Question

Post-spinal shivering.

Hint:

Warming measures and pharmacological suppression of shivering are essential to manage post-spinal shivering effectively.

Answer 1

Step 1: Understanding Post-Spinal Shivering.
Shivering after spinal anaesthesia is commonly caused by a temperature drop, particularly as the sympathetic blockade induces vasodilation, leading to heat loss. This results in a mismatch between the body's temperature and the hypothalamic set point, triggering shivering as the body's attempt to generate heat.

Step 2: Causes of Post-Spinal Shivering.
- Hypothermia: Often induced by the cool operating room environment, the low ambient temperature exacerbates the thermoregulatory response.
- Sympathetic Blockade: Spinal anaesthesia can block sympathetic nervous system activity, reducing the body's ability to conserve heat by causing vasodilation in the peripheral vasculature.

Step 3: Management of Post-Spinal Shivering.
- Warming Measures: These include covering the patient with warm blankets, using forced air warming systems, or heating intravenous fluids to prevent further heat loss.
- Shivering Suppressants: Medications such as clonidine, dextromethorphan, or meperidine (a pethidine) can be used to suppress shivering. - Fluid Administration: IV fluids at body temperature can help re-establish normal thermoregulation and prevent further heat loss.

Step 4: Conclusion.
Post-spinal shivering is typically self-limiting but can cause patient discomfort. Appropriate management involves warming the patient, suppressing shivering pharmacologically, and preventing further heat loss. Monitoring and addressing these factors can help ensure a comfortable post-operative recovery.