Shivering, which usually occurs as a thermoregulatory response to cold, may also occur following general or neuraxial anesthesia. Some of the causative factors of this type of shivering may be common to both, but some are particular to neuraxial anesthesia. Although shivering may have beneficial thermoregulatory effects, it places the body under increased physiological stress. In a broad sample of 21 studies, the median incidence of shivering related to neuraxial anesthesia in the control groups was 55%. Both pharmacological and nonpharmacological mechanisms have been found to be effective in reducing this shivering. This review aims to elucidate the mechanisms of the shivering that occurs during neuraxial anesthesia, and to examine strategies for prevention and treatment of this shivering. 相似文献
Electrocardiograph artifacts are known to occur in uncontrolled muscle activity, classically in seizures. With the use of therapeutic hypothermia in post cardiac arrest patients in modern ICUs, occurrence of EKG artifact is common due to shivering in patients.
We present a 52-year-old admitted to the intensive care unit post cardiac arrest secondary to cyclobenzaprine overdose been treated with therapeutic hypothermia for cerebral protection. Within 5 h of cooling, his cardiac monitor started to show persistent wide complex tachycardia with a rate of more than 300/min. It was decided to give loading dose of amiodarone. Before starting amiodarone it was seen that the arterial line showed a normal waveform with a rate of 70/min and BP of 140/70 mm Hg. The paradoxical waveform was presumptively attributed to shivering of patient. Patient was paralyzed with vecuronium and the cardiac monitor changed to normal sinus rhythm with a rate of 70/min almost immediately.
Arrhythmias are unique among transient pathologies because even in the absence of symptoms and other clinical correlations, they often lead to intensive investigations and treatments. When artifacts mimic arrhythmias, these tests are unnecessary and can be potentially dangerous. 相似文献
This paper discusses the course of recovery from the thermoregulatory deficits produced in rats by electrolytic lesions in the preoptic/anterior hypothalamic area. Severe damage rendered rats ectothermic, that is unable to maintain their body temperatures at normal levels unless they were incubated at an ambient temperature of 30 degrees C. Less severe damage produced rats that maintained subnormal but stable body temperatures at 23 degrees C, but that did not increase metabolic rate or shiver and whose body temperatures dropped drastically in the cold (5 degrees C). As the animals recovered, nonshivering thermogenesis returned. Eventually the rats became excessively hyperthermic in normal room temperatures, due to very high metabolic rates. They were still unable to shiver or increase metabolic rate further in the cold and were therefore still unable to prevent a large drop in body temperature. Muscle tonus and shivering recovered gradually, and oxygen consumption returned to near normal levels. The data are described in terms of levels of integration of the nervous control of thermoregulation. 相似文献