Association Between Bispectral Index (BIS) Value and Postoperative Shivering in Patients Undergoing Orthopedic Surgery

Authors

  • Manijeh Yousefi Moghadam Department of Anesthesiology, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
  • Mohammad Nemat-Shahi Department of Anesthesiology, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
  • Bardia Dowlat-Abadi Department of Anesthesiology, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
  • Seyed Ehsan Safari Centre for Quantitative Medicine, Duke - NUS Medical School, Singapore, Asia
  • Saeed Yajan Department of Anesthesiology, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran

DOI:

https://doi.org/10.3889/oamjms.2019.240

Keywords:

Anesthesia, Consciousness Monitors, Bispectral index (BIS), Shivering, Orthopedics

Abstract

BACKGROUND: Postoperative shivering is one of the most common adverse effects after general anaesthesia.

AIM: This study aimed to evaluate the association between the Bispectral index (BIS) monitoring value and postoperative shivering in patients undergoing orthopaedic surgery.

MATERIAL AND METHODS: This cross-sectional study was conducted in Shahid Beheshti Hospital in Sabzevar city, from August 2017 to September 2018. Patients who underwent orthopaedic surgery, using general anaesthesia, were enrolled. Recording of the depth of anaesthesia using BIS monitoring was started exactly 5 minutes after intubating the patient and continued until the discharge from post-anesthesia care unit (PACU). The incidence of postoperative shivering was evaluated using a scale proposed by Crossley and Mahajan.

RESULTS: A total number of 80 patients were evaluated. 32.5% of patients experience postoperative shivering grade 2, with mean BIS score 41.85. The univariate and multivariate linear regression analysis indicated a statistically significant relationship between shivering score and patients' heart rate, blood pressure, BIS score, temperature, age, height, gender and blood cell distribution width (RDW) (p < 0.05).

CONCLUSION: The results of this study indicate a significant positive association between BIS value and postoperative shivering in patients undergoing orthopaedic surgery, so that, patients with higher BIS score experienced significantly more postoperative shivering. It seems that BIS-guided anaesthesia can reduce the risk and incidence of postoperative shivering in patients undergoing orthopaedic surgery.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Golembiewski J. Pharmacological Management of Perioperative Shivering. J Perianesth Nurs. 2015; 30(4):357-9. https://doi.org/10.1016/j.jopan.2015.05.002 PMid:26210569

Alfonsi P. Postanaesthetic shivering: epidemiology, pathophysiology, and approaches to prevention and management. Drugs. 2001; 61(15):2193-205. https://doi.org/10.2165/00003495-200161150-00004 PMid:11772130

Lopez MB. Postanaesthetic shivering - from pathophysiology to prevention. Rom J Anaesth Intensive Care. 2018; 25(1):73-81. PMid:29756066 PMCid:PMC5931188

Weant KA, Martin JE, Humphries RL, Cook AM. Pharmacologic options for reducing the shivering response to therapeutic hypothermia. Pharmacotherapy. 2010; 30(8):830-41. https://doi.org/10.1592/phco.30.8.830 PMid:20653360

Caruselli M. Postoperative shivering: a common phenomenon with multiple causes. Minerva Anestesiol. 2018; 84(12):1340-1342. https://doi.org/10.23736/S0375-9393.18.13138-5 PMid:30328332

Yousuf B, Samad K, Ullah H, Hoda MQ. Efficacy of tramadol in preventing postoperative shivering using thiopentone or propofol as induction agent: A randomized controlled trial. J Anaesthesiol Clin Pharmacol. 2013; 29(4):521-5. https://doi.org/10.4103/0970-9185.119166 PMid:24249991 PMCid:PMC3819848

Lotfi Fatemi SN, Armat MR, Emami Zeydi A, Soleimani A, Hasanzadeh Kiabi F. Inadvertent Perioperative Hypothermia: A Literature Review of an Old Overlooked Problem. Acta Facultatis Medicae Naissensis. 2016; 33(1):5-11. https://doi.org/10.1515/afmnai-2016-0001

Song Y-K, Lee C. Effects of ramosetron and dexamethasone on postoperative nausea, vomiting, pain, and shivering in female patients undergoing thyroid surgery. J Anesth. 2013; 27(1):29-34. https://doi.org/10.1007/s00540-012-1473-8 PMid:22965329

Chiang MH, Chung KC, Syue YJ, Chiaâ€Shen Yang J, Chien CY, Kuo YR. The role of meperidine in reduction of postanesthetic shivering and its possible impact on flap outcomes. Microsurgery. 2014; 34(2):106-11. https://doi.org/10.1002/micr.22133 PMid:23843309

Bhukal I, Solanki SL, Kumar S, Jain A. Pre-induction low dose pethidine does not decrease incidence of postoperative shivering in laparoscopic gynecological surgeries. J Anaesthesiol Clin Pharmacol. 2011; 27(3):349-53. https://doi.org/10.4103/0970-9185.83680 PMid:21897506 PMCid:PMC3161460

Alfonsi P. Postanaesthetic shivering. Epidemiology, pathophysiology and approaches to prevention and management. Minerva Anestesiol. 2003; 69(5):438-42. PMid:12768180

Hoshijima H, Takeuchi R, Kuratani N, Nishizawa S, Denawa Y, Shiga T, et al. Incidence of postoperative shivering comparing remifentanil with other opioids: A meta-analysis. J Clin Anesth. 2016; 32:300-12. https://doi.org/10.1016/j.jclinane.2015.08.017 PMid:26432635

Díaz M, Becker DE. Thermoregulation: physiological and clinical considerations during sedation and general anesthesia. Anesth Prog. 2010; 57(1):25-32. https://doi.org/10.2344/0003-3006-57.1.25 PMid:20331336 PMCid:PMC2844235

Crowley LJ, Buggy DJ. Shivering and neuraxial anesthesia. Reg Anesth Pain Med. 2008; 33(3):241-52. https://doi.org/10.1097/00115550-200805000-00009

Ekman A, Lindholm ML, Lennmarken C, Sandin R. Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand. 2004; 48(1):20-6. https://doi.org/10.1111/j.1399-6576.2004.00260.x PMid:14674969

Chan MT, Cheng BC, Lee TM, Gin T, Group CT. BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol. 2013; 25(1):33-42. https://doi.org/10.1097/ANA.0b013e3182712fba PMid:23027226

Medical Advisory S. Bispectral index monitor: an evidence-based analysis. Ont Health Technol Assess Ser. 2004; 4(9):1-70.

Kiekkas P, Poulopoulou M, Papahatzi A, Souleles P. Effects of hypothermia and shivering on standard PACU monitoring of patients. AANA J. 2005; 73(1):47-53. PMid:15727284

Crossley AW, Mahajan RP. The intensity of postoperative shivering is unrelated to axillary temperature. Anaesthesia. 1994; 49(3):205-7. https://doi.org/10.1111/j.1365-2044.1994.tb03422.x PMid:8147511

Oliveira CRD, Bernardo WM, Nunes VM. Benefit of general anesthesia monitored by bispectral index compared with monitoring guided only by clinical parameters. Systematic review and meta-analysis. Braz J Anesthesiol. 2017; 67(1):72-84. https://doi.org/10.1016/j.bjan.2016.10.002

De Witte J, Sessler DI. Perioperative ShiveringPhysiology and Pharmacology. Anesthesiology. 2002; 96(2):467-84. https://doi.org/10.1097/00000542-200202000-00036 PMid:11818783

Habibi MR, Baradari AG, Soleimani A, Emami Zeydi A, Nia HS, Habibi A, et al. Hemodynamic responses to etomidate versus ketamine-thiopental sodium combination for anesthetic induction in coronary artery bypass graft surgery patients with low ejection fraction: a double-blind, randomized, clinical trial. J Clin Diagn Res. 2014; 8(10):GC01-5. https://doi.org/10.7860/JCDR/2014/10237.5006

Lewis SR, Nicholson A, Smith AF, Alderson P. Alphaâ€2 adrenergic agonists for the prevention of shivering following general anaesthesia. Cochrane Database Syst Rev. 2015; (8):CD011107. https://doi.org/10.1002/14651858.CD011107.pub2

Published

2019-04-14

How to Cite

1.
Yousefi Moghadam M, Nemat-Shahi M, Dowlat-Abadi B, Safari SE, Yajan S. Association Between Bispectral Index (BIS) Value and Postoperative Shivering in Patients Undergoing Orthopedic Surgery. Open Access Maced J Med Sci [Internet]. 2019 Apr. 14 [cited 2024 May 6];7(7):1166-9. Available from: https://oamjms.eu/index.php/mjms/article/view/oamjms.2019.240

Issue

Section

B - Clinical Sciences