PostanestheticShivering.pptVIP

2003/11/26 Chih-Min Liu Postanesthetic Shivering Epidemiology, Pathophysiology, Prevention and Management Reference Perioperative Shivering Physiology and Pharmacology Anesthesiology 2002; 96: 467-84 Postanesthetic Shivering Epidemiology, Pathphysiology, and Approaches to Prevention and Management Drugs 2001; 61 (15): 2193-2205 Clinical Anesthesiology, third edition Chapter 6: Patient monitors; 117-120 Clinical Considerations Hypothermia: 36 oC O2 consumption x 5; decrease saturation; myocardial ischemia and angina Increased mortality rate Monitoring site: Tympanic membrane: brain temperature Nasopharyngeal mucosa: core temperature Rectum: slow response in change to core temp Esophagus Epidemiology 40-60% after volatile anesthetics Young male adult, rare in elder (age impairs thermoregulatory control) Length of anesthesia or surgery Peri-op rewarming procedure: if not Mild hypothermia The more serious hypothermia, the higher the probability Anesthetic used Less common with propofol; more with halogenated agent, pentothal Pathophysiology Consequence of postanesthetic shivering Discomfort Increased pain IICP, IOP O2 consumption (VO2): more 40 – 120% Increased minute ventilation Cardiac morbidity Pathophysiology Two types of postanesthetic shivering Thermoregulated shivering With cutaneous vasoconstriction, the response of hypothermia Perioperative hypothermia Non-thermoregulated shivering Mechanism unknown Postoperative pain related? Pathophysiology Origins of Postanesthetic Shivering Perioperative hypothermia Postoperative pain Perioperative heat loss Direct effect of certain anesthetics Hypercapnia or respiratory alkalosis The existence of pyogens Hypoxia Early recovery of spinal reflex activity Sympathetic overactivity Perioperative hypothermia Phase I: 1st hour Internal redistribution: from center to peripheral Phase II: 2-4 hours Heat loss: skin, viscera Phase III: Steady-state Pathophysiology Early recovery of spinal reflex activity Residual effect