective Thyroid Surgeries

MATERIALS AND METHODS 90 Patients randomly allocated into three groups- qroup P, qroup G, qroup S in each group 30patientswere Selected Group P Patients were given Inj Pethidine 25 mg intravenously 5 minutes before induction of general anaesthesia. Group G Patients were given Inj Granisetron 40 microgram /Kgintravenously 5 minutes before induction of general anaesthesia. Group S Patients were given Saline intravenously 5 minutes before induction of general anaesthesia. RESULTS Postoperative shivering graded after extubation at 15 and 30 minutes interval no shivering in Pethidine group 83.3% {n= 25} Granisetron, qroup 73% {n=22} Placebo qroup 27% {n=8} P value not significant between P & G group but significant in Placebo qroup {P <0.05}. shivering occurs at grade 3in pethidine group 7% [n=2] Granisetron group 10%[n=3], Placebo group 60%[n=18] P value statistically not significant between P & G groups but significant in Placebo qroup {P <0.05}. CONCLUSION From this study prophylactic use of both Pethidine and Granisetron were equally effective for the prevention of postoperative shivering

The effects of crystalloid warming on maternal body temperature and fetal outcomes: a randomized controlled trial / Os efeitos do aquecimento de cristaloides sobre a temperatura corporal materna e nas condições fetais: ensaio clínico randômico

Abstract Background and objectives: Hypothermia occurs in about 60% of patients under anesthesia and is generally not managed properly during short lasting surgical procedures. Hypothermia is associated with adverse clinical outcomes. The current study is designed to assess the effects of crystalloid warming on maternal and fetal outcomes in patients undergoing elective cesarean section with spinal anesthesia. Methods: In this prospective randomized controlled trial, sixty parturients scheduled for elective cesarean section with spinal anesthesia were randomly allocated to receive crystalloid at room temperature or warmed at 37 °C. Spinal anesthesia was performed at L3-L4 interspace with 10 mg of hyperbaric bupivacaine without adding opioids. Core temperature, shivering, and hemodynamic parameters were measured every minute until 10th minute and 5-min intervals until the end of operation. The primary outcome was maternal core temperature at the end of cesarean section. Results: There was no difference for baseline tympanic temperature measurements but the difference was significant at the end of the operation (p = 0.004). Core temperature was 36.8 ± 0.5 °C at baseline and decreased to 36.3 ± 0.5 °C for isothermic warmed crystalloid group and baseline tympanic core temperature was 36.9 ± 0.4 °C and decreased to 35.8 ± 0.7 °C for room temperature group at the end of the operation. Shivering was observed in 43.3% in the control group. Hemodynamic parameter changes and demographic data were not significant between groups. Conclusions: Isothermic warming crystalloid prevents the decrease in core temperature during cesarean section with spinal anesthesia in full-term parturients. Fetal Apgar scores at first and fifth minute are higher with isothermic warming.

Resumo Justificativa e objetivos: A hipotermia ocorre em cerca de 60% dos pacientes sob anestesia e geralmente não é tratada adequadamente durante procedimentos cirúrgicos de curta duração. A hipotermia está associada a desfechos clínicos adversos. O presente estudo teve como objetivo avaliar os efeitos do aquecimento de cristaloides nas condições maternas e fetais em pacientes submetidas à cesariana eletiva com raquianestesia. Métodos: Neste estudo prospectivo, randômico e controlado, 60 parturientes agendadas para cesárea eletiva com raquianestesia foram distribuídas aleatoriamente para receber cristaloides à temperatura ambiente ou aquecidos a 37 °C. A raquianestesia foi realizada no interespaço L3-L4 com 10 mg de bupivacaína hiperbárica sem adição de opioides. Temperatura central, tremores e parâmetros hemodinâmicos foram medidos a cada minuto até o décimo minuto e em intervalos de 5 min até o fim da operação. O desfecho primário foi a temperatura central materna ao final da cesárea. Resultados: Não houve diferença nas mensurações basais da temperatura timpânica, mas a diferença foi significativa no fim da operação (p = 0,004). A temperatura central foi de 36,8 ± 0,5 °C na fase basal e diminuiu para 36,3 ± 0,5 °C no grupo com aquecimento isotérmico de cristaloides e a temperatura basal timpânica foi de 36,9 ± 0,4 °C e diminuiu para 35,8 ± 0,7 °C no grupo sem aquecimento das soluções no fim da operação. Tremores foram observados em 43,3% no grupo controle. Alterações nos parâmetros hemodinâmicos e dados demográficos não foram significantes entre os grupos. Conclusões: O aquecimento isotérmico de cristaloides previne a redução da temperatura central durante a cesariana com raquianestesia em parturientes a termo. Os escores de Apgar para os fetos no primeiro e quinto minutos são maiores com o aquecimento isotérmico.

To Compare Efficacy Of Dexmedetomidine And Tramadol In Treating Post Subarachnoid Block Shivering And Their Side Effects

Background: Shivering is a frequent complication of regional anaesthesia. This study aimed to compare efficacy of Dexmedetomidine and Tramadol in treating post subarachnoid block shivering and their side effects. Methods: Prospective, experimental, randomized, comparative study of 60 patients of ASA grade–l & II of either gender, aged 18 to 60 years scheduled for elective surgeries, under subarachnoid block were allocated to two groups: Group T (n=30) received intravenous (IV) Tramadol 0.5 mg/kg and Group D (n=30) received IV Dexmedetomidine 0.5 µg/kg. Grade of shivering, time interval from treatment to cessation of shivering, hemodynamics and side effects were observed. Results: Recovery time from shivering was 40.34(± 6.20) sec in Dexmedetomidine whereas 210.3(±26.97) sec in Tramadol group. Side effects nausea and vomiting in Tramadol group whereas sedation and adycardia in Dexmedetomidine group were significant. Conclusion: Dexmedetomidine offers better thermodynamics than Tramadol.

A prospective, randomized, double-blinded control study on comparison of tramadol, clonidine and dexmedetomidine for post spinal anesthesia shivering / Estudo prospectivo randômico, duplo-cego e controlado comparando tramadol, clonidina e dexmedetomidina para tremores pós-raquianestesia

Abstract Introduction Shivering, a common intraoperative problem under spinal anesthesia increases the oxygen consumption considerably and is uncomfortable and distressing to the patient, anesthesiologist as well as surgeon. The present study was designed to explore the effectiveness of tramadol, clonidine and dexmedetomidine in the treatment of post spinal anesthesia shivering and to look for their adverse effects. Methods This prospective, randomized, double blinded control study was done on 90 patients who developed shivering under spinal anesthesia. They were randomly allocated into three groups with Group T receiving tramadol 1 mg.kg-1, Group C getting clonidine 1 mcg.kg-1 and Group D patients receiving dexmedetomidine 0.5 mcg.kg-1. The time taken to control shivering, recurrence rate, hemodynamic variables, sedation score and adverse effects were observed. Results Dexmedetomidine was faster in the control of shivering in 5.7 ± 0.79 minutes (min) whereas tramadol took 6.76 ± 0.93 min and clonidine was slower with 9.43 ± 0.93 min. The recurrence rate was much lower in the dexmedetomidine group with 3.3% than for clonidine (10%) and tramadol (23.3%) group. The sedation achieved with dexmedetomidine was better than clonidine and tramadol. The tramadol group had more cases of vomiting (four) and dexmedetomidine group had six cases of hypotension and two cases of bradycardia. Two of the clonidine patients encountered bradycardia and hypotension. Conclusion Dexmedetomidine is better than tramadol and clonidine in the control of shivering because of its faster onset and less recurrence rate. Though complications are encountered in the dexmedetomidine group, they are treatable.

Resumo Introdução O tremor, problema comum no período intraoperatório sob raquianestesia, aumenta consideravelmente o consumo de oxigênio, além de ser desconfortável e angustiante para o paciente, o anestesiologista e o cirurgião. O presente estudo foi concebido para explorar a eficácia de tramadol, clonidina e dexmedetomidina no tratamento de tremores pós-raquianestesia e observar seus efeitos adversos. Métodos Este estudo prospectivo, randômico, controlado e duplo-cego foi feito com 90 pacientes que desenvolveram tremores sob raquianestesia. Os pacientes foram randomicamente alocados em três grupos para receber 1 mg.kg-1 de tramadol (Grupo T), 1 mcg.kg-1 de clonidina (Grupo C) e 0,5 mcg.kg-1 de dexmedetomidina (Grupo D). O tempo necessário para controlar os tremores, a taxa de recorrência, as variáveis hemodinâmicas, os níveis de sedação e os efeitos adversos foram registrados. Resultados Dexmedetomidina foi mais rápida para controlar os tremores, com tempo de 5,7 ± 0,79 minutos (min); o tempo de tramadol foi de 6,76 ± 0,93 min; clonidina foi mais lenta, com tempo de 9,43 ± 0,93 min. A taxa de recorrência foi muito menor no grupo dexmedetomidina (3,3%) do que nos grupos clonidina (10%) e tramadol (23,3%). A sedação obtida com dexmedetomidina foi melhor do que a obtida com clonidina e tramadol. O grupo tramadol teve mais casos de vômito (quatro); o grupo dexmedetomidina teve seis casos de hipotensão e dois casos de bradicardia. Dois pacientes do grupo clonidina apresentaram bradicardia e hipotensão. Conclusão Dexmedetomidina foi melhor do que tramadol e clonidina para o controle de tremores devido ao seu início de ação mais rápido e à taxa de recorrência mais baixa. Embora complicações tenham sido observadas no grupo dexmedetomidina, elas foram tratáveis.

An interpretation of an evidence-based guideline from the American Neuro-critical Care Society about the implementation of targeted temperature management / 中华危重病急救医学

Objective Targeted temperature management (TTM) is often used in neuro-critical care to minimize secondary neurologic injury and improve outcomes. Evidence-based implementation guideline of TTM was generated from clinical questions relevant to TTM implementation for neuro-critical care by experts recruited by the American Neuro-critical Care Society. Interpretation of this guideline would help the readers to understand the implementation of TTM, bring benefits to standardization of TTM application, and contribute to the solving of specific issues related to TTM implementation.

Efficacy of nalbuphine in preventing shivering after neuraxial anesthesia in patients undergoing cesarean section / 中华麻醉学杂志

Objective To evaluate the efficacy of nalbuphine in preventing shivering after neuraxial anesthesia in patients undergoing cesarean section.Methods Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 20-35 yr,weighing 55-80 kg,undergoing elective cesarean section under neuraxial anesthesia,were divided into nalbuphine group (group N,n=40) and control group (group C,n=40) using a random number table method.After delivery,nalbuphine 0.1 mg/kg was intravenously injected immediately before clamping the umbilical cord in group N,and the equal volume of normal saline was given instead in group C.Ramsay sedation score was recorded before giving nalbuphine,at 5 min after giving nalbuphine,and at the end of surgery.The development of shivering was recorded from the end of nalbuphine administration until the end of surgery,and the shivering intensity was estimated using Wrench grading.The development of over-sedation,nausea and vomiting,bradycardia,hypotension and dizziness was recorded from the end of nalbuphine administration until the end of surgery.Results Compared with group C,Ramsay sedation scores were significantly increased at 5 min after giving nalbuphine and at the end of surgery,the incidence of shivering was decreased,the shivering intensity was reduced (P＜0.05),and no significant change was found in the incidence of adverse reactions in group N (P＞ 0.05).Conclusion Nalbuphine can prevent the occurrence of shivering after neuraxial anesthesia in patients undergoing cesarean section.

Clinical investigation of nalbuphine for treatment of post combined spinal-epidural anesthesia shivering in patients undergoing cesarean section / 临床麻醉学杂志

Objective To investigate the clinical efficacy and side effects of nalbuphine for treatment of post combined spinal epidural anesthesia shivering undergoing cesarean section.Methods Ninety puerpera underwent elective caesarean section under combined spinal-epidural anesthesia,who developed shivering Wrench grade 3 or 4,aged 20-35 years,ASA physical status Ⅰ or Ⅱ,were randomly and double-blindly divided into three groups with 30 puerpera each to receive either saline (group C) or nalbuphine (group N,0.07 mg/kg) or tramadol (group T,1 mg/kg) as a slow intravenous bolus for treatment of shivering.Onset of shivering,time interval from treatment to cessation of shivering,success rate,recurrence rate after successon treatment outcome of shivering,OAA/S sedation scores,nausea and vomiting,bradycardia and hypotension were recorded.Results There was no significant difference of the time interval from treatment to cessation of shivering between the three groups.Compared with group C,there was statistically significant shorter time interval from treatment to cessation of shiveringin group N [(3.6±1.3) min vs (14.3±7.3) min] and group T [(4.2± 2.2) min vs (14.3±7.3) min],higher success ratein group N (93.3％ vs 16.7％) and group T (90％ vs 16.7％) and lower recurrance ratein group N (7.1％ vs 80.0％) and group T (11.1％ vs 80.0％)(P＜ 0.05).Higher sedation scores in group N were observed (P＜0.05).The incidence of nausea and vomiting was 60.0％ in group T,which was significantly higher than those in group C (20.0％) and group N (13.3％) (P＜0.05).There was no significant difference in the incidence of bradycardia and hypotension in three groups.Conclusion Nalbuphine can control the shivering of post combined spinal epidural anesthesia undergoing cesarean section safely and effectively,which seems suitable for parturients cesarean delivery due to the lower incidence of nause and vomiting and a certain sedation effect.

Perioperative Hypothermia and shivering in women undergoing Caesarean section under Spinal anesthesia from a tertiary care hospital in Fiji islands - A Cross-sectional Study

Introduction@#Hypothermia and shivering have been known to occur with spinal anaesthesia intra-operatively. We carried out the present study to assess the incidence and associated factors of hypothermia and shivering amongst women undergoing Caesarean section under spinal anaesthesia.@*Methods@#A cross-sectional study was carried out amongst 300 pregnant women requiring spinal anaesthesia for Caesarean section with American Society of Anaesthesiology category I/II. The following details were captured for each eligible patient: demographics, foyer temperature, time spent in the foyer, patients calf (leg) temperature and pre-anaesthesia patient temperature, intra-operative axillary temperatures at 10, 30, 60 and 90 minutes after spinal anaesthesia depending on the duration of surgery, time spent in the operating theatre and the room temperature was documented. Any active or passive warming provided to the patients before and after spinal blockade was also documented. Other information collected include the details of drugs used in the spinal blockade, amount of IV fluids given, amount of ephedrine used, and the details of any blood products required intra-operatively.@*Results@#Out of the total 300 study participants, 63 (21%) patients received spinal anaesthesia for elective caesarean section while 237 (79%) women had emergency surgery. A total of 233/300 (77.7%) had perioperative hypothermia of which only 50/233 (21.5%) had shivering. Only 140 (46.7%) women were warmed during their caesarean delivery. Seventy two participants out of the total 135 (53.3%) who were warmed intra-operatively developed hypothermia while 116/156 (74.4%) of those who did not undergo any warming intra-operatively developed the same (P=0.0002). Average pre-anaesthesia temperature of patients who became hypothermic was lower than that of patients who maintained temperatures more than 36⁰C after spinal block (36.5 ±0.5 vs. 37.0 ±0.5; P=0.0001). Postoperative hypothermia was less common in those patient who were warmed inside OT than those who were not warmed (53.3% vs. 74.4%; P= 0.0002). There was a more significant difference in hypothermia between the patients who were actively warmed with a convection warmer and those who were not (26/75, 34.7% vs. 43/50, 86%; P= 0.0001). Only 21.6% of the hypothermic patients had shivering while 49.3% of the normothermic patients were noted to have shivering after spinal anaesthesia (P=0.0001).@*Conclusion@#Perioperative hypothermia is a major problem in women who have caesarean section under spinal anaesthesia at CWMH. Efforts directed toward routine temperature monitoring and aggressive maintenance of intraoperative normothermia in these women will very likely improve clinical outcomes and patient satisfaction.

The Effects of 30-Minutes of Pre-Warming on Core Body Temperature, Systolic Blood Pressure, Heart Rate, Postoperative Shivering, and Inflammation Response in Elderly Patients with Total Hip Replacement under Spinal Anesthesia: A Randomized Double-blind Co

PURPOSE: This study was designed to determine the effects of pre-warming on core body temperature (CBT) and hemodynamics from the induction of spinal anesthesia until 30 min postoperatively in surgical patients who undergo total hip replacement under spinal anesthesia. Our goal was to assess postoperative shivering and inflammatory response. METHODS: Sixty-two surgical patients were recruited by informed notice. Data for this study were collected at a 1,300-bed university hospital in Incheon, South Korea from January 15 through November 15, 2013. Data on CBT, systemic blood pressure (SBP), and heart rate were measured from arrival in the pre-anesthesia room to 3 hours after the induction of spinal anesthesia. Shivering was measured for 30 minutes post-operatively. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured pre-operatively, and 1 and 2 days postoperatively. The 62 patients were randomly allocated to an experimental group (EG), which underwent pre-warming for 30 minutes, or a control group (CG), which did not undergo pre-warming. RESULTS: Analysis of CBT from induction of spinal anesthesia to 3 hours after induction revealed significant interaction between group and time (F=3.85, p=.008). In addition, the incidence of shivering in the EG was lower than that in the CG (χ²=6.15, p=.013). However, analyses of SBP, heart rate, CRP, and ESR did not reveal significant interaction between time and group. CONCLUSION: Pre-warming for 30 minutes is effective in increasing CBT 2 and 3 hours after induction of spinal anesthesia. In addition, pre-warming is effective in decreasing post-operative shivering.

Effectiveness of Active Warming Intervention for Women Undergoing Cesarean Section: A Systematic Review and Meta-analysis / 기본간호학회지

PURPOSE: The aim of this study was to synthesize the best available evidence for active warming interventions during cesarean section. METHODS: A database search was done for randomized controlled trials utilizing active warming interventions. Maternal temperature, shivering and neonatal temperature were evaluated as outcome variables. Data were analyzed using Cochrane Review Manager software Version 5.3. RESULTS: Thirteen studies including 1306 patients were reviewed. The degree of lowering of maternal temperature decreased in the warmed fluids (MD 0.51; p=.004) and warming mattress interventions (MD 0.22; p<.001) compared with control groups. Incidence of shivering was also lower in the active warming group (OR 0.55; p=.003). There was no statistically significant difference in maternal temperature with a forced air warming intervention (MD 0.64; p=.15) or in neonatal temperature (MD 0.12; p=.26). CONCLUSION: Findings show that with warmed fluids and warming mattresses applied during cesarean sections maternal temperature decline was reduced and also the incidence of shivering declined, but no significant effect was observed for forced air warming interventions. These findings provide a basis for developing a warming guideline for women having a cesarean section and will help to improve the quality of care for cesarean section patients.

Analysis and nursing of postoperative hypothermia in patients with anesthesia recovery room / 中国生化药物杂志

Objective To analyze and analyze the causes of hypothermia after operation in patients with anesthesia recovery room and the nursing measures. Methods 68 cases of abdominal anesthesia surgery patients were divided into two groups randomly. The control group was given routine nursing measures, the experimental group was given nursing intervention measures, pay attention to the environmental factors, a reasonable adjustment of environmental temperature, hot water bag can be given when necessary, good oxygen nursing, prevention of shiver, warm. A comparative analysis of the experimental group and the control group of patients after rewarming time, temperature and shivering times index. Results After the corresponding nursing measures, the rewarming time of the experimental group was (30.90±2.32) min, significantly shorter than that of the control group (48.90±4.78) min, with statistical difference (P<0.05). The control group ran 19 times, the experimental group ran 6 times, with significant differences between the two groups (P<0.05). The stay time of the control group was (62.30±3.89) min, significantly longer than that of the experimental group, and the residence time was (38.90±5.78) min, with statistical difference (P<0.05). Conclusion Nursing measures for patients in anesthesia recovery room corresponding preventive care, shivering and heating nursing measures, can significantly reduce the number of warm, chills, shorten the thawing time.