Risk factors for shivering during caesarean section under spinal anaesthesia. A prospective observational study

Abstract

Background Shivering during caesarean section (CS) under spinal anaesthesia is a common phenomenon. It could not only alter patient's physiology by increasing oxygen consumption but also affect the parturient's experience of childbirth. Shivering is thought to be associated with intraoperative hypothermia, but the risk factors and exact mechanism remain unclear. Methods We conducted a prospective, observational study to examine the potential risk factors for intraoperative shivering, including anxiety levels. Two hundred patients undergoing elective CS under spinal anaesthesia were recruited. Parturient anxiety levels were evaluated using the State‐Trait Anxiety Inventory (STAI) questionnaire. Age, weight, height, BMI, anxiety level, number of previous deliveries, sensory block level, level of education, temperature difference during surgery and American Society of Anesthesiologists score were investigated as potential risk factors. Stepwise logistic regression was used to assess the predictors for shivering. Results Data from 155 parturients were analysed. Shivering incidence was 21.9% (34 parturients). The statistical model predicted 8.5% of a shivering incidence variability (R‐square Nagelkerke = 0.085). Out of all measured variables, only the number of previous deliveries [(W) = 4.295 Exp(B) = 0.562 P < .05] and STAI‐X1 [(W) = 4.127 Exp(B) = 1.052 P < .05] were significant. In our model, the risk of shivering decreased by 44% with every previous delivery and increased by 5.2% with each 1‐point increase in STAI‐X1. Conclusion We failed to prove a strong correlation between the measured variables and shivering. Our findings, however, support the hypothesis, that to a limited extent, anxiety promotes shivering during CS.

Comparing the Effects of Low Dose of Ketamine, Tramadol, and Ondansetron in Prevention of Post Spinal Anesthesia Shivering in Cesarean Section

“…Besides, in different studies, patients have not been assessed by equal accuracy, especially lower grades of shivering (0 and 1) might not be detected. Furthermore, it has been shown that level of preoperative anxiety in pregnant women is strongly correlated with the severity of shivering (31). In this study, the incidence of perioperative DAR like, nausea, vomiting, hallucination, nystagmus, and sedation showed a significant difference among the four study groups.…”

Maternal hypothermia during elective caesarean delivery: A prospective observational study

“…Traditionally, shivering is largely attributed to intra-operative hypothermia, but shivering could have multiple causes in the parturient and the mechanisms remain unclear. 25 Feng and colleagues 26…”

Risk factors associated with intraoperative shivering during caesarean section: a prospective nested case-control study

“…Anxiety and stress can have adverse impacts on pregnant women and the fetus, as well as on postoperative recovery and the length of hospital stay [ 22 , 23 ]. A previous study reported that anxiety could contribute to shivering during cesarean sections [ 15 ]. Our present study further confirmed this result.…”

“…Identifying and minimizing the risk factors associated with intraoperative shivering could reduce the incidence of shivering and improve maternal outcomes. Several previous studies have suggested that anxiety, hypotension, and hypothermia may be associated with intraoperative shivering during cesarean sections [ 3 , 15 ], but another study failed to demonstrate a relationship between anxiety and shivering during surgical operations [ 16 ]. Studies have also suggested that epidural anesthesia might affect shivering, but the results are controversial [ 17 , 18 ].…”