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ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2010, Number 2

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An Med Asoc Med Hosp ABC 2010; 55 (2)

Desaturation, possible factor associated with transanesthetic tremor in patients undergoing cesarian section under regional anesthesia

Montoya PT, Valdez OR, Jiménez RA, Cardona HG, Romo VEU, Hurtado RC, Luna OP

Language: Spanish
References: 18
Page: 66-70
PDF size: 55.05 Kb.


ABSTRACT

Introduction: Shivering like tremor is a common anesthetic complication associated with increased morbidity perioperative increasing oxygen consumption up to 600%. Shivering associated with spinal and epidural anesthesia occurs in 56.7% of patients, it is uncomfortable and can interfere with electrocardiographic monitoring, blood pressure and oxygen saturation. Previous publications have identified associated factors with shivering; however these are not consistent in the literature. Objective: To determine the frequency of shivering like tremor and evaluate possible associated factors. Methods: Observational, retrospective, descriptive, cases and controls. We included 50 patients ASA I-III from Hospital Adolfo López Mateos del ISSSTE. We applied descriptive statistics, parametric and nonparametric according to the variables distribution, considering a p ‹ 0.05 as significant. Results: The overall population characteristics were: Age 30.4 ± 7.3 years, temperature 36.4 ± 0.3 °C, anesthetic time 85.8 ± 22.2 minutes, surgical time 67.6 ± 19.3 minutes, epidural anesthesia 56.8%, 43.2% mixed anesthesia, desaturation 34%. Thirteen patients (26%) developed shivering like tremor. Univariate analysis showed a desaturation with OR 3.2, 95% CI 1.0-11.6 (p = 0.08) for shivering. Conclusion: Our results showed the desaturation as a possible factor associated with transanesthetic shivering and though our results do not show causation, we highlight the clinical significance of this association.


REFERENCES

  1. Sessler DI, Rubinstein EH, Moayeri A. Physiological responses to mild perianesthetic hypothermia in humans. Anesthesiology 1991; 75: 594-610.

  2. Crossley AW. Six months of shivering in a district general hospital. Anesthesia 1992; 47: 845-848.

  3. Chen JC, Hsu SW, Hu LH, Hong YJ, Tsai PS, Lin TC, Lin CF, Wei TT. Intrathecal meperidine attenuates shivering induced by spinal anesthesia. Ma Zui Xue Za Zhi 1993; 31 (1): 19-24.

  4. Ciofolo MJ, Clergue F, Devilliers C, Ben Ammar M, Viars P. Changes in ventilation, oxygen uptake, and carbon dioxide output during recovery from isoflurane anesthesia. Anesthesiology 1989; 70 (5): 737-741.

  5. Guffin A, Girard D, Kaplan JA. Shivering following cardiac surgery: Hemodynamic changes and reversal. Journal of Cardiothoracic Anesthesia 1987; 1 (1): 24-28.

  6. Piper SN, Fent MT, Röhm KD, Maleck WH, Suttner SW, Boldt J. Urapidil does not prevent postanesthetic shivering: a dose-ranging study. Can J Anaesth 2001; 48 (8): 742-747.

  7. De Witte J, Sessler DI. Perioperative shivering: Physiology and pharmacology. Anesthesiology 2002; 96 (2): 467-484.

  8. Crossley AW, Mahajan RP. The intensity of postoperative shivering is unrelated axillary temperature. Anaesthesia 1994; 49: 205-207.

  9. Horn EP. Postoperative shivering: Aetiology and treatment. Curr Opin Anaesthesiol 1999; 12 (4): 449-453.

  10. Sessler D. Temperature monitoring and perioperative thermoregulation. Anesthesiology 2008; 109 (2): 318-338.

  11. Sessler DI, Ponte J. Shivering during epidural anesthesia. Anesthesiology 1990; 72: 816–821.

  12. Hynson J, Sessler DI, Glosten B, McGuire J. Thermal balance and tremor patterns during epidural anesthesia. Anesthesiology 1991; 74: 680–690.

  13. Ponte J, Collett BJ, Walmsley A. Anaesthetic temperature and shivering in epidural anaesthesia. Acta Anaesthesiol Scand 1986; 30: 584–587.

  14. Ponte J, Sessler DI. Extradurals and shivering: Effects of cold and warm extradural saline injections in volunteers. Br J Anaesth 1990; 64: 731–733.

  15. Harris MM, Lawson D, Cooper CM, Ellis J. Treatment of shivering after epidural lidocaine. Reg Anesth 1989; 14: 13–18.

  16. Horn E-P, Sessler DI, Standl T et al. Nonthermoregulatory shivering in patients recovering from isoflurane or desflurane anesthesia. Anesthesiology 1998; 89: 878–886.

  17. Panzer O, Ghazanfari N, Sessler DI et al. Shivering and shivering-like tremor during labor with and without epidural analgesia. Anesthesiology 1999; 90: 1609–1616.

  18. Horn E-P, Schroeder F, Wilhelm S et al. Postoperative pain facilitates non-thermoregulatory tremor. Anesthesiology 1999; 91: 979–984.




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