Findings from the Department of Outcomes
Research and Outcomes Research Consortium
Perioperative Shivering:
Physiology and Pharmacology
Release Date: May 20, 2008
Renewal Date: July 27, 2011
Expiration Date: July 27, 2012
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How to Obtain AMA PRA
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Estimated Time of Completion: 2 Hours
Description
In homeothermic species, a thermoregulatory system coordinates defenses against cold and heat to maintain internal body temperature within a narrow range, thus optimizing normal physiologic and metabolic function. The combination of anesthetic-induced thermoregulatory impairment and exposure to a cool environment makes most unwarmed surgical patients hypothermic (1-7). Although shivering is but one consequence of perioperative hypothermia, and rarely the most serious. It occurs frequently (i.e., 40%-60% after volatile anesthetics) (8, 9 ) and it remains poorly understood. While cold-induced thermoregulatory shivering remains an obvious etiology, the phenomenon has also been attributed to numerous other causes.
Learning Objectives
- Discuss the etiology of normal and postoperative shivering-like tremor.
- Describe pharmacological modulation of shivering by biogenic amines, cholinomimetics, peptides, NMDA receptors and analeptic agents.
- Discuss the special anti-shivering efficacy of meperidine.
Target Audience
This activity is intended for anesthesiologists and other physicians and nurses caring for perioperative and critical-care patients.
Accreditation
The Cleveland Clinic Foundation Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The Cleveland Clinic Foundation Center for Continuing Education designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Participants claiming CME credit from this activity may submit the credit hours to the American Osteopathic Association Council on Continuing Medical Education for Category 2 credit.
Activity Director / Author
Daniel I. Sessler, MD
Chairman, Department of Outcomes Research
Cleveland Clinic
Cleveland, Ohio
Author/Faculty
Jan L. DeWitte, MD
Attending Anesthesiologist
Department of Anesthesia and Intensive Care
OLV Hospital
Aalst, Belgium
Disclosure
In accordance with the Standards for Commercial Support issued by the Accreditation Council for Continuing Medical Education (ACCME), The Cleveland Clinic Foundation Center for Continuing Education requires resolution of all faculty conflicts of interest to ensure CME activities are free of commercial bias.
The following faculty have indicated that they have no relationship which, in the context of their presentations, could be perceived as a potential conflict of interest:
Jan L. DeWitte, MD
Daniel I. Sessler, MD
This CME activity was produced by The Cleveland Clinic Foundation
Center for Continuing Education and the Outcomes Research Consortium.
