Postanaesthetic shivering - from pathophysiology to prevention

Area of Science:

• Anesthesiology
• Perioperative Medicine
• Critical Care

Background:

• Postoperative shivering is a frequent complication following anesthesia.
• It can elevate oxygen consumption, risk of hypoxemia, lactic acidosis, and catecholamine release, particularly in high-risk patients.
• Shivering causes significant patient discomfort and its etiology is not fully understood, with potential links to hypothermia, pain, and opioid withdrawal.

Purpose of the Study:

• To review current understanding and treatment strategies for postoperative shivering.
• To evaluate the effectiveness of various pharmacological and non-pharmacological interventions.
• To highlight the need for improved evidence-based guidelines for managing postoperative shivering.

Main Methods:

• Review of existing literature on postoperative shivering.
• Analysis of pharmacological and non-pharmacological treatment strategies.
• Evaluation of the quality of current antishivering guidelines.

Main Results:

• Perioperative hypothermia prevention is key to avoiding shivering.
• The combination of forced-air warming and intravenous meperidine is the most validated treatment.
• High-quality evidence for optimal antishivering medication is lacking, and current guidelines have low overall quality.

Conclusions:

• Effective control of postoperative shivering is achievable through combined pharmacological and non-pharmacological methods.
• Further research with rigorous methodology and transparency is needed to establish optimal evidence-based treatment protocols.
• Improving the quality of antishivering guidelines is crucial for consistent clinical practice.