POSTANESTHETIC SHIVERING

Postanesthetic shivering
Postanesthetic shivering
Specialty	Anesthesia

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

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.^[2] The anesthetic ketamine can also be used to manage postanesthetic shivering.^[3]

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.

References

^ English W (2002). "Post-operative shivering, causes, prevention and treatment (letter)". Update in Anaesthesia. 1 (3). Archived from the original on 29 May 2011. 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. S2CID 46962855.
^ Zhou, Y; Mannan, A; Han, Y; Liu, H; Guan, HL; Gao, X; Dai, MS; Cao, JL (30 December 2019). "Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: a systematic review and meta analysis". BMC Anesthesiology. 19 (1): 245. doi: 10.1186/s12871-019-0910-8. PMC 6937868. PMID 31888509.

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.

[English2002-1] English W (2002). "Post-operative shivering, causes, prevention and treatment (letter)". Update in Anaesthesia. 1 (3). Archived from the original on 29 May 2011. Retrieved 8 September 2010.

[2] 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. S2CID 46962855.

[3] Zhou, Y; Mannan, A; Han, Y; Liu, H; Guan, HL; Gao, X; Dai, MS; Cao, JL (30 December 2019). "Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: a systematic review and meta analysis". BMC Anesthesiology. 19 (1): 245. doi: 10.1186/s12871-019-0910-8. PMC 6937868. PMID 31888509.

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v t e Anesthesia and anesthesiology
Types	General Sedation Procedural sedation and analgesia Twilight anesthesia Local Continuous wound infiltration Topical Neuraxial blockade Combined spinal and epidural anaesthesia Epidural anesthesia Spinal anaesthesia Nerve block Brachial plexus block Fascia iliaca block Femoral nerve block Inferior alveolar nerve block Intercostal nerve block Interpleural block Intravenous regional anesthesia Occipital nerve block Paracervical block Pudendal nerve block Retrobulbar block Sciatic nerve block Transverse abdominis plane block Total intravenous anaesthesia
Pharmacologic agents	Anticholinergics Antiemetics Butyrophenones Benzodiazepines General anesthetics Inhalational anesthetics Local anesthetics Neuromuscular-blocking drugs Opioids Sedatives
Techniques	Airway management Anesthesia provision in the US Bronchoscopy Dogliotti's principle Intravenous therapy Laryngoscopy Tracheal intubation Rapid sequence induction
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 Body mass index Capnography Entropy monitoring Fick principle Goldman index Guedel's classification Intraoperative neurophysiological monitoring Mallampati score Neuromuscular monitoring Pain scale Thyromental distance
Instruments	Anaesthetic machine Anesthetic vaporizer Arterial catheter Bronchial blocker Double-lumen endobronchial tube Gas cylinder Laryngeal mask airway Laryngeal tube Magill forceps Relative analgesia machine Tracheal tube
Complications	Allergic reactions Anesthesia awareness Drug-induced amnesia Effects of early-life exposures to anesthesia on the brain Emergence delirium Local anesthetic toxicity Malignant hyperthermia Perioperative mortality Postanesthetic shivering Postoperative nausea and vomiting Postoperative residual curarization
Subspecialties	Cardiothoracic Critical emergency medicine Geriatric Intensive care medicine Obstetric Oral sedation dentistry Pain medicine
Professions	Anesthesiologist Anesthesiologist assistant Nurse anesthetist Operating department practitioners Certified anesthesia technician Certified anesthesia technologist Anaesthetic technician Physicians' assistant (anaesthesia)
History	ACE 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 Royal College of Anaesthetists Association of Veterinary Anaesthetists Australian and New Zealand College of Anaesthetists Australian Society of Anaesthetists International Anesthesia Research Society European Society of Anaesthesiology and Intensive Care
Category Outline

v t e Anesthesia and anesthesiology
Types	General Sedation Procedural sedation and analgesia Twilight anesthesia Local Continuous wound infiltration Topical Neuraxial blockade Combined spinal and epidural anaesthesia Epidural anesthesia Spinal anaesthesia Nerve block Brachial plexus block Fascia iliaca block Femoral nerve block Inferior alveolar nerve block Intercostal nerve block Interpleural block Intravenous regional anesthesia Occipital nerve block Paracervical block Pudendal nerve block Retrobulbar block Sciatic nerve block Transverse abdominis plane block Total intravenous anaesthesia
Pharmacologic agents	Anticholinergics Antiemetics Butyrophenones Benzodiazepines General anesthetics Inhalational anesthetics Local anesthetics Neuromuscular-blocking drugs Opioids Sedatives
Techniques	Airway management Anesthesia provision in the US Bronchoscopy Dogliotti's principle Intravenous therapy Laryngoscopy Tracheal intubation Rapid sequence induction
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 Body mass index Capnography Entropy monitoring Fick principle Goldman index Guedel's classification Intraoperative neurophysiological monitoring Mallampati score Neuromuscular monitoring Pain scale Thyromental distance
Instruments	Anaesthetic machine Anesthetic vaporizer Arterial catheter Bronchial blocker Double-lumen endobronchial tube Gas cylinder Laryngeal mask airway Laryngeal tube Magill forceps Relative analgesia machine Tracheal tube
Complications	Allergic reactions Anesthesia awareness Drug-induced amnesia Effects of early-life exposures to anesthesia on the brain Emergence delirium Local anesthetic toxicity Malignant hyperthermia Perioperative mortality Postanesthetic shivering Postoperative nausea and vomiting Postoperative residual curarization
Subspecialties	Cardiothoracic Critical emergency medicine Geriatric Intensive care medicine Obstetric Oral sedation dentistry Pain medicine
Professions	Anesthesiologist Anesthesiologist assistant Nurse anesthetist Operating department practitioners Certified anesthesia technician Certified anesthesia technologist Anaesthetic technician Physicians' assistant (anaesthesia)
History	ACE 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 Royal College of Anaesthetists Association of Veterinary Anaesthetists Australian and New Zealand College of Anaesthetists Australian Society of Anaesthetists International Anesthesia Research Society European Society of Anaesthesiology and Intensive Care
Category Outline

Description and treatment

Intensity

References

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Description and treatment

Intensity

References

Further reading

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