Objective: The aim of study was to identify risk factors that can be modified to reduce incidence of postoperative shivering in normothermic patient who underwent general anesthesia.Material and Methods: A retrospective case control study was conducted between January 2017 and August 2018 by assessing the anesthetic records of normothermic patients at a post anesthesia care unit who underwent general anesthesia. A control group of 201 patients was randomly matched with 201 cases by age (±5 years) and site of surgery. Medical records were reviewed for data including patient demographics, operative time, anesthetic medication, type of fluid, core temperature at the end of surgery and occurrence of postoperative shivering. Conditional logistic regression analysis was performed to assess the association between potential risk factors and postoperative shivering.Results: Higher body mass index (BMI) [odds ratio (OR) 0.91, 95% confidence interval (CI) 0.87-0.96] and higher core temperature at end of surgery (OR 0.33 95% CI 0.18-0.63) are associated with reduced risk of postoperative shivering. Whereas emergency case compared with elective case (OR 3.06 95% CI 1.63-5.72) and longer duration every 10 minutes (OR 1.05 95% CI 1.03-1.08) are associated with an increased risk of postoperative shivering.Conclusion: Emergency case, longer duration of surgery, lower BMI and lower core temperature at end of surgery were significantly associated with postoperative shivering.

Background: Prolonged preoperative fasting can cause hypoglycemia, hyperglycemia, and intravascular volume depletion in children. We aimed to examine whether prolonged preoperative fasting is associated with in-hospital mortality and other morbidities in pediatric cardiothoracic surgery. Methods: This retrospective cohort study included children aged 0-3 years who underwent cardiac surgery between July 2014 and October 2020. The patient demographic data, surgery-related and anesthesia-related factors, and postoperative outcomes, including hypoglycemia, hyperglycemia, sepsis, length of intensive care unit stay, and in-hospital mortality, were recorded. The main exposure and outcome variables were prolonged fasting and time-to-death after surgery, respectively. The associations between prolonged fasting and perioperative death were analyzed using multivariate Cox regression analysis. Results: In total, 402 patients were recruited. The incidence of perioperative mortality was 21% (85/402). The proportion of perioperative deaths was significantly higher in the prolonged fasting group than that in the normal fasting group. The proportion of postoperative bacteremia and hypoglycemia was significantly higher in the very prolonged fasting group than that in the prolonged fasting group. After adjusting for preoperative conditions and anesthesia-and surgery-related factors, preoperative prolonged fasting >14.4 h was significantly associated with time-to-death (HR [95% CI]: 2.2 [1.2, 3.9], p = 0.036). The 30-day survival rates of fasting time >14.4 h, 9.25-14.4 h, and <9.25 h were 0.67 (0.55, 0.81), 0.79 (0.72, 0.87), and 0.85 (0.79, 0.91), respectively. Conclusions: Preoperative fasting of more than 14.4 h was associated with a two-fold increase in the hazard rate of time-to-death in children who underwent cardiac surgery.