Six months of shivering in a district general hospital

Abstract

SummaryOf 2595 patients admitted to a recovery room in Derbyshire Royal Infirmary over a 6-month period, 164 (6.3%) shivered postoperatively. Data regarding the anaesthetic techniques to which these patients had been subjected were gathered from the Derby Anaesthetic Audit System. Subsequent analysis demonstrated the importance of a number of factors that led to shivering, including male gender, anaesthetic techniques involving spontaneous ventilation. and anticholinergic premedication. The administration of pethidine. alfentanil or morphine intra-operatively reduced the incidence of shivering postoperatively.

Postanaesthetic shivering in children

“…Consequently oxygen consumption may increase by up to 500%, with a concomitant increase in carbon dioxide production [I]. It has been shown to be more common with decreasing age in adults [2], but its true incidence is uncertain. Moir and Doyle found that between 17 and 32% of children shivered following halothane anaesthesia [3].…”

A reply

“…Anticholinergic premedication increases the incidence of postanaesthetic shivering, by a peripheral mechanism that is postulated to involve alteration in skin blood flow [8]. A similar line of reasoning could lead one to suggest other possible mechanisms of action which could include serotonergic effects since ketanserin reduces postanaesthetic shivering [9] or an effect on peripheral vasodilatation. The latter is mimicked by clonidine which also reduces shivering postoperatively [9].…”

“…A similar line of reasoning could lead one to suggest other possible mechanisms of action which could include serotonergic effects since ketanserin reduces postanaesthetic shivering [9] or an effect on peripheral vasodilatation. The latter is mimicked by clonidine which also reduces shivering postoperatively [9].…”

“…The Occurrence of shivering is influenced by many factors [8,9], but all these factors have not been controlled in any published clinical study and therefore a definitive conclusion may be premature. The aim of our study was to compare the effects of various drugs on the treatment of the postanaesthetic shivering and not to verify if its occurrence is linked to core hypothermia.…”

“…A similar line of reasoning could lead one to suggest other possible mechanisms of action which could include serotonergic effects since ketanserin reduces postanaesthetic shivering [9] or an effect on peripheral vasodilatation. The latter is mimicked by clonidine which also reduces shivering postoperatively [9].Finally the use of pethidine to arrest postoperative shivering should not be undertaken lightly in hypothermic patients as they may fail to rewarm and may in fact become Anaesthesia, Volume 50, November 1995 cooler [lo]. Whilst postoperative shivering is not an efficient means of rewarming, it is often sufficient to maintain core temperature against an adverse environmental temperature.…”