A CROSS SECTIONAL STUDY ON THE MAGNITUDE AND ASSOCIATED FACTORS OF INTRAOPERATIVE SHIVERING AFTER CAESAREAN DELIVERY UNDER SPINAL ANESTHESIA

Main Article Content

Muhammad Farman
Maria Masood
Laiba Zia
Muzzamil Khan
Muhammad Ateeq
Zia-Ur-Rehman Farooqi

Keywords

Shivering, Factors, Cesarian section, Spinal Anesthesia

Abstract

The object of this study was to determine the magnitude and associated factors of intraoperative shivering after cesarean section under spinal anesthesia in the operation theater of tertiary care hospitals (RMI and HMC Peshawar). It was conducted in the Obstetrics and Gynecology OT of tertiary care hospitals, (RMI and HMC) Peshawar, KPK. The duration of this study was 6 months (1st July, 2022 –20th December, 2022). The total sample size was 295, which was calculated by the non-defined population formula and the data was collected through a semi-structured questionnaire. Finally, the data was analyzed on SPSS version 26.A number of 295 participants were included in the study, out of which 127 experienced shivering. The total incidence of shivering was 43.1% and the factors contributing to shivering were Body mass index, maternal comorbidities (hypertension, asthma, obesity), room temperature, premedication, duration of preoperative fasting, bupivacaine dose were associated with shivering in multivariate logistic regression having P-value<0.05. Type of fluid (crystalloid or Colloid), oxygen saturation during surgery, dose of oxytocin and incidence of nausea were significantly associated with shivering in the bivariate logistic regression with P-value< 0.000. The frequency of intraoperative shivering after caesarean section delivery under spinal anesthesia was comparable to many studies i.e., 43.1%. The factors that mainly contributed to intraoperative shivering were Type of fluid, oxygen saturation during surgery, dose of oxytocin and incidence of nausea. The peak incidence of shivering in our study was recorded in less than five minutes after caesarean delivery

Abstract 209 | pdf Downloads 106

References

1. Ferede YA, Aytolign HA, Mersha AT. “The magnitude and associated factors of intraoperative shivering after cesarean section delivery under Spinal anesthesia’’: A cross sectional study. Ann Med Surg [Internet]. 2021;72(October):103022. Available from: https://doi.org/10.1016/j.amsu.2021.103022
2. Ali S, Athar M, Ahmed SM. Basics of CPB. Indian J Anaesth. 2019;49(4):257–62.
3. Lema GF, Gebremedhn EG, Gebregzi AH, Desta YT, Kassa AA. Efficacy of intravenous tramadol and low-dose ketamine in the prevention of post-spinal anesthesia shivering following cesarean section: A double-blinded, randomized control trial. Int J Womens Health. 2017;9:681–8.
4. Ciebiera M. Pediatrics Consequences of Caesarean Section — A Systematic Review and Meta-Analysis.Gilson SD. Cesarean Section. Small Anim Surg Emergencies. 2015;389–96.
6. Subramani Y, Nagappa M, Kumar K, Fochesato LA, Chohan MBY, Zhu YF, et al. Effect of intrathecal lipophilic opioids on the incidence of shivering in women undergoing cesarean delivery after spinal anesthesia: a systematic review and bayesian network meta- analysis of randomized controlled trials. BMC Anesthesiol. 2020;20(1):1–13.
7. Haider G, Zehra N, Munir AA, Haider A. Frequency and indications of cesarean section in a tertiary care hospital. Pakistan J Med Sci. 2009;25(5):791–6.
8. Najafianaraki A, Mirzaei K, Akbari Z, MacAire P. The effects of warm and cold intrathecal bupivacaine on shivering during delivery under spinal anesthesia. Saudi J Anaesth. 2012;6(4):336–40.
9. Shami S, Nasseri K, Shirmohammadi M, Sarshivi F, Ghadami N, Ghaderi E, et al. Effect of low dose of intrathecal pethidine on the incidence and intensity of shivering during cesarean section under spinal anesthesia: A randomized, placebo-controlled, double-blind clinical trial. Drug Des Devel Ther. 2016;10:3005–12.
10. Buggy DJ, Crossley AWA, Le L. Thermoregulation , mild perioperative hypothermia and post- anaesthetic shivering. Br J Anaesth [Internet]. 2000;84(5):615–28. Available from: http://dx.doi.org/10.1093/bja/84.5.615
11. Sultan P, Habib AS, Cho Y, Carvalho B. The Effect of patient warming during Caesarean delivery on maternal and neonatal outcomes: A meta-analysis. Br J Anaesth [Internet]. 2015;115(4):500–10. Available from: http://dx.doi.org/10.1093/bja/aev325
12. Locks G de F. Incidência de tremores após cesarianas sob raquianestesia com ou sem sufentanil intratecal: estudo aleatório. Rev Bras Anestesiol. 2012;62(5):680–4.
13. Qi X, Chen D, Li G, Cao J, Yan Y, Li Z, et al. Risk factors associated with intraoperative shivering during caesarean section: a prospective nested case-control study. BMC Anesthesiol [Internet]. 2022;22(1):1–10. Available from: https://doi.org/10.1186/s12871-022-01596-7
14. Catholic T. Comparison of Three Warming Devices for the Prevention of Core Hypothermia and Post-anaesthesia Shivering. 2008;923–31.
15. Liu J, Wang Y, Ma W. Shivering prevention and treatment during cesarean delivery under neuraxial anesthesia: A systematic review. Minerva Anestesiol. 2018;84(12):1393–405.
16. Feng G, Wang Y, Feng J, Luo X, Li C, Yao S. The relationship between core temperature and perioperative shivering during caesarean section under intrathecal anesthesia with bupivacaine and ropivacaine: a randomized controlled study. J Anesth [Internet]. 2021;35(6):889–95. Available from: https://doi.org/10.1007/s00540-021-02995-9
17. Luggya TS, Kabuye RN, Mijumbi C, Tindimwebwa JB, Kintu A. Prevalence, associated factors and treatment of post spinal shivering in a Sub-Saharan tertiary hospital: A prospective observational study. BMC Anesthesiol [Internet]. 2016;16(1):1–5. Available from: http://dx.doi.org/10.1186/s12871-016-0268-0
18. Sadegh A, Tazeh-kand NF, Eslami B. Intrathecal fentanyl for prevention of shivering in spinal anesthesia in cesarean section. Med J Islam Repub Iran. 2012;26(2):85–9.
19. Desgranges FP, Bapteste L, Riffard C, Pop M, Cogniat B, Gagey AC, et al. Predictive factors of maternal hypothermia during Cesarean delivery: a prospective cohort study. Can J Anesth. 2017;64(9):919–27.
20. Badawy AA, Mokhtar AM. The role of ondansetron in prevention of post-spinal shivering (PSS) in obstetric patients: A double-blind randomized controlled trial. Vol. 33, Egyptian Journal of Anaesthesia. 2017. p. 29–33.
21. Factors A, Shivering P, Patients A, Operated W, General U, Anesthesia R, et al. Journal of Anesthesia & Clinical Magnitude and Associated Factors of Postanaesthesia Shivering Among Patients Who Operated Under General and Regional Anesthesia , Northwest Ethiopia : A Cross Sectional Study. 2015;6(11):6–10.
22. Dal D, Kose A, Honca M, Akinci SB, Basgul E, Aypar U. Efficacy of prophylactic ketamine in preventing postoperative shivering. Br J Anaesth [Internet]. 2005;95(2 PAPER):189–92. Available from: http://dx.doi.org/10.1093/bja/aei148
23. Yu SC, Ngan Kee WD, Kwan ASK. Addition of meperidine to bupivacaine for spinal anaesthesia for Caesarean section. Br J Anaesth. 2002;88(3):379–83.
24. Qona’ah A, Rosuliana NE, Bratasena IMA, Cahyono W. Management of Shivering in Post-Spinal Anesthesia Using Warming Blankets and Warm Fluid Therapy. J Ners. 2020;14(3):305.
25. Upadhya R K, Shenoy L, Venkateswaran R. Effect of intravenous dexmedetomidine administered as bolus or as bolus-plus-infusion on subarachnoid anesthesia with hyperbaric bupivacaine. J Anaesthesiol Clin Pharmacol. 2018;34(3):46–50.
26. Wódarski B, Chutkowski R, Banasiewicz J, Moorthi K, Wójtowicz S, Malec-Milewska M, et al. Risk factors for shivering during caesarean section under spinal anaesthesia. A prospective observational study. Acta Anaesthesiol Scand. 2020;64(1):112–6.
27. Karim N, Negin G, Bijan N. Effects of intrathecal dexmedetomidine on shivering after spinal anesthesia for cesarean section: a double-blind randomized clinical trial. Drug Des Devel Ther. 2017;11:1107–13.
28. Chan AMH, Ng KFJ, Tong EWN, Jan GSK. Control of shivering under regional anesthesia in obstetric patients with tramadol. Can J Anaesth. 1999;46(3):253–8.
29. Hydrocortisone I. Research article. :459–63.
30. Impact THE, Simulators OF, Container ON, Info A. Research Article. 2019;5(Spring):38–40.
31. Mohammadi S, Jabbarzadeh S, Movafegh A. Efficacy of granisetron on prevention of shivering, nausea and vomiting during cesarean delivery under spinal anesthesia: A randomized double-blinded clinical trial. J Obstet Anaesth Crit Care. 2015;5(1):22.
32. Adibi P, Vatankhah M, Razavi BM, Fendereski F, Malekshoar M. Intravenous Pethidine versus Diclofenac Suppository in Shivering after Cesarean Section under Spinal Anesthesia. J Med Chem Sci. 2022;5(7):1142–9.
33. Najafianaraki A. The effects of warm and cold intrathecal bupivacaine on shivering during delivery under spinal anesthesia. 2012;6(4):336–41.

Most read articles by the same author(s)