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Post Anaesthetic Shaking

Published online by Cambridge University Press:  25 February 2009

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Abstract

Bastien (1950), cited by Horn et al (1998b) first described post anaesthetic shaking over fifty years ago. Although the existence of this phenomenon is well documented, definition, cause and the benefits of individual treatments remain open for debate (Fotheringham 1998). However the mechanism for Post Anaesthetic Shaking (PAS) remains unclear (Sessler and Sessler 1998b), although the literature does suggest hypothermia is a factor, as too might be pain and stress. There are many variables effecting whether a patient will develop PAS. As much controversy remains regarding this condition the rationale for undertaking this paper is to improve care by broadening knowledge and thus allowing rapid and effective treatment to reduce the discomfort and distress experienced by the patient. This article is presented as a critical incident. Implications, for practice arising from this work suggest that more frequent monitoring and early intervention would enhance the available treatments. Further to this it appears that warming patients preoperatively, particularly those groups known to be at risk would reduce the incidence of hypothermia and consequently post anaesthetic shaking. Recommendations for future research would be further investigation in to the suggestion that body temperature need only vary by 0.2°C to affect a bodily response (such as shivering).

Type
Research Article
Copyright
Copyright © British Association of Anaesthetic and Recovery Nursing 2002

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References

Alfonsi, P. Hongnat, J. Lebrault, C. and Chauvin, M. (1995) The effects of pethadine, fentynal and lignocaine on postanaesthetic shivering. Anaesthesia 50: 214217Google Scholar
Annadata, R. Sessler, D. and Kurz, A. (1995) Desflurane slightly increases the sweating threshold but produces marked, nonlinear decreases in the vasoconstriction and shivering thresholds. Anesthesiology 83; 12051211Google Scholar
Baxendale, B. Mahajan, R. and Crossley, A. (1994) Anticholinergic premedication influences the incidence of postoperative shivering. British Journal of Anaesthesia 72: 2991–294.CrossRefGoogle ScholarPubMed
Belin, B. Shavit, Y. and Razumovsky, J. (1998) Effects of mild perioperative hypothermia on cellular immune responses. Anesthesiology 89: 1133–40.Google Scholar
Connor, E. and Wren, K. (2000) Detrimental effects of hypothermia: a system analysis. Journal of Peri Anaesthesia Nursing. 15 (3) 151155.Google Scholar
Crossley, A. (1992) Six months of shivering in a district general hospital. Anaesthesia 47: 845848.Google Scholar
Crossley, A. (1992) Peri–operative shivering. Anaesthesia 47: 193195.CrossRefGoogle ScholarPubMed
Crossley, A. and Mahajan, R. (1994) The intensity of postoperative shivering is unrelated to axillary temperature. Anaesthesia 49: 205207CrossRefGoogle ScholarPubMed
Fortheringham, D. (1998) Post–anaesthetic shaking. Surgical Nurse. 4 (15) 857860Google Scholar
Fossum, S. Hays, J. and Henson, M. (2001) A comparison study on the effects of prewarming patients in the outpatients surgery setting. Journal of Perianesthesia Nursing. 16: (3) 187194.CrossRefGoogle Scholar
Haltzclaw, (1990) Shivering: a clinical nursing problem. Nursing Clinics of North America 25: (4) 977986CrossRefGoogle Scholar
Holdcroft, A. and Hall, G. (1978) Heat loss during anaesthesia. British Journal of Anaesthesia 50: 157164.CrossRefGoogle ScholarPubMed
Horn, E. Werner, C. Sessler, D. and Steinfath, M. (1997) Late intraoperative Clonidine administration prevents postanaesthetic shivering after total intravenous or volatile anesthesia. Anesthesia Analgesia 84: 613–7.Google ScholarPubMed
Horn, E. Sessler, D. and Standl, T. (1998a) Physostigmine prevents postanesthetic shivering as does Meperidine of Clonidine. Anaesthesiology 88: (1) 108113CrossRefGoogle ScholarPubMed
Horn, E. Sessler, D. and Standl, T. (1998b) Nontheromregulatory shivering in patients recovering from Isoflurane or Desflurane Anaesthesia. Anesthesiology 89 (4) 878886CrossRefGoogle ScholarPubMed
Horn, E. Schroeder, F. Wihelm, S, JUULSessler, D. (1999) Postoperative pain facilitates nonthermoregulatory tremor. Anaesthesiology 91: 979–84.Google Scholar
Jeran, L. (2001) Patient temperature; an introduction to the clinical guideline for the prevention of unplanned perioperative hypothermia. Journal of Perianaesthesia Nursing. 16: (5) 303304.CrossRefGoogle Scholar
Johns, C. (1995) The value of reflective practice for nursing. Journal of Clinical Nursing. 4: 2330Google Scholar
Joris, J. Banuche, M. Bonnet, F. Sessler, D. and Lamy, M. (1993) Clonadine and ketanserin are both effective treatments for post–anaesthetic shivering. Anaesthesiology 79: 532–9CrossRefGoogle Scholar
Just Trevien, V. and Delva, E. (1993) Prevention of intraoperative hypothermia by preoperative skin–surface warming. Anesthesiology 79 (2) 214218Google Scholar
Kelly, J. Doughty, J. Hasselbeck, A. and Vacchiano, C. (2000) The effects of arthroscopic irrigation fluid warming on body temperature. Journal of Perianesthesia Nursing 15: (4) 245252.CrossRefGoogle ScholarPubMed
Kurz, A. Sessler, D. and Ledhardt, R. (1996) Perioperatoive normorethermia to reduce the incidence of surgical–wound infection and shorten hospitalisation. New England Journal of Medicine 334: 1912091215.CrossRefGoogle Scholar
Lendhardt, R. Marker, E. Goll, V. and Tschernich, H. (1997) Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology 87: 1318–23.CrossRefGoogle Scholar
Leslie, K and Sessler, D. (1996) Reduction in shivering threshold is proportional to spinal block height. Anesthesiology 84; 1327–31CrossRefGoogle ScholarPubMed
Lonning, P. (1986) Accidental hypothermia. Review of the Literature. Acta Anaesthesiol Scand 30: 601613.Google Scholar
Lyons, B. Taylor, A. Power, C and Cassey, W. (1996) Post anaesthetic shivering in children. Anaesthesia 51: 442445Google Scholar
Matsukana, T. (1995) Propofol linearly reduces the vasoconstriction and shivering threshold. Anesthesiology 82: (5) 1169–80CrossRefGoogle Scholar
Melling, A. Ali, B. Scott, E. and Leaper, D. (2001) Effects of preoperative warming on the incidence of wound infection after surgery: a randomised controlled trial. The Lancet 358: 876880.CrossRefGoogle ScholarPubMed
Moss, R. (1998) Inadvertent perioperative hypothermia. AORN Journal 67: (2) 460463.Google Scholar
Nicoluou, G. Chen, A. Johnston, C. Kenny, G. and Bristow, G. (1997) Clonidine decreases vasoconstriction and shivering thresholds, without affecting sweating threshold. Canadian Journal of Anaesthesia 44: (6) 636642Google Scholar
Pauca, A. Savage, R. Simpson, S. and Roy, R. (1984) Effect of pethadine, fentynal and morphine on post–operative shivering in man. Acta Anaesthesiol Scand 28: 138143CrossRefGoogle Scholar
Plattner, O. Takehiko, I. and Sessler, D. (1997) Post anaesthetic vasoconstriction slows peripheral to core transfer of cutaneous heat, thereby isolating the core thermal compartment. Anaesthesia Analgesia 85: 899–90.CrossRefGoogle Scholar
Sessler, D. Israel, D. Pozos, R. and Pozos, M. (1988) Spontaneous postoperative tremor does not resemble thermoregulatory shivering. Anesthesiology 68: 843850Google Scholar
Sessler, D. I. (1991) Physiological response to mild perianesthetic hypothermia in humans. Anesthesiology 75: 594610.CrossRefGoogle ScholarPubMed
Sessler, D. I.(1997) Mild Perioperative Hypothermia. New England Journal of Medicine. 336: 1730–7CrossRefGoogle ScholarPubMed
Sessler, D. and Sessler, A. (1998a) Experimental determination of heat flow parameters during induction of general anaesthesia. Anesthesiology 89: 757–65CrossRefGoogle Scholar
Sessler, D. (1998b) A proposal for new temperature monitoring and thermal management guidelines. Anesthesiology 89: (5) 12981300.CrossRefGoogle ScholarPubMed
Shah, J. Hudson, J. Keenan, R. and Simpson, P. (1992) Hypothermia and its impact on the post anesthesia care unit. Anesthesiology 77: (3) 266269Google Scholar
Singh, P. Dimitriou, V. Mahajan, R. and Crossley, A. (1993) Double–blind comparison between doxapram and pethadine in the treatment of postanaesthetic shivering. British Journal of Anaesthesia 71: 685688.Google Scholar
Sharkey, A. (1993) Effects of radiant heat on the metabolic cost of postoperative shivering. British Journal of Anaesthesia 70: 449450CrossRefGoogle ScholarPubMed
Takehiho, I. Jin–Soo, M. Sessler, M. and Chiharu, N. (1998) Isloflurane alters shivering patterns and reduces maximum shivering intensity. Anesthesiology. 88: 866–73Google Scholar
Vaughan, R. (1981) Postoperative hypothermia in adults: relationship of age, analgesia, and shivering to rewarming Analgesia Anaesthesia 60: 746–51CrossRefGoogle Scholar
Vassiheff, N. Rosencher, N. Sessler, D. (1995) Shivering threshold during spinal anaesthesia is reduced in elderly patients Ansethesiology 83: 11621166CrossRefGoogle Scholar
Vogelsang, J. (1993) Patients who develop postanaesthesa shaking increase body temperature at the same rate as those who do not develop shaking. Journal of Postanaesthesa Nursing 8 (1) 312Google Scholar
Wallis, R. (2000a) Post Anaesthetic Shaking: A Review of the Literature. Nursing Praxis in New Zealand. 15: 2332Google Scholar
Wallis, R. (2000b) Preventing post–anaesthetic shaking. KaiTiaki Nursing New Zealand November PG 2224Google Scholar
Washington, D. Sessler, D. and Moayeri (1993) Thermoregulatory response to hypothermia in humans. Journal of Applied Physiology 74: 8287CrossRefGoogle Scholar
Wrench, I. Singh, P. Dennis, A. Mahajan, R. and Crossley, A. (1997) The minimum effective doses of pethadine and doxapram in the treatment of postanaesthetic shivering. Anaesthesia 52: 3236Google Scholar
Xiong, J. Kurz, A. Sessler, M. Plattner, O. Christensen, R. Dechert, M. and Takahiko, I. (1996) Isoflurane produces marked non–linear decreases in the vasoconstriction and shivering thresholds. Anaesthesiology 85: 240–45CrossRefGoogle Scholar