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Perfusion index as a possible predictor for postanesthetic shivering

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Abstract

Background

Postanesthetic shivering can be triggered by surgical stress and several aspects of anesthetic management and is frequently preceded by a decrease in peripheral blood flow due to thermoregulatory vasoconstriction. As perfusion index correlates with peripheral blood flow, we examined whether perioperative perfusion index, measured using pulse oximetry, might be correlated with postanesthetic shivering.

Methods

Twenty-eight patients presenting for elective abdominal surgery were enrolled. Core (esophagus) and peripheral (finger) temperatures and perfusion index were recorded in the perioperative periods. Correlations between perfusion index and peripheral temperature and core-to-peripheral temperature gradient were then explored. Plasma levels of epinephrine and norepinephrine were also measured. The extent of shivering was graded after emergence from anesthesia.

Results

Perfusion index declined before emergence from anesthesia in patients who then developed postanesthetic shivering. This coincided with the time at which the difference between core and peripheral temperature became dissociated and peripheral temperature declined. Perioperative perfusion index was correlated with peripheral temperature and peripheral-core temperature gradient. Perfusion index at closure of the peritoneum predicted postanesthetic shivering and was significantly correlated with the extent of shivering. Plasma levels of both epinephrine and norepinephrine were significantly elevated after shivering events.

Conclusions

Perfusion index was significantly lower in patients with postanesthetic shivering before emergence from anesthesia, indicating that measurement of perfusion index during and before the end of anesthesia might be a useful means of predicting postanesthetic shivering.

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan

    Chiharu Kuroki, Kohei Godai, Maiko Hasegawa-Moriyama, Tamotsu Kuniyoshi, Akira Matsunaga & Yuichi Kanmura

  2. Department of Physiology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan

    Chiharu Kuroki & Tomoyuki Kuwaki

Authors
  1. Chiharu Kuroki
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  2. Kohei Godai
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  3. Maiko Hasegawa-Moriyama
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  4. Tamotsu Kuniyoshi
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  5. Akira Matsunaga
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  6. Yuichi Kanmura
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  7. Tomoyuki Kuwaki
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Corresponding author

Correspondence to Maiko Hasegawa-Moriyama.

Additional information

C. Kuroki and K. Godai contributed equally to this work.

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Kuroki, C., Godai, K., Hasegawa-Moriyama, M. et al. Perfusion index as a possible predictor for postanesthetic shivering. J Anesth 28, 19–25 (2014). https://doi.org/10.1007/s00540-013-1658-9

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  • DOI: https://doi.org/10.1007/s00540-013-1658-9

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