Background and Goal of Study: Shivering is a common problem during neuraxial block (spinal and epidural) (1). There is uncertainty in the treatment and prevention of shivering under neuraxial blockade due to a lack of good evidence base. In obstetrics, there is a potential for the fetus to be affected by shivering in the mother due to compromise of oxygen supply to placenta especially in cases of fetal compromise due to other factors. Neonatal effects of placental transfer and secretion into breast milk of drugs used in the treatment of shivering also need to be considered.
In the face of uncertainty about the optimum treatment strategy, we performed this survey to ask the anaesthetists about their views about this problem, and to determine whether there is a common consensus about the management of shivering during neuraxial block.
Material and methods: We designed and sent an online questionnaire through group of obstetric anaesthetists in north-east website (www.goa-ne.org.uk) to anaesthetists in the northern deanery. The results were collated and data was analysed.
Results and Discussion: There were a total of 87 responses. Only 26% anaesthetists included shivering as a risk of neuraxial block in the consent. The prevention and treatment of shivering was considered by 32% and 36% of anaesthetists respectively. The temperature monitoring was considered when patient was shivering under neuraxial blockade during emergency LSCS (33% responses), elective LSCS (38%), emergency LSCS (68%) and elective LSCS (51%).
The most common interventions used to reduce shivering associated with neuraxial blockade were use of warm blanket (82%), warm fluids (59%), increasing theatre temperature (39%) and opioids (47%). Less common interventions were use of warm local anaesthetic extradurally/intrathecally (1%), Doxapram (2%) and Clonidine (3%).
Conclusion: The results showed a lack of anaesthetist appreciation of perioperative shivering despite its common occurrence and serious physiological sequelae. The available evidence base regarding therapeutic options for prevention and treatment of shivering are limited (2). but there are a number of treatment strategies in common use. This survey showed areas of improvement in the consent and consideration of prevention and treatment of perioperative shivering.
1. Risks associated with your anaesthetic - Information for Patients: RCOA
2. Crowley et al. Shivering and Neuraxial Anaesthesia. RAPM 2008;33:241-252.