Anestéziológia a intenzívna medicína 2/2016
Postanaesthetic shivering – epidemiology, pathophysiology, prevention and treatment options
Backround and objectives: Postanaesthetic shivering is unvolutary movement of one or more muscular groups that is usually seen in the early recovery period after general anaesthesia or just during neuroaxial anaesthesia in order to increase core temperature by increasing basal metabolic rate. During the shivering patients feel unpleasant sense of cold and many of them allege that this sense they will not like to feel anymore after surgery. The objective of this review is to enlighten causes and mechanisms of shivirering origin in perioperative period and also prevention and treatment options. Methods:Review of scientific literature in internet databases dealing with postanaestetic shivering issues. Results:According trials the postanesthetic shivering incidence is between 6,3 – 66 %. Risk group are young men and patients undergo prolonged surgery. From all of hypothesis that could explain postanaesthetic shivering occurence were confirmed only perioperative hypothermia and pain. Main clinical consequence of perioperative shivering is increased tissue oxygen consumption. Another consequence that exhibits on patient comfort is increased pain sensation as a result of muscular contractions in surgery wound. Shivering also interferes with monitoring equipments and increases intraocular nad intracranial pressure. Conclusion:Postanaesthetic shivering phenomenon has decreasing trend due to systematic perioperative hypothermia prevention which includes heat loss avoidance and active warming of patients and infusions during surgery. However, when shivering has already elapsed it should be treat systematicly in order to increase patient comfort and analgesia. Skin surface rewarming is less effective than pharmacological shivering treatment by pethidine, tramadol, dexamethasone or in spedcific situations by clonidine or dexmedetomidine.
Keywords: postanaesthetic shivering, perioperative shivering, perioperative hypothermia, prevention, treatment
