Postanesthetic shivering

Postanesthetic shivering
Classification and external resources

Postanesthetic shivering (PAS) is shivering after anesthesia.^[1]

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.

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.^[2]

References

↑ English W (2002). "Post-operative shivering, causes, prevention and treatment (letter)". Update in Anaesthesia 1 (3). Retrieved 8 September 2010.
↑ Alfonsi, P (2001). "Postanaesthetic shivering: epidemiology, pathophysiology, and approaches to prevention and management.". Drugs 61 (15): 2193–205. doi:10.2165/00003495-200161150-00004. PMID 11772130.

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.
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.
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.
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.

Anesthesia (outline)

Types	General Spinal Epidural Conduction anesthesia Local Topical Intercostal nerve block Sedation / Twilight anesthesia Dental (Inferior alveolar nerve) Neuroleptanalgesic anesthesia

Techniques	Airway management Anesthesia provision in the US Arterial catheter Bronchoscopy Capnography Dogliotti's principle Drug-induced amnesia Intraoperative neurophysiological monitoring Nerve block Penthrox inhaler Tracheal intubation

Scientific Principles	Blood–gas partition coefficient Concentration effect Fink effect Minimum alveolar concentration Second gas effect

Measurements	ASA physical status classification system Baricity Bispectral index Direct Fick method Entropy monitoring Fick principle Goldman index Guedel's classification Mallampati score Neuromuscular monitoring Thyromental distance

Instruments	Anaesthetic machine Anesthesia cart Boyle's machine Gas cylinder Laryngeal mask airway Laryngeal tube Medical monitor Odom's indicator Relative analgesia machine Vaporiser Double-lumen endotracheal tube Endobronchial blocker

Drugs	Benzodiazepine Etomidate General anaesthetic Inhalational anaesthetic Infiltration analgesia Ketamine Local anesthetic Methohexital Methoxyflurane Midazolam Neuraxial blockade Opiate Propofol Thiopental Thiopentone

Complications	Emergence delirium Allergic reactions Anesthesia awareness Local anesthetic toxicity Malignant hyperthermia Perioperative mortality Postanesthetic shivering Postoperative nausea and vomiting Postoperative residual curarization

Fields of study	Cardiothoracic Geriatric Oral sedation dentistry

Professions	Anesthesiologist Anesthesiologist assistant Nurse anesthetist Operating Department Practitioners Certified Anesthesia Technician Certified Anesthesia Technologist Anaesthetic technician

History	A.C.E. mixture Helsinki Declaration for Patient Safety in Anaesthesiology History of general anesthesia History of neuraxial anesthesia History of tracheal intubation

Organizations	American Association of Nurse Anesthetists American Society of Anesthesia Technologists & Technicians American Society of Anesthesiologists Anaesthesia Trauma and Critical Care Association of Anaesthetists of Great Britain and Ireland Association of Veterinary Anaesthetists Australian and New Zealand College of Anaesthetists Australian Society of Anaesthetists International Anesthesia Research Society

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Postanesthetic shivering

References

Further reading