OBJECTIVE: To observe the effect of electroacupuncture (EA) on laparoscope postoperative shivering in patients undergoing general anesthesia and explore its effect mechanism. METHODS: A total of 80 patients with elective laparoscopic resection of intestinal tumor under general anesthesia were randomly divided into an EA group and a tramadol group, 40 cases in each group. Thirty min prior to the end of the operation, in the EA group, EA was exerted at Neimadian and Zusanli (ST 36), with disperse-dense wave, 2 Hz/100 Hz in frequency, 1 mA in intensity, and lasting 30 min. In the tramadol group, tramadol hydrochloride injection was dropped intravenously, 1 mg/kg. The conditions of shivering, dizziness, nausea, vomiting and agitation were observed in the post-anesthesia care unit (PACU). Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were observed before treatment (T₀), at the moment of extubation (T₁), in 3 min of extubation (T₂) and 1 h after operation (T₃). Using ELISA, at T₀ and T₃, the expression levels of interleukin 6 (IL-6) and 5-hydroxytryptamine (5-HT) in plasma were detected separately. Choking and agitation were recorded during extubation. RESULTS: ① In the EA group, the incidence of shivering, dizziness, nausea, vomiting and agitation in the PACU was lower than that in the tramadol group (P<0.05). ②Compared with T₀, HR, SBP and DBP were increased at T₁ and T₂ in the tramadol group (P<0.05). HR, SBP and DBP in the EA group were lower than the tramadol group at T₁ and T₂ (P<0.05). ③Compared with T₀, the expression levels of IL-6 and 5-HT in plasma were increased at T₃ in the tramadol group (P<0.05). The expression levels of IL-6 and 5-HT in the EA group were lower than the tramadol group at T₃ (P<0.05). ④The incidence of choking and agitation during exudation in the EA group was lower than that in the tramadol group (P<0.05). CONCLUSION Electroacupuncture can reduce the incidence of laparoscopic postoperative shivering under general anesthesia. The potential mechanism mays related to the modulation of the expression levels of IL-6 and 5-HT caused by surgical trauma.
Anesthesia, General/adverse effects* ; Electroacupuncture ; Humans ; Laparoscopes ; Postoperative Period ; Shivering

BACKGROUND: Hypothermia below 36℃ is a common problem during arthroscopic shoulder surgery. Geriatric patients are more vulnerable to perioperative hypothermia. The present study compared postoperative hypothermia between geriatric and young adult patients receiving arthroscopic shoulder surgery. METHODS: Data were collected retrospectively from a geriatric group (aged 65 or more, n = 29), and a control group (aged 19–64, n = 33) using the anesthesia records of patients who had undergone arthroscopic shoulder surgery. The primary outcome measure was the incidence of hypothermia upon arrival in the postanesthesia care unit (PACU). The secondary outcome measure was the decrease in body temperature from admission into the operating room to admission into the PACU. RESULTS: The incidence of hypothermia was 93.1% and 54.5% in the geriatric and control groups, respectively, demonstrating a significant difference between the groups (P < 0.001). Comparison between body temperature revealed a decrease of 1.5 ± 0.6℃ and 1.0 ± 0.4℃ in the geriatric and control groups, respectively, showing a significant difference between the groups (P < 0.001). The degree of hypothermia was significantly different between the groups (P = 0.027). No shivering was observed in either of the two groups, but the incidence of thermal discomfort was higher in the geriatric group than in the control group (P = 0.021). CONCLUSIONS: In geriatric patients undergoing arthroscopic shoulder surgery, both the incidence of postoperative hypothermia and the associated temperature drop are more prominent than those in young adult patients. Additional warming methods will be needed to prevent postoperative hypothermia in geriatric patients.
Anesthesia ; Arthroscopy ; Body Temperature ; Humans ; Hypothermia* ; Incidence ; Operating Rooms ; Outcome Assessment (Health Care) ; Retrospective Studies ; Shivering ; Shoulder* ; Young Adult

BACKGROUND: At least 30 minutes of pre-warming has been recommended for the prevention of redistribution hypothermia. However, it has been reported that less than 30 minutes of pre-warming is also effective. The aim of this study was to evaluate the ability of 10 minutes of pre-warming to prevent inadvertent perioperative hypothermia. Results were compared with 30 minutes of pre-warming. METHODS: In this prospective randomized study, 59 patients scheduled for elective surgery less than 120 minutes under general anesthesia were divided into 2 groups: the first group was pre-warmed for 10 minutes (n = 30), the second group for 30 minutes (n = 29). The patients were pre-warmed for 10 or 30 minutes in the pre-anesthetic area using a forced-air warmer. When the patients' body temperatures decreased below 36℃, we warmed them with a forced-air warmer intraoperatively and postoperatively. Body temperatures were recorded during perioperative periods. Shivering and thermal comfort were evaluated in the pre-anesthetic area and post-anesthesia care unit. RESULTS: The incidence of intraoperative and postoperative hypothermia were not significantly different (P > 0.05). However, the temperatures were higher in the 30 minute group from the post-warming time to 90 minutes after anesthetic induction (P < 0.05). CONCLUSIONS: Ten minutes of pre-warming has the same effectiveness as 30 minutes of pre-warming for preventing inadvertent perioperative hypothermia. It is a preferable choice for the patients scheduled for surgery less than 120 minutes under general anesthesia.
Anesthesia, General ; Body Temperature ; Humans ; Hypothermia* ; Incidence ; Perioperative Period ; Prospective Studies ; Shivering

BACKGROUND: The conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum cesarean section (CS) often fails, resulting in intraoperative pain. Spinal anesthesia (SA) can provide a denser sensory block than ESA. The purpose of this prospective, non-blinded, parallel-arm, randomized trial was to compare the rate of pain-free surgery between ESA and SA following ELA for intrapartum CS. METHODS: Both groups received continuous epidural infusions for labor pain at a rate of 10 ml/h. In the ESA group (n = 163), ESA was performed with 17 ml of 2% lidocaine mixed with 100 µg fentanyl, 1 : 200,000 epinephrine, and 2 mEq bicarbonate. In the SA group (n = 160), SA was induced with 10 mg of 0.5% hyperbaric bupivacaine and 15 µg fentanyl. We investigated the failure rate of achieving pain-free surgery and the incidence of complications between the two groups. RESULTS: The failure rate of achieving pain-free surgery was higher in the ESA group than the SA group (15.3% vs. 2.5%, P < 0.001). There was no statistical difference between the two groups in the rate of conversion to general anesthesia; however, the rate of analgesic requirement was higher in the ESA group than in the SA group (12.9% vs. 1.3%, P < 0.001). The incidence of high block, nausea, vomiting, hypotension, and shivering and Apgar scores were comparable between the two groups. CONCLUSIONS: SA after ELA can lower the failure rate of pain-free surgery during intrapartum CS compared to ESA after ELA.
Analgesia* ; Anesthesia* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal* ; Bupivacaine ; Cesarean Section* ; Epinephrine ; Female ; Fentanyl ; Hypotension ; Incidence ; Labor Pain ; Lidocaine ; Nausea ; Pregnancy ; Prospective Studies* ; Shivering ; Vomiting

BACKGROUND: Intraoperative hypothermia is common in patients undergoing general anesthesia during arthroscopic hip surgery. In the present study, we assessed the effect of heating and humidifying the airway with a heated wire humidification circuit (HHC) to attenuate the decrease of core temperature and prevent hypothermia in patients undergoing arthroscopic hip surgery under general anesthesia. METHODS: Fifty-six patients scheduled for arthroscopic hip surgery were randomly assigned to either a control group using a breathing circuit connected with a heat and moisture exchanger (HME) (n = 28) or an HHC group using a heated wire humidification circuit (n = 28). The decrease in core temperature was measured from anesthetic induction and every 15 minutes thereafter using an esophageal stethoscope. RESULTS: Decrease in core temperature from anesthetic induction to 120 minutes after induction was lower in the HHC group (–0.60 ± 0.27℃) compared to the control group (–0.86 ± 0.29℃) (P = 0.001). However, there was no statistically significant difference in the incidence of intraoperative hypothermia or the incidence of shivering in the postanesthetic care unit. CONCLUSIONS: The use of HHC may be considered as a method to attenuate intraoperative decrease in core temperature during arthroscopic hip surgery performed under general anesthesia and exceeding 2 hours in duration.
Anesthesia, General* ; Arthroscopy ; Body Temperature ; Heating ; Hip* ; Hot Temperature* ; Humans ; Hypothermia ; Incidence ; Methods ; Respiration ; Shivering ; Stethoscopes

PURPOSE: Oral naloxone is combined with oxycodone to alleviate or prevent opioid-induced constipation in cancer pain patients. However, there is still concern that oral naloxone may precipitate opioid withdrawal symptoms in patients on opioids. We retrospectively investigated clinical characteristics of cancer patients who experienced opioid withdrawal symptoms. METHODS: We reviewed medical records of all patients who were prescribed with oral oxycodone/naloxone at a tertiary cancer center from January 1, 2012 through December 31, 2016. Eligible patients were screened based on demographics, opioid and naloxone dosages, clinical manifestation and pain intensity. RESULTS: Among a total of 1,641 patients, 10 patients were selected. Seven patients were male, and the average age was 68.1 years. The median dose of naloxone that induced withdrawal symptoms was 20 mg. Most common withdrawal symptom was shivering (seven patients) followed by cold sweating (five), and muscle twitching (five). Other symptoms included restlessness, fever, dizziness, and yawning. Pain was exacerbated from the median intensity of numeric rating scale (NRS) 3 to NRS 6. CONCLUSION: Opioid withdrawal symptoms may occur when switching to oral oxycodone/naloxone for cancer patients who have been treated with other strong opioids. A prospective, multicenter study on this issue should be conducted in future.
Analgesics, Opioid* ; Constipation ; Demography ; Dizziness ; Fever ; Humans ; Male ; Medical Records ; Naloxone ; Oxycodone ; Prospective Studies ; Psychomotor Agitation ; Retrospective Studies ; Shivering ; Substance Withdrawal Syndrome* ; Sweat ; Sweating ; Yawning

We presented a patient with cerebral decompression sickness, who showed predominant vasogenic edema on a 3.0 Tesla (3T) magnetic resonance imaging (MRI) findings, including diffusion-weighted image (DWI) and apparent diffusion coefficient (ADC) mapping. Within minutes of surfacing, he developed paresis of the right lower limb. During transport, he began shivering, followed by severe spasm that eventually progressed to a tonic-clonic seizure. Emergent hyperbaric oxygen therapy (HBOT) was performed with U.S. Navy treatment table 6A after a treatment of seizure activity. Brain MRI was performed after hyperbaric oxygen therapy to detect any cerebral lesions, which showed subcortical hyperintensity signal changes in the left fronto-parietal region on the ADC map. Overlying cortical hyperintensity on DWI sequences and cortical hypointensity on the ADC map were simultaneously observed. Moreover, these findings disappeared in a followup MRI with complete resolution of symptoms. These findings indicate that vasogenic edema can cause cerebral decompression sickness (DCS) and that 3T MRI with DWI and ADC mapping may be useful for diagnosing cerebral DCS. In addition, these findings suggest that DW-MRI may also be useful in predicting the prognosis of cerebral DCS.
Brain ; Brain Edema ; Decompression Sickness* ; Decompression* ; Diffusion ; Diffusion Magnetic Resonance Imaging ; Edema ; Follow-Up Studies ; Humans ; Hyperbaric Oxygenation ; Lower Extremity ; Magnetic Resonance Imaging* ; Paresis ; Prognosis ; Seizures ; Shivering ; Spasm

BACKGROUND: Hypothermia (< 36°C) is common during arthroscopic shoulder surgery. It is known that 30 to 60 minutes of prewarming can prevent perioperative hypothermia by decreasing body heat redistribution. However, the effect of short-term prewarming (less than 30 minutes) on body temperature in such surgery has not been reported yet. Therefore, the aim of this prospective study was to investigate the effect of short-term prewarming for less than 30 minutes using forced-air warming device on body temperature during interscalene brachial plexus block (ISBPB) procedure in arthroscopic shoulder surgery before general anesthesia. METHODS: We randomly assigned patients scheduled for arthroscopic shoulder surgery to receive either cotton blanket (not pre-warmed, group C, n = 26) or forced-air warming device (pre-warmed, group F, n = 26). Temperature was recorded every 15 minutes from entering the operating room until leaving post-anesthetic care unit (PACU). Shivering and thermal comfort scale were evaluated during their stay in the PACU. RESULTS: There were significant differences in body temperature between group C and group F from 30 minutes after induction of general anesthesia to 30 minutes after arrival in the PACU (P < 0.05). The median duration of prewarming in group F was 14 min (range: 9-23 min). There was no significant difference in thermal comfort scale or shivering between the two groups in PACU. CONCLUSIONS: Our results showed that short-term prewarming using a forced-air warming device during ISBPB in arthroscopic shoulder surgery had beneficial effect on perioperative hypothermia.
Anesthesia, General ; Body Temperature* ; Brachial Plexus Block ; Hot Temperature ; Humans ; Hypothermia ; Operating Rooms ; Prospective Studies ; Shivering ; Shoulder*

BACKGROUND: Hypothermia (< 36°C) is common during arthroscopic shoulder surgery. It is known that 30 to 60 minutes of prewarming can prevent perioperative hypothermia by decreasing body heat redistribution. However, the effect of short-term prewarming (less than 30 minutes) on body temperature in such surgery has not been reported yet. Therefore, the aim of this prospective study was to investigate the effect of short-term prewarming for less than 30 minutes using forced-air warming device on body temperature during interscalene brachial plexus block (ISBPB) procedure in arthroscopic shoulder surgery before general anesthesia. METHODS: We randomly assigned patients scheduled for arthroscopic shoulder surgery to receive either cotton blanket (not pre-warmed, group C, n = 26) or forced-air warming device (pre-warmed, group F, n = 26). Temperature was recorded every 15 minutes from entering the operating room until leaving post-anesthetic care unit (PACU). Shivering and thermal comfort scale were evaluated during their stay in the PACU. RESULTS: There were significant differences in body temperature between group C and group F from 30 minutes after induction of general anesthesia to 30 minutes after arrival in the PACU (P < 0.05). The median duration of prewarming in group F was 14 min (range: 9-23 min). There was no significant difference in thermal comfort scale or shivering between the two groups in PACU. CONCLUSIONS: Our results showed that short-term prewarming using a forced-air warming device during ISBPB in arthroscopic shoulder surgery had beneficial effect on perioperative hypothermia.
Anesthesia, General ; Body Temperature* ; Brachial Plexus Block ; Hot Temperature ; Humans ; Hypothermia ; Operating Rooms ; Prospective Studies ; Shivering ; Shoulder*

PURPOSE: This study was designed to determine the effects of pre-warming on core body temperature (CBT) and hemodynamics from the induction of spinal anesthesia until 30 min postoperatively in surgical patients who undergo total hip replacement under spinal anesthesia. Our goal was to assess postoperative shivering and inflammatory response. METHODS: Sixty-two surgical patients were recruited by informed notice. Data for this study were collected at a 1,300-bed university hospital in Incheon, South Korea from January 15 through November 15, 2013. Data on CBT, systemic blood pressure (SBP), and heart rate were measured from arrival in the pre-anesthesia room to 3 hours after the induction of spinal anesthesia. Shivering was measured for 30 minutes post-operatively. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured pre-operatively, and 1 and 2 days postoperatively. The 62 patients were randomly allocated to an experimental group (EG), which underwent pre-warming for 30 minutes, or a control group (CG), which did not undergo pre-warming. RESULTS: Analysis of CBT from induction of spinal anesthesia to 3 hours after induction revealed significant interaction between group and time (F=3.85, p=.008). In addition, the incidence of shivering in the EG was lower than that in the CG (χ²=6.15, p=.013). However, analyses of SBP, heart rate, CRP, and ESR did not reveal significant interaction between time and group. CONCLUSION: Pre-warming for 30 minutes is effective in increasing CBT 2 and 3 hours after induction of spinal anesthesia. In addition, pre-warming is effective in decreasing post-operative shivering.
Aged* ; Anesthesia, Spinal* ; Arthroplasty, Replacement, Hip* ; Blood Pressure* ; Blood Sedimentation ; Body Temperature Regulation ; Body Temperature* ; C-Reactive Protein ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hypothermia ; Incheon ; Incidence ; Inflammation* ; Korea ; Shivering*