| Postanesthetic shivering | |
|---|---|
| Specialty | Anesthesia |
Postanesthetic shivering (PAS) is shivering after anesthesia.
Description and treatment
Postanesthetic shivering is one of the leading causes of discomfort in patients recovering from general anesthesia. It usually results due to the anesthetic inhibiting the body's thermoregulatory capability, although cutaneous vasodilation (triggered by post-operative pain) may also be a causative factor. First-line treatment consists of warming the patient; more persistent/severe cases may be treated with medications such as tramadol, pethidine, clonidine, and nefopam, which work by reducing the shivering threshold temperature and reducing the patient's level of discomfort. As these medications may react and/or synergize with the anesthetic agents employed during the surgery, their use is generally avoided when possible. The anesthetic ketamine can also be used to manage postanesthetic shivering.
Intensity
The intensity of PAS may be graded using the scale described by Crossley and Mahajan:
- 0 = no shivering;
- 1 = no visible muscle activity but piloerection, peripheral vasoconstriction, or both are present (other causes excluded);
- 2 = muscular activity in only one muscle group;
- 3 = moderate muscular activity in more than one muscle group but no generalized shaking;
- 4 = violent muscular activity that involves the whole body.
Further reading
- Crossley AW, Mahajan RP (March 1994). "The intensity of postoperative shivering is unrelated to axillary temperature". Anaesthesia. 49 (3): 205–7. doi:10.1111/j.1365-2044.1994.tb03422.x. PMID 8147511. S2CID 205247789.
- Buggy DJ, Crossley AW (May 2000). "Thermoregulation, mild perioperative hypothermia and postanaesthetic shivering". Br J Anaesth. 84 (5): 615–28. doi:10.1093/bja/84.5.615. PMID 10844839.
- Alfonsi P (May 2003). "Postanaesthetic shivering. Epidemiology, pathophysiology and approaches to prevention and management". Minerva Anestesiol. 69 (5): 438–42. PMID 12768180.
- Kranke P, Eberhart LH, Roewer N, Tramèr MR (February 2002). "Pharmacological treatment of postoperative shivering: a quantitative systematic review of randomized controlled trials". Anesth. Analg. 94 (2): 453–60. doi:10.1213/00000539-200202000-00043. PMID 11812718. S2CID 12094935.
- Kranke P, Eberhart LH, Roewer N, Tramèr MR (September 2004). "Single-dose parenteral pharmacological interventions for the prevention of postoperative shivering: a quantitative systematic review of randomized controlled trials". Anesth. Analg. 99 (3): 718–27. doi:10.1213/01.ANE.0000130589.00098.CD. PMID 15333401. S2CID 35191305.
- Eberhart LH, Döderlein F, Eisenhardt G, et al. (December 2005). "Independent risk factors for postoperative shivering". Anesth. Analg. 101 (6): 1849–57. doi:10.1213/01.ANE.0000184128.41795.FE. PMID 16301273. S2CID 5752644.
