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Perioperative Shivering: Physiology and Pharmacology

IN homeothermic species, a thermoregulatory system coordinates defenses against cold and heat to maintain internal body temperature within a narrow range, thus optimizing normal physiologic and metabolic function. The combination of anesthetic-induced thermoregulatory impairment and exposure to a cool environment makes most unwarmed surgical patients hypothermic. Although shivering is but one consequence of perioperative hypothermia, and rarely the most serious, it occurs frequently (i.e., 40–60% after volatile anesthetics), and it remains poorly understood. While coldinduced thermoregulatory shivering remains an obvious etiology, the phenomenon has also been attributed to numerous other causes. Our first goal is to review the organization of the thermoregulatory system, and particularly the physiology of postanesthetic shivering. We then discuss the pharmacology of thermoregulation and review the putative mechanisms and sites of action of various antishivering drugs.