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

ABSTRACT

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.