Pharmacological methods of preventing perioperative shivering
| 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 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 IV | ||
| 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 IT |
Nonpharmacological methods of preventing perioperative shivering
| 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 |