Narrative Review on Perioperative Shivering during Caesarean Section under Neuraxial Anaesthesia

	Mechanism	Remark
Opioid	Mu and Kappa receptor agonism, anticholinergic action, monoamine reuptake inhibition	Effective at reducing the incidence and severity of perioperative shivering
Meperidine 10 mg ITFentanyl 20 – 25 μg ITTramadol 10 mg IT
5-HT3 Antagonist	Inhibit serotonin reuptake at the pre-optic anterior hypothalamic region	May be effective when compared to inactive placebo but not when compared to intrathecal fentanyl
Ondansetron 8 mg IV
NMDA Antagonist	Modulate noradrenergic and serotonergic neurons in the locus coeruleus	Ketamine appears effective while evidence on magnesium is limited
Ketamine 0.25 – 0.5 mg/kg IVMagnesium Sulphate 50 mg Epid
Alpha-2 Agonist	Alpha-2 receptor stimulation decreases the thermoregulatory threshold for shivering at the hypothalamus level, and modulate cutaneous thermal inputs via descending inhibition, thus inhibiting shivering at the spinal cord level	Dexmedetomidine is effective at reducing shivering but can lead to bradycardia
Dexmedetomidine 5 – 10 μg ITDexmedetomidine 1 μg/kg EpidDexmedetomidine 30 mcg IV

	Example	Mechanism	Remark
Prewarming	Blanket, forced-air warmer, warmed IV fluids	Increases body surface heat content and reduces heat loss from redistribution	Active warming is more effective than passive warming
Intraoperative warming	Forced-air warmer, warmed IV fluids	Reduces core-to-surface heat loss	Lower body forced-air warmer is more effective than upper body

Frequenza di pubblicazione:: 2 volte all'anno
Argomenti della rivista:: Medicina, Medicina clinica, Medicina clinica, altro, Chirurgia, Chirurgia, altro, Anestesiologia, Medicina d'urgenza e medicina di terapia intensiva