Shivering following cardiac surgery: hemodynamic changes and reversal

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Critical Care Medicine

Background:

• Postoperative shivering is a common complication after cardiopulmonary bypass.
• Shivering can negatively impact hemodynamics and systemic oxygenation.
• Understanding the effects of shivering and effective interventions is crucial for patient recovery.

Purpose of the Study:

• To investigate the impact of shivering on hemodynamics and systemic oxygenation in patients post-cardiopulmonary bypass.
• To evaluate the effectiveness of therapeutic interventions in mitigating shivering and improving mixed venous oxygen saturation (SvO2).

Main Methods:

• Thirty adult patients undergoing cardiopulmonary bypass with hypothermia were monitored postoperatively.
• Hemodynamic measurements, blood temperature, and SvO2 were recorded.
• Shivering was graded, and patients received either morphine or meperidine if shivering or decreased SvO2 occurred.

Main Results:

• Twenty out of thirty patients experienced significant shivering, leading to a decrease in SvO2.
• As shivering intensity increased, SvO2 significantly decreased (from 74% to 57%).
• Narcotic therapy was required for 67% of patients due to shivering or reduced SvO2.

Conclusions:

• Shivering significantly impairs systemic oxygenation in the immediate postoperative period after cardiopulmonary bypass.
• Pharmacologic interventions, specifically morphine and meperidine, can effectively reduce shivering and restore oxygen saturation.
• Prompt management of postoperative shivering is essential for optimizing patient outcomes.