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1、postanesthesiashiveringHuangYayiPostanesthesiashivering?spontaneous,involuntary,tremor-likemuscle-hyperactivityClinicalConsiderationsHypothermia:<36oCO2consumptionx5;decreasesaturation;myocardialischemiaandanginaIncreasedmortalityrateMonitoringsiteTympanicmembraneNasopharyngealm
2、ucosaRectumEsophagusEpidemiology40-60%aftervolatileanestheticsYoungmaleadult,rareinelderorchildrenLengthofanesthesiaorsurgeryPeri-oprewarmingprocedure:ifnotMildhypothermiaAnestheticusedPathophysiologyConsequenceofpostanestheticshiveringDiscomfortIncreasedpainIICP,IOPO2consumptio
3、n(VO2):more40–120%IncreasedminuteventilationCardiacmorbidityPathophysiologyTwotypesofpostanestheticshiveringThermoregulatedshiveringWithcutaneousvasoconstriction,theresponseofhypothermiaPerioperativehypothermiaNon-thermoregulatedshiveringMechanismunknownPostoperativepainrelated?
4、PathophysiologyOriginsofPostanestheticShiveringPerioperativehypothermiaPostoperativepainPerioperativeheatlossDirecteffectofcertainanestheticsHypercapniaorrespiratoryalkalosisTheexistenceofpyogensHypoxiaPathophysiologyHumandefensestohypothermiaSkinvasomotoractivityNonshiveringthe
5、rmogenesisShiveringSweatingShiveringisthelast-resortdefensePrevention&ManagementPerioperativeHypothermiaPreventionLimitingtheeffectsofinternalredistributionReduceheatlossIntravenousfluidrewarmingPrevention&ManagementPassivepreventionisnotenoughActiveheattransfer1/3coverofthecuta
6、neoussurfaceisenoughUnderGA>vasodilatation>heatlossPrevention&ManagementPhysicaltreatmentShiveringthreshold:RaisetemptoinhibitpostoperativeshiveringRadiationheatsystemForcedairwarmer:Prevention&ManagementMedicaltreatmentOpiates:MeperidineCentralstimulant?:Doxapramα2-AdrenergicAg
7、onists:ClonidineInhibitreuptakeof5-HT,NE:Tramadol,Ketanserin,NefopamandOndensetronOtherdrugsConclusionHypothermiaishighriskPreventionofhypothermiaconsistsoflimitingheatlossandactiverewarmingsystemEffectivetreatmentisnecessarySkinsurfacerewarmingislessefficientthenmedicaltreatmen
8、tor,incertainsituationssuggestedthatpainandther
