Thermoregulation, mild perioperative hypothermia and post-anaesthetic shivering

Buggy, Donal J.; Crossley, A. W. A.

doi:10.1093/bja/84.5.615

Cited by 308 publications

(188 citation statements)

References 118 publications

Supporting

Mentioning

160

Contrasting

Unclassified

Order By: Relevance

“…The option for prophylaxis means the unnecessary administration of drugs to several patients, exposing them to side effects. Since intraoperative body warming and maintenance of core temperature greatly influence the incidence of postoperative tremors 10 , the use of pharmacological prophylaxis is questioned. Patients in whom the cardiac supply of oxygen is compromised are a special case; in these cases, pharmacological prophylaxis is preferable, and clonidine should be the rational choice because, besides the anti-tremor effect, it has a favorable effect on the heart 79 .…”

Section: Resultsmentioning

confidence: 99%

“…Pode também gerar complicações, sobretudo em pacientes com doença coronariana devido ao aumento do consumo de oxigênio (O 2 ), de 100% a 600%; produção de gás carbônico (CO 2 ), resultando em maior ventilação por minuto e aumento no débito cardíaco 6 ; circulação de catecolaminas (aumento da freqüência cardíaca); além de diminuir a saturação de O 2 no sangue venoso misto [7][8][9] . É possível, também, haver aumento da pressão intracraniana e intra-ocular, interferência com ECG, aferição da oximetria de pulso 10 , pressão arterial, aumento do metabolismo e acidose láctica [7][8][9] . O tremor pós-operatório pode ser de dois tipos.…”

Section: Introductionunclassified

“…They can also lead to complications, especially in patients with coronary artery disease, due to an increase in oxygen consumption (O 2 ) by 100% to 600%, increase production of carbon dioxide (CO 2 ), resulting in reduced minute ventilation, increased cardiac output 6 , increase in circulating catecholamines (increased heart rate), besides decreasing O 2 saturation in mixed venous blood 7-9 . There can also be an increase in intracranial and intraocular pressures, interference with the ECG, pulse oximetry 10 , blood pressure, increase in metabolism, and cause lactic acidosis 7-9 . Postoperative tremors can be of two types: the first corresponds to the tremor associated with thermal regulation that is associated with vasoconstriction, being a physiological response to central or peripheral hypothermia 11,12 that develops in the intraoperative period; the second corresponds to the tremor associated with vasodilation or tremor not associated with thermal regulation 13 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Tremores intra e pós-operatório: prevenção e tratamento farmacológico

Albergaria

Lorentz²,

Lima³

2007

Rev. Bras. Anestesiol.

View full text Add to dashboard Cite

RESUMOAlbergaria VF, Lorentz MN, Lima FAS -Tremores Intra e Pós-Operatório: Prevenção e Tratamento Farmacológico. JUSTIFICATIVA E OBJETIVOS:Os tremores podem ocorrer como um efeito adverso da intervenção cirúrgica e anestesia. A incidência de tremores pós-operatórios varia entre 6,3% e 66%. Pacientes jovens, sexo masculino, uso de agentes anestésicos halogenados e tempo prolongado de anestesia ou procedimento cirúrgico estão relacionados com tremores. Os tremores são involuntários e apresentam-se como atividade muscular oscilatória com finalidade de aumentar a produção de calor. Tremor pós-operatório é uma desagradável complicação que está relacionada com o aumento de morbidade. O tremor aumenta o metabolismo, resultando em um acréscimo de 200% a 500% no consumo de oxigênio. CONTEÚDO:Discute as causas, a prevenção e o tratamento dos tremores intra-e pós-operatório em pacientes adultos e pediátri-cos submetidos à intervenção cirúrgica sob anestesia geral ou do neuroeixo. CONCLUSÕES:Os tremores são, juntamente com náuseas e vô-mitos, causas de intenso desconforto na sala de recuperação pós-anestésica, além de potencialmente prejudiciais por gerarem aumento da demanda metabólica. Embora a presença de tremores não tenha sido diretamente relacionada com a morbidade cardía-ca, a prevenção tem se tornado tema de debate e de vários artigos científicos. A prevenção e o tratamento de tremores devem ser implementados. Pacientes com reserva cardiopulmorar limitada podem sofrer com acidose láctica, dessaturação venosa mista e hipoxemia.Unitermos: ANESTESIA: Geral, Locorregional; COMPLICAÇÕES: hipotermia, tremor; TREMOR: prevenção, tratamento. SUMMARYAlbergaria VF, Lorentz MN, Lima FAS -Intra-and Postoperative Tremors: Prevention and Pharmacological Treatment. BACKGROUND AND OBJECTIVES:Tremors can be an adverse effect of the surgical intervention and anesthesia. The incidence of postoperative tremors varies from 6.3% to 66%. Young age, male gender, the use of halogenated anesthetics, and prolonged anesthesia or surgical procedure are related with tremors. Tremors are involuntary and present as oscillating muscular activity aiming at increasing heat production. Postoperative tremors are a disagreeable complication related with increased morbidity. Tremors increase the metabolism, resulting in a 200% to 500% increase in oxygen consumption. CONTENTS:The objective of this paper was to discuss the causes, prevention, and treatment of intra-and postoperative tremors in adults and children undergoing general anesthesia or neuroaxis anesthesia for surgical interventions. CONCLUSIONS:Tremors, along with nausea and vomiting, cause severe discomfort in the recovery room, besides being highly prejudicial because they generate an increase in the metabolism. Although the presence of tremors has not been directly related with cardiac morbidity, its prevention has become the subject of discussion and several scientific reports. Prevention and treatment of tremors should be implemented. Patients with limited cardiovascular reserve could devel...

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Introductionunclassified

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Tremores intra e pós-operatório: prevenção e tratamento farmacológico

Albergaria

Lorentz²,

Lima³

2007

Rev. Bras. Anestesiol.

View full text Add to dashboard Cite

show abstract

“…There is now convincing evidence that a typical amount of intraoperative hypothermia, of the order of 2°C, predisposes to complications and alters patient outcome. 4 Perioperative hypothermia was shown to prolong recovery, 5 to increase oxygen demands in the postoperative period, 6 to increase bleeding, 7,8 and to decrease surgical wound healing. 9 The role of fluid warming as an adjunct to prevent hypothermia during anesthesia has received significant coverage in the anesthesia literature.…”

Section: Discussionmentioning

confidence: 99%

Active warming of saline or blood is ineffective when standard infusion tubing is used: an experimental study

Bissonnette

Paut

2002

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose: To determine the effect of infusion rate, tubing length and fluid composition on the temperature of the infusate reaching the distal end of an infusion tubing with and without active fluid warming.Methods: Warmed normal saline (W-NS) and packed red blood cells (W-PRBC), were infused with a fluid warmer through a modified infusion set. The fluids were delivered at eight infusion rates from 50 to 999 mL·hr -1 . The infusate temperature was monitored at 20 cm intervals on the iv tubing. The same temperature monitoring protocol was applied to PRBC without warmer (NoW-PRBC).Results: In W-NS and W-PRBC groups, there was a decrease in the infusate temperature, at each flow rate, from the drip chamber to the distal end of tubing ( P <0.001). In NoW-PRBC group, there was a rapid increase in the infusate temperature from the bag to the drip chamber ( P <0.001). Thereafter, there was no change in temperature, except at the 999 mL·hr -1 infusion rate, where a slight increase in the infusate temperature throughout the tubing was shown. In W-NS and W-PRBC groups increasing the flow rate produced a significant increase in the infusate temperature, at each measurement point ( P <0.001). In the NoW-PRBC group, increasing the flow rate did not alter the infusate temperature. The fluid composition did not influence the infusate temperature.Conclusion: There is an important heat exchange within the tubing, which is aggravated at low flow rates. At infusion rates appropriate for pediatric anesthesia the clinical and economic value of fluid warming without the use of heated extension tubing is questionable.Objectif : Déterminer l'effet de la vitesse de perfusion, de la longueur de la tubulure et de la composition du liquide sur la température de la solution intraveineuse à la partie distale de la tubulure, le liquide étant soumis ou non à un réchauffement actif. Méthode : Une solution salée (SS-R) et un concentré de globules rouges réchauffés (CGR-R) ont été perfusés avec un ensemble à perfusion modifié comprenant un réchauffeur de liquide. Les liquides ont été administrés selon huit vitesses de perfusion, de 50 à 999 mL·h -1 . La température du soluté a été mesurée à des intervalles de 20 cm sur la tubulure iv. Le même protocole de surveillance de la tempéra-ture a été appliqué au CGR non réchauffé (CGR-NonR). Résultats : Dans les groupes SS-R et CGR-R, la température du liquide perfusé a baissé pour toutes les vitesses de perfusion, entre la chambre compte-gouttes et la partie distale de la tubulure (P < 0,001). Dans le groupe CGR-NonR, elle a augmenté rapidement, entre le sac et la chambre compte-gouttes (P < 0,001). Par la suite, il n'y a pas eu

show abstract

“…Post pada jam pertama termasuk saat sebelum bayi dilahirkan. Anesthetic Shivering (PAS) atau menggigil pasca-anestesia terjadi pada 5-65% pasien yang menjalani anestesi umum Opioid dan anestesia lokal menggunakan efek dan lebih kurang 33-56,7% pasien dengan anestesia antinosiseptif yang dimiliki pada korda spinalis dengan regional (1,2). mekanisme yang berbeda-beda.…”

Section: Pendahuluanunclassified

FentanylIntratekal Mencegah Menggigil Pasca Anestesi Spinal pada Seksio Sesaria

Isngadi

2013

JKB

View full text Add to dashboard Cite

ABSTRAKMenggigil pasca-anestesia dapat merugikan metabolisme tubuh. Salah satu cara yang diduga efektif secara farmakologis adalah dengan penambahan fentanyl intratekal saat dilakukan anestesi spinal. Penelitian eksperimental acak tersamar ganda dilakukan di kamar operasi RSU dr. Syaiful Anwar Malang untuk mengetahui efek fentanyl intratekal terhadap kejadian menggigil pada pasien seksio sesaria dengan anestesia spinal. Pasien yang menjalani operasi seksio sesaria sebanyak 40 orang, dibagi secara acak berdasarkan kelompok fentanyl 20 µg ditambahkan pada bupivacaine 0,5%H 10 mg dan kelompok bupivacaine 0,5%H 10 mg murni. Setelah dilakukan anestesi spinal, pasien dievaluasi dan dicatat tiap 5 menit sampai menit ke 60. Kejadian dan intensitas menggigil diukur dengan skala Crossley dan Mahajan. Hasil kedua kelompok dibandingkan menggunakan uji t tidak berpasangan, uji korelasi waktu pengukuran dan kejadian menggigil, uji fisher exact test, serta uji ANOVA dan Post Hoc untuk mengevaluasi masing-masing derajat menggigil. Hasil uji t menunjukkan kejadian menggigil pada kelompok kontrol lebih tinggi daripada kejadian menggigil pada kelompok perlakuan (p=0,002). Uji Fisher exact test menunjukkan hubungan signifikan (p=0,006) antara perlakuan dengan kejadian menggigil. Kelompok kontrol risiko untuk mengalami kejadian menggigil bila dibandingkan kelompok perlakuan (OR=10,99; 95% CI= 2,00-58,82). Uji ANOVA menunjukkan perbedaan signifikan kejadian menggigil selama operasi antara kelompok kontrol dan perlakuan berdasarkan setiap derajat menggigil (p=0,000). Efek samping berupa mual muntah ditemukan sesudah operasi pada 25% pasien dengan penambahan fentanyl. Dapat disimpulkan bahwa penambahan fentanyl intratekal dapat menurunkan risiko menggigil dengan efek samping mual dan muntah yang minimal (OR=10,99; 95% CI= 2,82). ANOVA test revealed a significant difference of shivering incident during surgery between control and intervention group based on degree of shivering (p=0,000). The side effect (nausea and vomitus) was found after operation in 25% subjects in fentanyl group. It can be concluded that fentanyl intratechal administration has potential benefit for reducing post anesthetic shivering with minimal side effect.

show abstract

Thermoregulation, mild perioperative hypothermia and post-anaesthetic shivering

Cited by 308 publications

References 118 publications

Tremores intra e pós-operatório: prevenção e tratamento farmacológico

Tremores intra e pós-operatório: prevenção e tratamento farmacológico

Active warming of saline or blood is ineffective when standard infusion tubing is used: an experimental study

FentanylIntratekal Mencegah Menggigil Pasca Anestesi Spinal pada Seksio Sesaria

Contact Info

Product

Resources

About