d. is largely deter-
mined by age and
core temperature
d. The risk of post-
operative shivering
in adults is largely
determined by
younger age and
drop in core temper-
ature. The incidence
of post-anesthetic shivering was once as high as 40% of patients being
admitted to PACU. It has decreased, however, with aggressive efforts to
keep all surgical patients normothermic and the increased use of opi-
oids, which directly inhibit shivering. Shivering can increase O
2
con-
sumption about 100% in proportion to heat loss; however, shivering is
actually poorly correlated to the development of cardiac ischemia. Post-
operative shivering in the elderly is actually rare and usually of low
intensity when it does occur. This suggests that increased metabolic rate
is not the primary mechanism by which myocardial ischemia occurs.
Shivering can place stress on the surgical wound, augmenting pain and
stretch on surgical sutures and increasing the risk of wound dehiscence.
11. Which pharmacologic agent is not commonly used to treat shivering?
a. Meperidine (Demerol)
b. Diphenhydramine (Benadryl)
c. Clonidine (Catapres)
d. Doxapram (Dopram, Stimulex)
6 5
J U N E 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T
z PREWARMING IV FLUIDS One of the advantages of warmed IV Fluids at nor-
mal body temperature is the improved absorption of administered medications.
