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Titolo:
Shivering and shivering-like tremor during labor with and without epiduralanalgesia
Autore:
Panzer, O; Ghazanfari, N; Sessler, DI; Yucel, Y; Greher, M; Akca, O; Donner, A; Germann, P; Kurz, A;
Indirizzi:
Univ Calif San Francisco, Dept Anesthesia, Outcomes Res Grp, San Francisco, Univ Calif San Francisco San Francisco CA USA 94143 s Grp, San Francisco, Univ Vienna, Dept Obstet & Gynecol, Vienna, Austria Univ Vienna Vienna Austria enna, Dept Obstet & Gynecol, Vienna, Austria Dept Obstet & Gynecol, Niederoesterreich, Austria Dept Obstet & Gynecol Niederoesterreich Austria deroesterreich, Austria Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, Univ Calif San Francisco San Francisco CA USA 94143 Care, San Francisco, Ludwig Boltzmann Inst Clin Anesthesia & Intens Ca, Vienna, Austria Ludwig Boltzmann Inst Clin Anesthesia & Intens Ca Vienna Austria ustria
Titolo Testata:
ANESTHESIOLOGY
fascicolo: 6, volume: 90, anno: 1999,
pagine: 1609 - 1616
SICI:
0003-3022(199906)90:6<1609:SASTDL>2.0.ZU;2-Y
Fonte:
ISI
Lingua:
ENG
Soggetto:
SWEATING THRESHOLD; SPINAL-ANESTHESIA; BLOOD-FLOW; TEMPERATURE; HYPOTHERMIA; HUMANS; VASOCONSTRICTION; ISOFLURANE; INCREASES; AMPLITUDE;
Keywords:
hyperthermia; hypothermia; temperature; thermoregulation; vasoconstriction;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
40
Recensione:
Indirizzi per estratti:
Indirizzo: Sessler, DI UnivAve,3rdSan Francisco, Dept Anesthesia, Outcomes Res Grp, 374 Parnassus Univ Calif San Francisco 374 Parnassus Ave,3rd Floor San Francisco CA USA 94143
Citazione:
O. Panzer et al., "Shivering and shivering-like tremor during labor with and without epiduralanalgesia", ANESTHESIOL, 90(6), 1999, pp. 1609-1616

Abstract

Background: Effective treatment and prevention of hyperthermia and shivering-like tremor during labor is hindered by a poor understanding of their causes. The authors sought to identify the incidence of nonthermoregulatory shivering-like tremor and the factors associated with this activity. Methods: The authors studied women in spontaneous fullterm labor who choseepidural analgesia (n = 21) or opioid sedation (n = 31). Shivering-like tremor and sweating were evaluated by observation, Core temperature was recorded in the external auditory canal using a compensated infrared thermometer. Arteriovenous shunt tone was evaluated with forearm minus fingertip skin temperature gradients; gradients less than 0 mere considered evidence of vasodilation. Tremor was considered nonthermoregulatory when core temperatureexceeded 37 degrees C and the arms were vasodilated. Pain was evaluated using a visual analog scale. Results: Shivering-like tremor was observed in 18% of 290, 30-min data-acquisition epochs before delivery. The patients were both normothermic and vasodilated during 15% of these epochs. Shivering was observed in 16% of 116 postdelivery epochs and was nonthermoregulatory in 28%. Sweating was observed in 30% of predelivery epochs, and the patients were both hypothermic andvasoconstricted during 12%. The mean core temperature in patients given epidural analgesia was approximately 0.2 degrees C greater than in those given sedation. Hyperthermia was observed during 10 epochs (38.4 +/- 0.3 degrees C) during epidural analgesia and during 10 epochs (38.4 +/- 0.3 degrees C) with sedation. The patients were vasoconstricted in more than 50% of these epochs in each group. Multivariate mixed-effects modeling identified highpain scores and vasoconstriction as significant predictors of shivering. There were no predictors for shivering epochs in patients who were simultaneously normothermic and vasodilated. Significant predictors of sweating weretime before delivery, high pain scores, hypothermia with vasoconstriction,high thermal comfort, and low mean skin temperature. There were no predictors for sweating epochs in patients who were simultaneously hypothermic andvasoconstricted. Conclusions: This study confirms the clinical impression that some peripartum shivering-like tremor is nonthermoregulatory. The authors also identified nonthermoregulatory sweating. These data indicate that shivering-like tremor and sweating in the peripartum period is multifactorial.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 14/07/20 alle ore 06:28:21