Management of shivering in hypothermia

PURPOSE: Despite the implementation of various insulation measures, the incidence of hypothermia during thyroid surgery remains high. This randomized controlled study aimed to evaluate the effects of aggressive thermal management combined with resistive heating mattresses to prevent perioperative hypothermia in patients undergoing thyroid surgery. PATIENTS AND METHODS: 142 consecutive patients scheduled for elective thyroid surgery were enrolled in the study. They were randomly and equally allocated to the aggressive warming or routine care groups (n = 71)...

Background and Objectives: Redistribution hypothermia occurs during anesthesia despite active intraoperative warming. Prewarming increases the heat absorption by peripheral tissue, reducing the central to peripheral heat gradient. Therefore, the addition of prewarming may offer a greater preservation of intraoperative normothermia as compared to intraoperative warming only. Materials and Methods : A single-center clinical trial of adults scheduled for non-cardiac surgery. Patients were randomized to receive or not a prewarming period (at least 10 min) with convective air devices...

BACKGROUND: Therapeutic hypothermia (TH) is a widely practiced neuroprotective strategy for neonates with hypoxic-ischemic encephalopathy. Induced hypothermia is associated with shivering, cold pain, agitation, and distress. OBJECTIVE: This scoping review determines the breadth of research undertaken for pain and stress management in neonates undergoing hypothermia therapy, the pharmacokinetics of analgesic and sedative medications during hypothermia and the effect of such medication on short- and long-term neurological outcomes...

To investigate the effect of forced-air warming and heated intravenous (IV) and irrigation fluids alone and in combination on body temperature, shivering, thermal comfort, pain, nausea and vomiting in adult patients undergoing surgery under general anesthesia in a prospective, four-group, randomized controlled trial. After induction of anesthesia, 120 patients were divided into the following groups: patients warmed with forced-air warming ( n  = 30), patients receiving warmed IV and irrigation fluid ( n  = 30), patients receiving warmed IV and irrigation fluid with forced-air warming ( n  = 30), and the control group without any intervention ( n  = 30)...

To explore the effect of the temperature chain management scheme on inadvertent perioperative hypothermia (IPH) during robot-assisted radical resection of urological tumors. Fifty male patients who underwent elective robot-assisted radical prostatectomy (RARP) or robot-assisted radical cystectomy (RARC) surgery from February 2022 to March 2023 in a teaching hospital were enrolled and randomized to receive either intraoperative warming, including forced-air warming blanket and prewarming fluid (group C) or the temperature chain management involving an active warming bunch covering the whole perioperative period (group T)...

Cardiac arrest (CA) is one of the leading causes of death worldwide. Therapeutic hypothermia (TH) is hypothesized to be a reliable practice for better prognosis in post-cardiac arrest (PCA) patients. Medical subject headings (MeSH) terminology was used to search PubMed Central, Medline, and PubMed databases for articles on the use of hypothermia in PCA patients. We selected various clinical trials, meta-analyses and review articles with complete texts in the English language. PCA syndrome occurs after a CA where the body experiences a state of global ischemia and multi-system dysfunction due to the release of reactive oxygen species (ROS) and inflammatory mediators...

Women undergoing breast surgery seem to be under the risk for hypothermia (central body temperature <36°) due to the uncertainty caused by the preoperative preparation time and the variety of operations, leading to neglect of warming precautions. The study examines the perioperative hypothermia (PH) in breast surgery and the relationships between the depth of decrease in body temperature and individual or clinical variables. This prospective, cross-sectional, observational study includes 120 female patients 18-65 years of age who were given general anesthesia for breast surgery...

Hypothermia has multiple physiological effects, including decreasing metabolic rate and oxygen consumption (VO2 ). There are few human data about the magnitude of change in VO2 with decreases in core temperature. We aimed to quantify to magnitude of reduction in resting VO2 as we reduced core temperature in lightly sedated healthy individuals. After informed consent and physical screening, we cooled participants by rapidly infusing 20 mL/kg of cold (4°C) saline intravenously and placing surface cooling pads on the torso...

Managing temperature is an important part of post-cardiac arrest care. Fever or hyperthermia during the first few days after cardiac arrest is associated with worse outcomes in many studies. Clinical data have not determined any target temperature or duration of temperature management that clearly improves patient outcomes. Current guidelines and recent reviews recommend controlling temperature to prevent hyperthermia. Higher temperatures can lead to secondary brain injury by increasing seizures, brain edema and metabolic demand...

This study aimed to determine the effects of preoperative active and passive warming on postoperative hypothermia, vital signs, and perception of thermal comfort in patients scheduled to undergo elective open abdominal surgery. This was a randomized controlled study. The study sample comprised 90 patients (30 in the active warming group, 30 in the passive warming group, and 30 in the control group) who agreed to participate and met the research criteria. According to the comparison of patients' vital signs, a statistically significant difference was observed in terms of patients' preoperative body temperature values ( χ 2  = 56...

The Cooling to Help Injured Lungs (CHILL) trial is an open label, two group, parallel design multicenter, randomized phase IIB clinical trial assessing the efficacy and safety of targeted temperature management with combined external cooling and neuromuscular blockade to block shivering in patients with early moderate-severe acute respiratory distress syndrome (ARDS). This report provides the background and rationale for the clinical trial and outlines the methods using the Consolidated Standards of Reporting Trials guidelines...

Fever is common in patients with stroke and is associated with worse outcomes. Studies in brain injury informed interventions commonly termed therapeutic temperature management (TTM) to improve the monitoring and management of fever. While the role and benefit of TTM in stroke patients has not been well studied, the nurse and healthcare team must extrapolate existing data to determine how to best monitor and apply TTM after stroke. Nurses should be knowledgeable about interventions to monitor and manage complications of TTM (eg, shivering), the studies underway to quantify the impact of fever treatment and emerging technology expected to improve TTM...

PURPOSE: This study aimed to determine the effects of a warming care protocol (WCM) on temperature control and thermal comfort perception in hypothermia following major abdominal surgery. DESIGN: A prospective nonrandomized controlled trial. METHODS: A total of 54 patients undergoing major abdominal surgery were assigned to receive routine care (control group, 27 patients) or the WCM (intervention group, 27 patients). The body temperature (core and peripheral) was measured, and physical symptoms were monitored every hour for 4 hours after arriving at the ward and then every 4 hours for up to 12 hours...

A numerical investigation is reported comparing various human thermoregulation mechanisms under hot and cold stress. The passive system of the developed model consists of 12 spherical/cylindrical segments and is modeled using the Pennes bioheat equation and finite difference method. The active system accounts for all regulatory responses, including the counter current heat exchange between veins and arteries; the respiratory heat loss; and threshold, gain, and maximum intensity of response mechanisms. The developed code analyzes various thermoregulatory defense mechanisms under hot and cold environments...

Targeted temperature management (TTM) is a complex and sophisticated intensive-care procedure that is included in the American Heart Association guidelines for treating patients who remain unconscious after resuscitation from cardiac arrest. TTM has been demonstrated to reduce brain injury associated with reperfusion after resuscitation and to improve the neurological prognosis in patients with cardiac arrest. The TTM process may be divided into four phases: induction, maintenance, rewarming, and normothermia...

This study aims to explore the value of lithotomy position thermal sleeve application during lower abdominal surgery in patients with hypothermia. A total of 100 patients who underwent urinary, gastrointestinal, or gynecological operations were included in this study. The patients were randomly divided into two groups: the test group ( n  = 50) and the control group ( n  = 50). In the control group, the environment, fluid, patient upper abdomen, and pasted 3 L stone-cut pants were heated...

Avoiding redistributional hypothermia that decreases core temperature by 0.5-1.5°C within the 1st hour of surgery is difficult. The efficacy of prewarming using a forced-air warming (FAW) device with a lower-body blanket on redistribution hypothermia during epidural procedures have not been investigated. After ethics approval, 113 patients undergoing laparoscopic surgery under general anesthesia combined with epidural anesthesia were enrolled. Intervention (prewarming) group patients who were warmed from operating room entry, including during epidural anesthesia, was compared with the control group that was warmed from just before surgery started...

Background: Propofol is a key component for the management of sedation and shivering during targeted temperature management (TTM) following cardiac arrest. The cardiac depressant effects of propofol have not been described during TTM and may be especially relevant given the stress to the myocardium following cardiac arrest. The purpose of this study is to describe hemodynamic changes associated with propofol administration during TTM. Methods: This single center, retrospective cohort study evaluated adult patients who received a propofol infusion for at least 30 minutes during TTM...

General anesthetic agents can change the shivering threshold. Sevoflurane and desflurane are widely used as inhalational anesthetics and have also been reported to lower the shivering threshold in a dose-dependent manner. Although the comparison of postoperative shivering (POS) between total intravenous anesthesia and inhalational anesthesia has been reported, there have been no reports on a direct comparison between sevoflurane and desflurane anesthesia and the occurrence of POS in open abdominal surgery. After obtaining approval from the Ethics Review Committee (2020-261), 683 adult patients who underwent open radical surgery for uterine, cervical, or pancreatic cancer under general anesthesia using inhalational anesthetics at Kyushu University hospital between December 2012 and March 2020 were included in this retrospective study...

Targeted temperature management (TTM) has become a standard of care over the past two decades for the improvement in neurologic function and mortality in postcardiac arrest patients. There are various mechanisms by which hypothermia helps to improve these outcomes, one of which is by reducing oxygen requirements. Less established is the use of nondepolarizing neuromuscular blockers (NMBs) to prevent shivering during TTM. Shivering can be disadvantageous in this setting as it increases oxygen requirements, which TTM is actively trying to decrease, in an already oxygen-deprived system as well as generates heat making it difficult to maintain hypothermia...