LETTERSTOTHEEDITOR 449 RudrashishHaldar∗,SukhminderJitSinghBajwa,
JasleenKaur
DepartmentofAnaesthesia,GianSagarMedicalCollege andHospital,Banur,India
∗Correspondingauthor.
E-mail:rudrashish@yahoo.com(R.Haldar). Availableonline12March2014
http://dx.doi.org/10.1016/j.bjane.2014.02.006
Importance
of
maternal
body
temperature
recording
after
injection
of
meperidine
during
spinal
anesthesia
in
patients
undergoing
cesarean
section:
an
offering
for
conducting
clinical
studies
A
importância
do
controle
da
temperatura
corporal
materna
após
injec
¸ão
de
meperidina
durante
a
raquianestesia
em
pacientes
submetidas
à
cesariana:
uma
sugestão
para
conduzir
estudos
clínicos
DearEditor,
Shiveringrelated tospinal and epidural anesthesiais dis-tressingtoparturientwomenasitmaycausecardiovascular and metabolic disturbances. Shivering increases cardiac outputandcausestachycardia; also,hypothermia-induced shiveringincreasestotalbodyoxygenconsumptionandcould cause hypoxemia. These effects may place mothers and thefetuses at thegreatest risk duringdelivery.1 The rate
of shiveringvaried from36% to55% in different studies.2
Meperidineisa(Kappa)-receptoragonistandopioid(Mu)
receptorthatreducesthethresholdofvascularconstriction andisknowntotreatshiveringeffectively.3Hereweprovide
commentsonthreepointsontheimportanceofbody tem-peraturerecordingafterinjectionofmeperidine,basedon clinical research conductedon patients undergoingspinal anesthesiaforcesareansection.
First, intra-operative shivering is a particular feature ofthermoregulationinawakepatientsundergoingregional anesthesia(inresponsetosympatholysis,vasodilatationand increasedheat loss). Intra-operativeshivering is inhibited during general anesthesia; accordingly patients are more pronetohypothermiaandpost-operativeshivering.Hence, therearetwoimportant elements toregional anesthesia-inducedshivering:(1)thedesiredeffectofshivering,i.e., heat preservation by increased basal metabolic rate and (2) the unwanted effects of shivering (increased venous O2,desaturation,myocardialO2extraction,discomfortand
anxiety for patient, and possibly movement for surgeon andmonitoringartifactsfortheanesthesiologist(e.g., sys-tolicpO2,noninvasive bloodpressureand ECGartifactsin
intra-operativeshivering).4,5Therefore,theauthorsshould
measurematernalbodytemperature toassessthedesired effects.
Second,whenevervolumepre-loadingwith10mL/kgor 15mL/kgofroomtemperaturecrystalloidisemployed,the
maternal hypothermia could reasonably be expected to altershivering prevalence. Therefore, maternal tempera-turerecordingisveryimportant.
Third,ifmeperidinesuppressesshivering,itmayleadto lowerbodytemperaturefollowing regionalanesthesiaand thismayleadtomorehypothermiaandalsotomore shiv-eringlateron.Accordingly,appropriatebodytemperature recordingafterinjectionofmeperidineduringspinal anes-thesia in patients undergoing cesarean section should be consideredby authorsinfuturestudies formore accurate andreliablefindings.
References
1.KhawKS,KeeWDN,LeeSWY.Hypotensionduringspinal anaes-thesiaforcaesareansection:implications,detectionprevention andtreatment.FetalMaterMedRev.2006;17:69.
2.BhukalI,SolankiSL,KumarS,etal.Pre-inductionlowdose pethi-dinedoesnotdecreaseincidenceofpostoperativeshiveringin laparoscopicgynecologicalsurgeries.JAnaesthesiolClin Pharma-col.2011;27:349.
3.Delaunay L, Bonnet F, Liu N, et al. Clonidine comparably decreasesthethermoregulatorythresholdsforvasoconstriction andshiveringinhumans.Anesthesiology.1993;79:470---4. 4.ChunDH,KilHK,KimHJ,etal.Intrathecalmeperidinereduces
intraoperativeshivering duringtransurethral prostatectomyin elderlypatients.KoreanJAnesthesiol.2010;59:389---93. 5.KhanZH,ZanjaniAP,MakaremJ,etal.Antishiveringeffectsof
twodifferentdosesofintrathecalmeperidineincaesarean sec-tion:aprospectiverandomisedblindedstudy.EurJAnaesthesiol. 2011;28:202---6.
MohamedAminGhobadifara,∗,HassanZabetianb,
MohammadYasinKaramic,ZahraMosallanezhadd,
NavidKalanib
aDepartmentofStudentResearchCommittee,Jahrom
UniversityofMedicalSciences,Jahrom,Iran
bDepartmentofAnesthesiology,JahromUniversityof
MedicalSciences,Jahrom,Iran
cDepartmentofGeneralSurgery,MazandaranUniversity
ofMedicalSciences,Mazandaran,Iran
dDepartmentofObstetricsandGynecology,Shiraz
UniversityofMedicalSciences,Shiraz,Iran
∗Correspondingauthor.
E-mails:aminm505@yahoo.com,m.ghobadi@jums.ac.ir (M.A.Ghobadifar).
Availableonline12March2014
