Prevalence, associated factors and treatment of post spinal shivering in a Sub-Saharan tertiary hospital: a prospective observational study.

Tonny Stone Luggya,Joseph Bahe Tindimwebwa,Cephas Mijumbi,Richard Nicholas Kabuye,Andrew Kintu

doi:10.1186/s12871-016-0268-0

Tonny Stone Luggya, Joseph Bahe Tindimwebwa + Show 3 more

Open Access

https://doi.org/10.1186/s12871-016-0268-0

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Journal: BMC anesthesiology	Publication Date: Oct 18, 2016
Citations: 49	License type: cc-by

Affiliation: Makerere University, Mulago Hospital

Abstract

BackgroundSurgery and anaesthesia cause shivering due to thermal dysregulation as a compensatory mechanism and is worsened by vasodilatation from spinal anaesthesia that redistributes core body heat. Due to paucity of data Mulago Hospital’s post spinal shivering burden is unknown yet it causes discomfort and morbidity.MethodsEthical approval was obtained to perform the study among consenting mothers due for elective caesarean section from March to May 2011. We recruited ASA class I & II parturients and excluded non-consenting or spinal contra-indication patients. A standard spinal anaesthetic of 2mls of 0.5 % bupivacaine was given, intraoperative vitals were recorded every 5 min and we monitored for perioperative shivering till PACU discharge.ResultsWe recruited 270 patients with majority being emergency caesarean deliveries (90.74 %), mainly due to failed progress from cephalopelvic disproportion. We noted 8.15 % shivering occuring mostly at 20 min, with hypotension plus hypothermia as associated factors. Intravenous pethidine (Meperidine) 25 mg effectively treated shivering and we had drowsiness, nausea and vomiting as PACU side effects that resolved on discharge to the ward.ConclusionPost spinal shivering had a prevalence of 8.15 %, commonly occurred at 20 min postoperatively with hypotension plus hypothermia as main associated factors and intravenous Pethidine controlled it.

Highlights

Surgery and anaesthesia cause shivering due to thermal dysregulation as a compensatory mechanism and is worsened by vasodilatation from spinal anaesthesia that redistributes core body heat
Exact causes of post spinal shivering are still unclear though various mechanisms have been postulated with some attributing it to a thermoregulatory response to hypothermia that causes temperatureinduced changes of neurons in the mesencephalic reticular formation and dorsolateral pontine and medullary reticular formation [7]
Oscillatory muscular activity that augments metabolic heat production up to 600 % above basal metabolic level [8] and clinically is associated with clonic or tonic skeletal muscle hyperactivity of different frequencies [9]. This increased muscular activity leads to increased oxygen consumption and carbon dioxide production that results in hypoxaemia, hypercarbia and lactic acidosis which are discomforting and worsens pain sensation [6]

Summary

Introduction

Surgery and anaesthesia cause shivering due to thermal dysregulation as a compensatory mechanism and is worsened by vasodilatation from spinal anaesthesia that redistributes core body heat. Exact causes of post spinal shivering are still unclear though various mechanisms have been postulated with some attributing it to a thermoregulatory response to hypothermia that causes temperatureinduced changes of neurons in the mesencephalic reticular formation and dorsolateral pontine and medullary reticular formation [7]. It is an involuntary, oscillatory muscular activity that augments metabolic heat production up to 600 % above basal metabolic level [8] and clinically is associated with clonic or tonic skeletal muscle hyperactivity of different frequencies [9]. We sought to determine the prevalence, associated factors and effect of intravenous pethidine (meperidine) on post spinal shivering among mothers undergoing spinal anaesthesia for caesarean section delivery at MNRTH

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Conclusion