Nursing care for postanesthesia shivering

Abstract

Patient shivering during recovery from anesthesia is often observed by the recovery room nurse. This reaction usually passes quickly, and the recovery room nurse may be concerned mainly for the comfort of the patient who looks cold or who complains of feeling cold. However, gross untreated shivering may lead to increased muscle activity and to cardiac stress if muscle activity and hypoxia persist. What can be done to avoid hypoxia, reduce cardiac stress, and provide comfort for the patient who experiences postanesthesia shivering? Nurses on the postanesthesia recovery unit (PARU) at Seattle Veterans Administration Medical Center (VAMC) have assisted in medical research of postanesthetic shivering. As a result of this research, we believe patient shivering is a hypothermia problem. This paper presents a brief literature review and describes a nursing care plan we have developed. The recovery room nurse should first understand some of the physiological factors and postoperative difficulties tha t predispose a patient to postanesthetic shivering. There are two types of postoperative muscle activity, according to Soliman. The first is spasticity, which is defined as “sustained muscular hypertonicity” observed in the jaw, neck, and pectoral muscles; flexors of the upper limbs: and the extensors and adductors ofthe lower limbs. In Soliman’s studies, spasticity lasted six to seven minutes depending on the patient’s rate of return to consciousness and disappeared when the patient responded to oral commands. According to Soliman, spasticity seems to be a part of normal emergence from anesthesia. Shivering, the second type of postoperative muscle activity, is a “rhythmic contraction of muscle groups with irregular intermittent periods of relaxation.” Shivering occurred in fewer than half of the 215 patients Soliman studied. It seemed largely related to temperature loss during the operative procedure and occurred after the patient could respond to simple commands. Shivering lasted an average of nine to ten minutes. The patient complained of being cold, and piloerection was observed.2 Basic to body heat loss is the temperature gradient. The operating room temperature influences a change in body temperature, according to Pflug. A patient with a normal temperature of 37 C experiences an operating room temperature of 20 C to 25 C. The possible degrees of heat loss or ambient temperature gradient is 12 C to 17 C.3 Several factors occurring during surgery allow cool environmental temperature to lower the patient’s core temperature. One is the length of time the patient is exposed to inhalation ane~thes ia .~ Halothane anesthesia is a d-