Shivering: A Common Problem During Spinal Anesthesia

Mild hypothermia is generally considered gentle and safe[8] although a minor subset of patients may experience side effects such as infections, coagulation and electrolyte disturbances and potentially life-threatening arrhythmias during post-cardiac arrest care[5].

Purpose: The purpose of this speech is to educate and inform my audience of the risks inherent from unintended hypothermia. I’m eager to alert perioperative staff of the potential dangers as well as the preventative measures that can be taken in order to avoid complications associated with unintended hypothermia. My central idea is hypothermia management saves lives.

It is a beneficial treatment that should be implemented as early in patient care as possible, such as, within the EMS system. Through the last century this therapy has been accepted and rejected by many medical professionals. Since medicine is an ever-changing field, future research and practice of hypothermia will dictate if this therapy is more beneficial than harmful, and maybe one day could be a permanent major role, or it may never be used again. Hypothermia has been proved to decrease neurological impairment after cardiac arrest, but also has many limitations that can occur. A major limitation of this therapy is, if continued care cannot be guaranteed by receiving hospitals, therapeutic hypothermia is irrelevant for EMS to initiate. Likewise, if hypothermia is not begun in the field by EMS, then the receiving facilities now will have a delayed time in starting the therapy and anoxic brain injury could have already occurred. EMS agencies can drive the implementation of therapeutic hypothermia in the medical field. This therapy allows EMS providers to have a major role in the outcome of a cardiac arrest patient’s recovery and neurological outcome. With the progression of research and practice, medicine is evolving day after day, and patient mortality and morbidity have decreased over the years. Although, cardiac arrest patients have a poor

Malignant Hyperthermia is primarily thought to be an autosomal dominant genetic disorder that causes a hypermetabolic state after administration of volatile anesthetics. When a patient is under anesthesia, the muscles are usually relaxed, but when a patient is experiencing Malignant Hyperthermia crisis, certain IV anesthesia causes the opposite effect. Most inhaled anesthetics other than nitrous oxide, cause or trigger Malignant Hyperthermia. More specifically, the anesthetic agents: Halothane, Chloroform, and Succinylcholine. The genic condition of Malignant Hyperthermia only becomes apparent when a patient is exposed to certain anesthetics such as halothane, which causes muscle rigidity.

In the book clinical manual of emergency pediatrics the Cain and Gershel state "spinal cord injury is sometimes overlooked during the initial evaluation of the severe brain injury patient" (Crain & Gershel, 2004. p.642). The head in humans is connected to the neck bone, therefore injury to the cervical spine should be ruled out. To evaluate this, ask the child if any numbness or tingling in any body part or does it feel like pins or needles. The toes or sole of the feet should be touched to detect sensation then ask "can you feel your toes being touched." "Paresthesia is an abnormal sensation" says Jarvis (2002. p.670).The goal is to detect any spinal cord injury. If there are any indications of a suspected traumatic brain injury a CAT scan of the brain should be done as long as no spinal injury is detected. The nurse should continually be alert to the signs and symptoms of increases in intracranial pressure, such as restlessness, nausea and vomiting, altered mental status, and changes in vital signs. Monitor closely for seizure activity.

THT is the only therapy that has appeared to positively affect the neurological outcome of patients after cardiac arrest. THT has been around for more than fifty years. The history of the scope of THT is limited and the only consistent application of this therapy invasive surgery. Within the last 10 years, the benefits of induced therapeutic hypothermia have been rediscovered, mainly with the improvement in neurological outcomes in out-of-hospital cardiac arrest (OOHCA) victims. In addition, therapeutic hypothermia has been suggested to improve outcome in other neurological conditions such as traumatic brain injury, neonatal asphyxia, cerebrovascular accidents and intracranial

According to the American Pregnancy organization “more than 50% of woman giving birth at hospitals use Epidural Anesthesia”. These women turn to epidural to relieve the pain of labor; however this decision poses many risks to both mother and child. An epidural is a type of regional anesthesia where pain medication is administered to the lumbar and sacral region of the back near clusters of nerves. The placement allows for nerve impulses to be blocked from the lower regions of the body resulting in decreased sensations. Although the epidural is known for taking pain away it could very well cause it too. Epidurals include the use of various narcotics and have side effects like hypotension, fever, fetal malposition, decreased fetal heart rate, respiratory depression, breastfeeding complications, an increased likelihood of operative vaginal delivery and cesarean and many more. These are the effects faced in result to a procedure that is not definite to work. In Fact “One in every 8 women” (OAA) will experience inadequate pain relief and must venture to other means of medication. Therefore, mothers should abstain from epidural anesthesia due to the risks it poses to themselves and to the fetus.

Patient was encouraged to continue with heat, followed by his home exercise program and ice. He will continue with his transcutaneous electrical nerve unit (TENS). Patient was given an ice pack to use, to reduce pain. He was given a 60 mg Toradol injection on this visit.

These procedures are not reported alone but as add-on codes used to identify extraordinary conditions of patients and their unusual risk factors. There are four kinds of certain codes used for particular circumstances which are: 1) Anesthesia for the age younger than one year and over the age of seventy (99100), 2) Anesthesia complicated by the utilization of total body hypothermia (99116), 3) Anesthesia complicated by the utilization of controlled hypotension (99135) and 4)Anesthesia complicated by emergency circumstances

Propofol was administered to put the patient to sleep initially. The patient was kept asleep with anesthesia gases. These gases are fluorinated ethers combined with nitrous oxide. A paralytic was also administered to keep the patient’s muscles from moving during the procedure. During the procedure, the CRNA monitored the patient’s vitals, especially the blood pressure. The blood pressure decreases prior to the initial incision and will increase after the cut is made. The CRNA was monitoring that the patient’s blood pressure did not get too low before the incision was made. The CRNA also made sure the patient was positioned to prevent injury such as pulled muscles and pinched nerves.

The evidence surrounding the topic of therapeutic hypothermia post cardiac arrest is one lathered in potentially advantageous benefits, as well as harmful side effects. Although this procedure has potentially lifesaving and neurologically preserving implications, it does come with various side effects which can be dangerous in general or if left untreated. This paper will first address the many benefits, some of which include prolongation of life, retention of neurological function. It will then shed light upon some of the subsequent risks and harmful effects that are associated with therapeutic hypothermia. Lastly the paper will discuss why or why not the overall benefits outweigh the aggravating factors. Thus, being a topic of much controversy

Ten patients were in a control group where no special precautions were taken, ten patients had preoperative and intraoperative active warming, and ten patients had intraoperative active warming only. By providing 45 minutes to 1 hour of pre-warming and intraoperative warming combined, hypothermia caused by general anesthesia was not experience. After induction the patients with just intraoperative warming were in a hypothermia state for at least the first two hours. It was not until the end of surgery that both groups (except the control group) were at a normothermia state.

We can detect relatively small temperature elevations before any irreversible tissue damage by using Quantitative MRI-based temperature mapping [15].

Over the past 50 years, laboratory and clinical studies have described the physiologic effects of the Trendelenburg position in normal and hypotensive states. Because of conflicting results, differing opinions thrive with regard to the usefulness of the position in various medical applications. Some of these applications include hypovolemic or septic shock, abdominal surgery, patients under general or regional anesthesia and patients with spontaneous or controlled ventilation. More specifically, the usefulness of the Trendelenburg position comes into question in the field of anesthesia for central catheter placement, and the administration of certain drugs at the spinal level. Even though numerous studies have proven no significant evidence showing the Trendelenburg position to be effective, a considerable number of present-day clinical protocols and guidelines developed by the health administration and natural scientific societies do, in fact, include leg raising in the decubitus supine position as a standard procedure for hypotension. However, the utility attributed to the Trendelenburg position in this situation is in severe contrast with most of the studies reviewed, which include that, despite possible improvement in cardiac output,

Residual neuromuscular blockade is commonly seen in the post anesthesia care unit (PACU) after nondepolarizing neuromuscular blocking drugs (NMBDs) are administered intraoperatively. Despite the use of intermediate-acting NMBDs and antagonism of neuromuscular blockade at the conclusions of the procedure, PORC is still a clinical problem in the PACU indicating the need for objective neuromuscular monitoring to be performed per operatively to ensure patient