Hypothermia after cesarean delivery and its reversal with lorazepam

Hess, Philip E.; Snowman, C.E.; Wang, J.

doi:10.1016/j.ijoa.2005.02.004

Cited by 31 publications

(49 citation statements)

References 17 publications

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“…8 We also observed a rapid increase in our patient's body temperature. Lorazepam binds to benzodiazepine receptors, which are subunits of gammaaminobutyric acid-A (GABA A ) receptors, and enhances the effect of GABA on GABA A receptors.…”

Section: Discussionsupporting

confidence: 65%

“…Persistent hypothermia after spinal anesthesia with intrathecal morphine has been described in six other case reports of 20 patients (Table), [5][6][7][8][9]11 and another case has been described in a non-obstetrical patient. 11 All of the patients reported nausea and diaphoresis; a number of them complained of feeling hot, and none of them shivered or felt cold.…”

Section: Discussionmentioning

confidence: 99%

“…The nadir of the temperature measurements ranged from 33.2°C (tympanic) 9 to 34.9°C (mean oral). 8 The duration of hypothermia varied widely (2-22 hr).…”

Section: Discussionmentioning

confidence: 99%

“…2,3 While hypothermia can be a common consequence of spinal anesthesia due to vasodilatation and the loss of the shivering reflex, 4 several anecdotal reports describe persistent hypothermia in the obstetrical population after spinal anesthesia using intrathecal morphine. [5][6][7][8][9] This case report describes persistent hypothermia following spinal anesthesia using intrathecal morphine for total knee arthroplasty and the return to normothermia after sublingual lorazepam.…”

Section: Résumémentioning

confidence: 99%

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Persistent hypothermia after intrathecal morphine: case report and literature review

Ryan

Price

Warriner

et al. 2011

Can J Anesth/J Can Anesth

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Purpose To describe a case of persistent hypothermia following spinal anesthesia with intrathecal morphine. Clinical features Following elective right total knee arthroplasty under spinal anesthesia with isobaric 0.5% bupivacaine 11 mg, fentanyl 15 lg, and preservative-free morphine 150 lg, a 57-yr-old female (93.5 kg, 151 cm) developed postoperative hypothermia with a nadir rectal temperature of 33.6°C four hours after surgery. At times, her temperature could not be measured by tympanic, temporal arterial, oral, axillary, or rectal routes. In spite of the low temperature, the patient complained of feeling hot and was diaphoretic without shivering. With the exception of her temperature, her vital signs were normal postoperatively, and aside from hyperglycemia, complete blood count, electrolytes, thyroid-stimulating hormone, serum cortisol, troponin, and twelve-lead electrocardiogram were normal. Her temperature did not respond to warming efforts with a forced-air warming blanket, infusion of warmed intravenous crystalloid, and hourly bladder irrigation with warm saline through an indwelling urinary catheter. Normothermia returned after she received a small dose of sublingual lorazepam eight hours after surgery. The remainder of her postoperative stay was uneventful. Conclusion Patients undergoing spinal anesthesia with intrathecal morphine may develop postoperative hypothermia that is resistant to warming measures. This complication may be treated successfully with lorazepam. RésuméObjectif De´crire un cas d'hypothermie persistante apre`s anesthe´sie me´dullaire avec administration intrathe´cale de morphine. Caractéristiques cliniques Apre`s arthroplastie totale programme´e du genou droit sous anesthe´sie me´dullaire utilisant de la bupivacaı¨ne 0,5 % isobare 11 mg, du fentanyl 15 lg et de la morphine 150 lg sans agent de conservation, une femme aˆge´e de 57 ans (93,5 kg, 151 cm) a pre´sente´une hypothermie postope´ratoire avec une tempe´rature rectale descendant jusqu'a`33,6°C quatre heures apre`s l'ope´ration. Par moment, sa tempe´rature n'a pas pu eˆtre mesure´e par voie tympanique, orale, axillaire, ou rectale, ou par le biais de l'arte`re temporale. En de´pit de cette tempe´rature basse, la patiente s'est plainte d'une sensation de chaleur et pre´sentait une diaphore`se sans frissonnement. A`l'exception de sa tempe´rature, ses signes vitaux postope´ratoires e´taient normaux et hormis une hyperglyce´mie, la formule sanguine comple`te, les e´lectrolytes, l'hormone thyre´otrope, le cortisol se´rique, la troponine et un e´lectrocardiogramme a`12 de´rivations e´taient normaux. Sa tempe´rature n'a pas re´agi aux efforts de re´chauffement avec une couverture chauffante aÀ uthor contributions Kenneth Ryan conducted the literature review, wrote the first draft of the case report, and contributed to the revisions of the manuscript. James Price was involved in the care of the patient and contributed extensively to the revisions of the manuscript. Brian Warriner was involved in the care of the patient and contr...

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

“…The nadir of the temperature measurements ranged from 33.2°C (tympanic) 9 to 34.9°C (mean oral). 8 The duration of hypothermia varied widely (2-22 hr).…”

Section: Discussionmentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

See 2 more Smart Citations

Persistent hypothermia after intrathecal morphine: case report and literature review

Ryan

Price

Warriner

et al. 2011

Can J Anesth/J Can Anesth

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“…Even in small amounts, intrathecal morphine is known to be associated with hypothermia (Hui et al., ). Cephalic spread of intrathecal morphine is proposed to decrease the thermoregulatory set point (Hess, Snowman, & Wang, ), which may explain the paradoxical symptoms sometimes found with intrathecal morphine‐associated hypothermia, whereby diaphoresis alongside hypothermia has been observed (Hess et al., ). As active warming may not be tolerable for these patients, thermal maintenance in patients given intrathecal morphine presents a greater challenge.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review of the Effectiveness of Warming Interventions for Women Undergoing Cesarean Section

Munday

Hines

Wallace

et al. 2014

Worldviews Ev Based Nurs

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Intravenous fluid warming by any method improves maternal temperature and reduces shivering during and after cesarean section, as does preoperative body warming. Preoperative warming strategies should be utilized where possible. Preoperative or intraoperative warmed IV fluids should be standard practice. Warming strategies are less effective when intrathecal opioids are administered. Further research is needed to investigate interventions in emergency cesarean section surgery. Larger scale studies using standardized, clinically meaningful temperature measurement time points are required.

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Hypothermia With Paradoxical Symptoms: A Case Series of Cesarean Deliveries With Intrathecal Morphine

Munday¹,

Ramis²,

Kynoch³

et al. 2023

AORN Journal

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Women receiving intrathecal morphine for cesarean delivery may experience hypothermia with paradoxical symptoms of sweating, nausea, and shivering. Despite being relatively rare in comparison to commonly experienced symptoms of perioperative hypothermia, hypothermia with paradoxical symptoms affects early maternal recovery and comfort. The cause is undetermined, and treatment approaches vary. Regular active‐warming strategies may not be tolerated because of the paradoxical symptoms of sweating and feeling overheated. This case series aims to explore the phenomenon through the evaluation of health care records of women receiving intrathecal morphine for cesarean delivery at a single, tertiary health care institution in Australia from 2015 to 2018. We also summarize published literature to review treatment approaches used in the care of women experiencing profound heat loss while feeling overheated.

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Hypothermia after cesarean delivery and its reversal with lorazepam

Cited by 31 publications

References 17 publications

Persistent hypothermia after intrathecal morphine: case report and literature review

Persistent hypothermia after intrathecal morphine: case report and literature review

A Systematic Review of the Effectiveness of Warming Interventions for Women Undergoing Cesarean Section

Hypothermia With Paradoxical Symptoms: A Case Series of Cesarean Deliveries With Intrathecal Morphine

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