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Postanaesthetic Shivering

Epidemiology, Pathophysiology, and Approaches to Prevention and Management

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Abstract

Along with nausea and vomiting, postanaesthetic shivering is one of the leading causes of discomfort for patients recovering from general anaesthesia. The distinguishing factor during electromyogram recordings between patients with postanaesthetic shivering and shivering in fully awake patients is the existence of clonus similar to that recorded in patients with spinal cord transection. Clonus coexists with the classic waxing and waning signals associated with cutaneous vasoconstriction (thermoregulatory shivering). The primary cause of postanaesthetic shivering is peroperative hypothermia, which sets in because of anaesthetic-induced inhibition of thermoregulation. However, shivering associated with cutaneous vasodilatation (non-thermoregulatory shivering) also occurs, one of the origins of which is postoperative pain.

Apart from causing discomfort and aggravation of pain, postanaesthetic shivering increases metabolic demand proportionally to the solicited muscle mass and the cardiac capacity of the patient. No link has been demonstrated between the occurence of shivering and an increase in cardiac morbidity, but it is preferable to avoid postanaesthetic shivering because it is oxygen draining.

Prevention mainly entails preventing peroperative hypothermia by actively rewarming the patient. Postoperative skin surface rewarming is a rapid way of obtaining the threshold shivering temperature while raising the skin temperature and improving the comfort of the patient. However, it is less efficient than certain drugs such as meperidine, clonidine or tramadol, which act by reducing the shivering threshold temperature.

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References

  1. Lee DS, Shaffer MJ. Low incidence of shivering with chronic propranolol therapy [letter]. Lancet 1986; I(8479): 500

    Google Scholar 

  2. Lienhart A, Fiez N, Deriaz H. Postoperative shivering: analysis of main associated factors. Ann Fr Anesth Reanim 1992; 11(5): 488–95

    PubMed  CAS  Google Scholar 

  3. Crossley AW. Six months of shivering in a district general hospital. Anaesthesia 1992; 47(10): 845–8

    PubMed  CAS  Google Scholar 

  4. Rosenberg H, Clofine R, Bialik O. Neurologic changes during awakening from anesthesia. Anesthesiology 1981; 54(2): 125–30

    PubMed  CAS  Google Scholar 

  5. Jones H, McLaren C. Postoperative shivering and hypoxaemia after halothane, nitrous oxide and oxygen anaesthesia. Br J Anaesth 1965; 37: 35–41

    PubMed  CAS  Google Scholar 

  6. Moir DD. Halothane and postoperative shivering. Anesth Analg 1963; 42(4): 423–8

    Google Scholar 

  7. Soliman MG, Gillies DM. Muscular hyperactivity after general anaesthesia. Can Anaesth Soc J 1972; 19(5): 529–35

    PubMed  CAS  Google Scholar 

  8. Smith R, Bachman L, Bougas T. Shivering following thiopental sodium and other anesthetic agents. Anesthesiology 1955; 16(5): 655–64

    PubMed  CAS  Google Scholar 

  9. Guffin A, Girard D, Kaplan JA. Shivering following cardiac surgery: hemodynamic changes and reversal. J Cardiothorac Anesth 1987 Feb; 1(1): 24–8

    PubMed  CAS  Google Scholar 

  10. Vaughan MS, Vaughan RW, Cork RC. Postoperative hypothermia in adults: relationship of age, anesthesia, and shivering to rewarming. Anesth Analg 1981; 60(10): 746–51

    PubMed  CAS  Google Scholar 

  11. Lyons B, Taylor A, Power C, et al. Postanaesthetic shivering in children. Anaesthesia 1996; 51(5): 442–5

    PubMed  CAS  Google Scholar 

  12. Cheong KF, Low TC. Propofol and postanaesthetic shivering. Anaesthesia 1995; 50(6): 550–2

    PubMed  CAS  Google Scholar 

  13. Frank SM, Fleisher LA, Olson KF, et al. Multivariate determinants of early postoperative oxygen consumption in elderly patients. Effects of shivering, body temperature, and gender. Anesthesiology 1995; 83(2): 241–9

    PubMed  CAS  Google Scholar 

  14. Cohen M. An investigation into shivering following anaesthesia: preliminary report. Proc R Soc Med 1967; 60(8): 752–3

    PubMed  CAS  Google Scholar 

  15. Baker KZ, Young WL, Stone JG, et al. Deliberate mild intraoperative hypothermia for craniotomy. Anesthesiology 1994; 81(2): 361–7

    PubMed  CAS  Google Scholar 

  16. Pflug AE, Aasheim GM, Foster C, et al. Prevention of post-anaesthesia shivering. Can Anaesth Soc J 1978; 25(1): 43–9

    PubMed  CAS  Google Scholar 

  17. Bay J, Nunn JF, Prys-Roberts C. Factors influencing arterial PO2 during recovery from anaesthesia. Br J Anaesth 1968; 40(6): 398–407

    PubMed  CAS  Google Scholar 

  18. Singh P, Harwood R, Cartwright DP, et al. A comparison of thiopentone and propofol with respect to the incidence of postoperative shivering. Anaesthesia 1994; 49(11): 996–8

    PubMed  CAS  Google Scholar 

  19. Crossley AW, Mahajan RP. The intensity of postoperative shivering is unrelated to axillary temperature. Anaesthesia 1994; 49(3): 205–7

    PubMed  CAS  Google Scholar 

  20. Horn EP, Werner C, Sessler DI, et al. Late intraoperative clonidine administration prevents postanesthetic shivering after total intravenous or volatile anesthesia. Anesth Analg 1997; 84(3): 613–7

    PubMed  CAS  Google Scholar 

  21. Pozos RS, Israel D, McCutcheon R, et al. Human studies concerning thermal-induced shivering, postoperative ‘shivering,’ and cold-induced vasodilation. Ann Emerg Med 1987; 16(9): 1037–41

    PubMed  CAS  Google Scholar 

  22. Sessler DI, Israel D, Pozos RS, et al. Spontaneous post-anesthetic tremor does not resemble thermoregulatory shivering. Anesthesiology 1988; 68(6): 843–50

    PubMed  CAS  Google Scholar 

  23. Sessler DI, Rubinstein EH, Moayeri A. Physiologic responses to mild perianesthetic hypothermia in humans. Anesthesiology 1991; 75(4): 594–610

    PubMed  CAS  Google Scholar 

  24. Horn EP, Sessler DI, Standl T, et al. Non-thermoregulatory shivering in patients recovering from isoflurane or desflurane anesthesia. Anesthesiology 1998; 89(4): 878–86

    PubMed  CAS  Google Scholar 

  25. Horn EP, Schroeder F, Wilhelm S, et al. Postoperative pain facilitates nonthermoregulatory tremor. Anesthesiology 1999; 91(4): 979–84

    PubMed  CAS  Google Scholar 

  26. Sessler DI. Perioperative heat balance. Anesthesiology 2000; 92(2): 578–96

    PubMed  CAS  Google Scholar 

  27. Carli F, Webster J, Nandi P, et al. Thermogenesis after surgery: effect of perioperative heat conservation and epidural anesthesia. Am J Physiol 1992; 263 (3 Pt 1): E441–E7

    PubMed  CAS  Google Scholar 

  28. Frank SM, Higgins MS, Breslow MJ, et al. The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia. A randomized clinical trial. Anesthesiology 1995; 82(1): 83–93

    PubMed  CAS  Google Scholar 

  29. Robinson KA, Haymes EM. Metabolic effects of exposure to hypoxia plus cold at rest and during exercise in humans. J Appl Physiol 1990; 68(2): 720–5

    PubMed  CAS  Google Scholar 

  30. Johnston CE, Elias DA, Ready AE, et al. Hypercapnia lowers the shivering threshold and increases core cooling rate in humans. Aviat Space Environ Med 1996; 67(5): 438–44

    PubMed  CAS  Google Scholar 

  31. Macario A, Weinger M, Carney S, et al. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999; 89(3): 652–8

    PubMed  CAS  Google Scholar 

  32. Mahajan RP, Grover VK, Sharma SL, et al. Intraocular pressure changes during muscular hyperactivity after general anesthesia. Anesthesiology 1987; 66(3): 419–21

    PubMed  CAS  Google Scholar 

  33. Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 1997; 277(14): 1127–34

    PubMed  CAS  Google Scholar 

  34. Ciofolo MJ, Clergue F, Devilliers C, et al. Changes in ventilation, oxygen uptake, and carbon dioxide output during recovery from isoflurane anesthesia. Anesthesiology 1989; 70(5): 737–41

    PubMed  CAS  Google Scholar 

  35. Delaunay L, Bonnet F, Duvaldestin P. Clonidine decreases postoperative oxygen consumption in patients recovering from general anaesthesia. Br J Anaesth 1991; 67(4): 397–401

    PubMed  CAS  Google Scholar 

  36. Just B, Delva E, Camus Y, et al. Oxygen uptake during recovery following naloxone. Relationship with intraoperative heat loss. Anesthesiology 1992; 76(1): 60–4

    PubMed  CAS  Google Scholar 

  37. Macintyre PE, Pavlin EG, Dwersteg JF. Effect of meperidine on oxygen consumption, carbon dioxide production, and respiratory gas exchange in postanesthesia shivering. Anesth Analg 1987; 66(8): 751–5

    PubMed  CAS  Google Scholar 

  38. Viale JP, Annat G, Lehot JJ, et al. Relationship between oxygen uptake and mixed venous oxygen saturation in the immediate postoperative period. Anesthesiology 1994; 80(2): 278–83

    PubMed  CAS  Google Scholar 

  39. Zwischenberger JB, Kirsh MM, Dechert RE, et al. Suppression of shivering decreases oxygen consumption and improves hemodynamic stability during postoperative rewarming. Ann Thorac Surg 1987; 43(4): 428–31

    PubMed  CAS  Google Scholar 

  40. Ralley FE, Wynands JE, Ramsay JG, et al. The effects of shivering on oxygen consumption and carbon dioxide production in patients rewarming from hypothermic cardiopulmonary bypass. Can J Anaesth 1988; 35(4): 332–7

    PubMed  CAS  Google Scholar 

  41. Roe CF. The influence of body temperature on early postoperative oxygen consumption. Surgery 1966; 60(1): 85–92

    Google Scholar 

  42. Rodriguez JL, Weissman C, Damask MC, et al. Physiologic requirements during rewarming: suppression of the shivering response. Crit Care Med 1983; 11(7): 490–7

    PubMed  CAS  Google Scholar 

  43. Dupuis JY, Nathan HJ, DeLima L, et al. Pancuronium or vecuronium for treatment of shivering after cardiac surgery. Anesth Analg 1994; 79(3): 472–81

    PubMed  CAS  Google Scholar 

  44. Mangano DT. Biventricular function after myocardial revascularization in humans: deterioration and recovery patterns during the first 24 hours. Anesthesiology 1985; 62(5): 571–7

    PubMed  CAS  Google Scholar 

  45. Frank SM, Beattie C, Christopherson R, et al. Unintentional hypothermia is associated with postoperative myocardial ischemia. The Perioperative Ischemia Randomized Anesthesia Trial Study Group. Anesthesiology 1993; 78(3): 468–76

    PubMed  CAS  Google Scholar 

  46. Jamieson WR, Turnbull KW, Larrieu AJ, et al. Continuous monitoring of mixed venous oxygen saturation in cardiac surgery. Can J Surg 1982; 25(5): 538–43

    PubMed  CAS  Google Scholar 

  47. Myers J, Froelicher VF. Hemodynamic determinants of exercise capacity in chronic heart failure. Ann Intern Med 1991; 115(5): 377–86

    PubMed  CAS  Google Scholar 

  48. Sessler DI. Mild perioperative hypothermia. N Engl J Med 1997; 336(24): 1730–7

    PubMed  CAS  Google Scholar 

  49. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 1996; 334(19): 1209–15

    PubMed  CAS  Google Scholar 

  50. Schmied H, Kurz A, Sessler DI, et al. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet 1996; 347(8997): 289–92

    PubMed  CAS  Google Scholar 

  51. Camus Y, Delva E, Sessler DI, et al. A. Pre-induction skin-surface warming minimizes intraoperative core hypothermia. J Clin Anesth 1995; 7(5): 384–8

    PubMed  CAS  Google Scholar 

  52. Sessler DI, Schroeder M, Merrifield B, et al. Optimal duration and temperature of prewarming. Anesthesiology 1995; 82(3): 674–81

    PubMed  CAS  Google Scholar 

  53. Sellden E, Branstrom R, Brundin T. Preoperative infusion of amino acids prevents postoperative hypothermia. Br J Anaesth 1996; 76(2): 227–34

    PubMed  CAS  Google Scholar 

  54. El-Gamal N, El-Kassabany N, Frank SM, et al. Age-related thermoregulatory differences in a warm operating room environment (approximately 26 degrees C). Anesth Analg 2000; 90(3): 694–8

    PubMed  CAS  Google Scholar 

  55. Camus Y, Delva E, Just B, et al. A. Leg warming minimizes core hypothermia during abdominal surgery. Anesth Analg 1993; 77(5): 995–9

    PubMed  CAS  Google Scholar 

  56. Cheng C, Matsukawa T, Sessler DI, et al. Increasing mean skin temperature linearly reduces the core-temperature thresholds for vasoconstriction and shivering in humans. Anesthesiology 1995; 82(5): 1160–8

    PubMed  CAS  Google Scholar 

  57. Lenhardt R, Greif R, Sessler DI, et al. Relative contribution of skin and core temperatures to vasoconstriction and shivering thresholds during isoflurane anesthesia. Anesthesiology 1999; 91(2): 422–9

    PubMed  CAS  Google Scholar 

  58. Plattner O, Ikeda T, Sessler DI, et al. Postanesthetic vasoconstriction slows peripheral-to-core transfer of cutaneous heat, thereby isolating the core thermal compartment. Anesth Analg 1997; 85(4): 899–906

    PubMed  CAS  Google Scholar 

  59. Weyland W, Weyland A, Hellige G, et al. Efficiency of a new radiant heater for postoperative rewarming. Acta Anaesthesiol Scand 1994; 38(6): 601–6

    PubMed  CAS  Google Scholar 

  60. Joachimsson PO, Nystrom SO, Tyden H. Postoperative ventilatory and circulatory effects of extended rewarming during cardiopulmonary bypass. Can J Anaesth 1989; 36(1): 9–19

    PubMed  CAS  Google Scholar 

  61. Henneberg S, Eklund A, Joachimsson PO, et al. Effects of a thermal ceiling on postoperative hypothermia. Acta Anaesthesiol Scand 1985; 29(6): 602–6

    PubMed  CAS  Google Scholar 

  62. Sharkey A, Lipton JM, Murphy MT, et al. Inhibition of postanesthetic shivering with radiant heat. Anesthesiology 1987; 66(2): 249–52

    PubMed  CAS  Google Scholar 

  63. Murphy MT, Lipton JM, Loughran P, et al. Postanesthetic shivering in primates: inhibition by peripheral heating and by taurine. Anesthesiology 1985; 63(2): 161–5

    PubMed  CAS  Google Scholar 

  64. Lennon RL, Hosking MP, Conover MA, et al. Evaluation of a forced-air system for warming hypothermic postoperative patients. Anesth Analg 1990; 70(4): 424–7

    PubMed  CAS  Google Scholar 

  65. Smith I, Newson CD, White PF. Use of forced-air warming during and after outpatient arthroscopic surgery. Anesth Analg 1994; 78(5): 836–41

    PubMed  CAS  Google Scholar 

  66. Sharkey A, Gulden RH, Lipton JM, et al. Effect of radiant heat on the metabolic cost of postoperative shivering. Br J Anaesth 1993; 70(4): 449–50

    PubMed  CAS  Google Scholar 

  67. Joris J, Banache M, Bonnet F, et al. Clonidine and ketanserin both are effective treatment for postanesthetic shivering. Anesthesiology 1993; 79(3): 532–9

    PubMed  CAS  Google Scholar 

  68. Buggy D, Higgins P, Moran C, et al. Clonidine at induction reduces shivering after general anaesthesia. Can J Anaesth 1997; 44(3): 263–7

    PubMed  CAS  Google Scholar 

  69. Horn EP, Standl T, Sessler DI, et al. Physostigmine prevents postanesthetic shivering as does meperidine or clonidine. Anesthesiology 1998; 88(1): 108–13

    PubMed  CAS  Google Scholar 

  70. Vanderstappen I, Vandermeersch E, Vanacker B, et al. The effect of prophylactic clonidine on postoperative shivering. A large prospective double-blind study. Anaesthesia 1996; 51(4): 351–5

    PubMed  CAS  Google Scholar 

  71. Piper SN, Maleck WH, Boldt J, et al. A comparison of urapidil, clonidine, meperidine and placebo in preventing postanesthetic shivering. Anesth Analg 2000; 90(4): 954–7

    PubMed  CAS  Google Scholar 

  72. Alfonsi P, Hongnat JM, Lebrault C, et al. The effects of pethidine, fentanyl and lignocaine on postanaesthetic shivering. Anaesthesia 1995; 50(3): 214–7

    PubMed  CAS  Google Scholar 

  73. Alfonsi P, Sessler DI, Du Manoir B, et al. The effects of meperidine and sufentanil on the shivering threshold in postoperative patients. Anesthesiology 1998; 89(1): 43–8

    PubMed  CAS  Google Scholar 

  74. Wrench IJ, Cavill G, Ward JE, et al. Comparison between alfentanil, pethidine and placebo in the treatment of postanaesthetic shivering. Br J Anaesth 1997; 79(4): 541–2

    PubMed  CAS  Google Scholar 

  75. Rodriguez JL, Weissman C, Damask MC, et al. Morphine and postoperative rewarming in critically ill patients. Circulation 1983; 68(6): 1238–46

    PubMed  CAS  Google Scholar 

  76. Pauca AL, Savage RT, Simpson S, et al. Effect of pethidine, fentanyl and morphine on post-operative shivering in man. Acta Anaesthesiol Scand 1984; 28(2): 138–43

    PubMed  CAS  Google Scholar 

  77. Terasako K, Yamamoto M. Comparison between pentazocine, pethidine and placebo in the treatment of post-anesthetic shivering. Acta Anaesthesiol Scand 2000; 44(3): 311–2

    PubMed  CAS  Google Scholar 

  78. Monso A, Riudeubas J, Barbai F, et al. A randomized, double-blind, placebo-controlled trial comparing pethidine to metamizol for treatment of post-anaesthetic shivering. Br J Clin Pharmacol 1996; 42(3): 307–11

    PubMed  CAS  Google Scholar 

  79. Singh P, Dimitriou V, Mahajan RP, et al. Double-blind comparison between doxapram and pethidine in the treatment of postanaesthetic shivering. Br J Anaesth 1993; 71(5): 685–8

    PubMed  CAS  Google Scholar 

  80. Casey WF, Smith CE, Katz JM, et al. Intravenous meperidine for control of shivering during caesarean section under epidural anaesthesia. Can J Anaesth 1988; 35(2): 128–33

    PubMed  CAS  Google Scholar 

  81. De Witte J, Deloof T, de Veylder J, et al. Tramadol in the treatment of postanesthetic shivering. Acta Anaesthesiol Scand 1997; 41(4): 506–10

    PubMed  Google Scholar 

  82. Crisinel D, Bissonnette B, Feihl F, et al. Efficacy of ketanserin on postanesthetic shivering. Ann Fr Anesth Reanim 1997; 16(2): 120–5

    PubMed  CAS  Google Scholar 

  83. Nalda MA, Gomar C, Luis M. The effect of ketanserin on postanaesthetic vasoconstriction and shivering. Eur J Anaesthesiol 1985; 2(3): 265–77

    PubMed  CAS  Google Scholar 

  84. Kizilirmak S, Karakas SE, Akca O, et al. Magnesium sulfate stops postanesthetic shivering. Ann N Y Acad Sci 1997; 813: 799–806

    PubMed  CAS  Google Scholar 

  85. Liem ST, Aldrete JA. Control of post-anaesthetic shivering. Can Anaesth Soc J 1974; 21(5): 506–10

    PubMed  CAS  Google Scholar 

  86. Yared JP, Starr NJ, Hoffmann-Hogg L, et al. Dexamethasone decreases the incidence of shivering after cardiac surgery: a randomized, double-blind, placebo-controlled study. Anesth Analg 1998; 87(4): 795–9

    PubMed  CAS  Google Scholar 

  87. Sarma V, Fry EN. Doxapram after general anaesthesia. Its role in stopping shivering during recovery. Anaesthesia 1991; 46(6): 460–1

    PubMed  CAS  Google Scholar 

  88. Brichard G, Johnstone M. The effect of methylphenidate (Ritalin) on post-halothane muscular spasticity. Br J Anaesth 1970; 42(8): 718–22

    PubMed  CAS  Google Scholar 

  89. Rosa G, Pinto G, Orsi P, et al. Control of post anaesthetic shivering with nefopam hydrochloride in mildly hypothermie patients after neurosurgery. Acta Anaesthesiol Scand 1995; 39(1): 90–5

    PubMed  CAS  Google Scholar 

  90. Piper SN, Suttner SW, Schmidt CC, et al. Nefopam and clonidine in the prevention of postanaesthetic shivering. Anaesthesia 1999; 54(7): 695–9

    PubMed  CAS  Google Scholar 

  91. Powell RM, Buggy DJ. Ondansetron given before induction of anesthesia reduces shivering after general anesthesia. Anesth Analg 2000; 90(6): 1423–7

    PubMed  CAS  Google Scholar 

  92. Lyons B, Carroll M, McDonald NJ. The treatment of postanaesthetic shivering: a double blind comparison between alfentanil and pethidine. Acta Anaesthesiol Scand 1995; 39(7): 979–82

    PubMed  CAS  Google Scholar 

  93. Ohqvist G, Hallin R, Gelinder S, et al. A comparison between morphine, meperidine and ketobemidone in continuous intravenous infusion for postoperative relief. Acta Anaesthesiol Scand 1991; 35(1): 44–8

    PubMed  CAS  Google Scholar 

  94. Kurz A, Go JC, Sessler DI, et al. Alfentanil slightly increases the sweating threshold and markedly reduces the vasoconstriction and shivering thresholds. Anesthesiology 1995; 83(2): 293–9

    PubMed  CAS  Google Scholar 

  95. Kurz A, Ikeda T, Sessler DI, et al. Meperidine decreases the shivering threshold twice as much as the vasoconstriction threshold. Anesthesiology 1997; 86(5): 1046–54

    PubMed  CAS  Google Scholar 

  96. Adler MW, Geller EB, Rosow CE, et al. The opioid system and temperature regulation. Annu Rev Pharmacol Toxicol 1988; 28: 429–49

    PubMed  CAS  Google Scholar 

  97. Kurz M, Belani KG, Sessler DI, et al. Naloxone, meperidine, and shivering. Anesthesiology 1993; 79(6): 1193–201

    PubMed  CAS  Google Scholar 

  98. Wang JJ, Ho ST, Lee SC, et al. A comparison among nalbuphine, meperidine, and placebo for treating postanesthetic shivering. Anesth Analg 1999; 88(3): 686–9

    PubMed  CAS  Google Scholar 

  99. Greif R, Laciny S, Rajek A, et al. Neither nalbuphine nor atropine possesses special anti-shivering activity. Anaesth Analg 2001; 93: 620–7

    CAS  Google Scholar 

  100. Glosten B, Sessler DI, Faure EA, et al. Central temperature changes are poorly perceived during epidural anesthesia. Anesthesiology 1992; 77(1): 10–6

    PubMed  CAS  Google Scholar 

  101. Delaunay L, Bonnet F, Liu N, et al. Clonidine comparably decreases the thermoregulatory thresholds for vasoconstriction and shivering in humans. Anesthesiology 1993; 79(3): 470–4

    PubMed  CAS  Google Scholar 

  102. Delaunay L, Herail T, Sessler DI, et al. Clonidine increases the sweating threshold, but does not reduce the gain of sweating. Anesth Analg 1996; 83(4): 844–8

    PubMed  CAS  Google Scholar 

  103. Nicolaou G, Chen AA, Johnston CE, et al. Clonidine decreases vasoconstriction and shivering thresholds, without affecting the sweating threshold. Can J Anaesth 1997; 44(6): 636–42

    PubMed  CAS  Google Scholar 

  104. Talke P, Tayefeh F, Sessler DI, et al. Dexmedetomidine does not alter the sweating threshold, but comparably and linearly decreases the vasoconstriction and shivering thresholds. Anesthesiology 1997; 87(4): 835–41

    PubMed  CAS  Google Scholar 

  105. Hommeril JL, Bernard JM, Passuti N, et al. [Effects of intravenous clonidine on postoperative shivering]. Ann Fr Anesth Reanim 1991; 10(6): 554–8

    PubMed  CAS  Google Scholar 

  106. Quintin L, Roudot F, Roux C, et al. Effect of clonidine on the circulation and vasoactive hormones after aortic surgery. Br J Anaesth 1991; 66(1): 108–15

    PubMed  CAS  Google Scholar 

  107. Erkola O, Korttila K, Aho M, et al. Comparison of intramuscular dexmedetomidine and midazolam premedication for elective abdominal hysterectomy. Anesth Analg 1994; 79(4): 646–53

    PubMed  CAS  Google Scholar 

  108. Jalonen J, Hynynen M, Kuitunen A, et al. Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology 1997; 86(2): 331–45

    PubMed  CAS  Google Scholar 

  109. Hammel HT. Regulation of internal body temperature. Ann Rev Physiol 1968; 30: 641–710

    CAS  Google Scholar 

  110. De Witte J, Rietman GW, Vandenbroucke G, et al. Post-operative effects of tramadol administered at wound closure. Eur J Anaesthesiol 1998; 15(2): 190–5

    PubMed  Google Scholar 

  111. De Witte JL, Kim JS, Sessler DI, et al. Tramadol reduces the sweating, vasoconstriction, and shivering thresholds. Anesth Analg 1998; 87(1): 173–9

    PubMed  Google Scholar 

  112. Xiong J, Kurz A, Sessler DI, et al. Isoflurane produces marked and nonlinear decreases in the vasoconstriction and shivering thresholds. Anesthesiology 1996; 85(2): 240–5

    PubMed  CAS  Google Scholar 

  113. McQuay HJ, Moore RA. Using numerical results from systematic reviews in clinical practice. Ann Intern Med 1997; 126(9): 712–20

    PubMed  CAS  Google Scholar 

  114. Bender R. Calculating confidence intervals for the number needed to treat. Control Clin Trials 2001; 22(2): 102–10

    PubMed  CAS  Google Scholar 

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The author thanks the REDAR Association for its helpful contribution to the preparation of this manuscript.

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Alfonsi, P. Postanaesthetic Shivering. Drugs 61, 2193–2205 (2001). https://doi.org/10.2165/00003495-200161150-00004

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