The effects of warmed intravenous fluids, combined warming (warmed intravenous fluids with humid‑warm oxygen), and pethidine on the severity of shivering in general anesthesia patients in the recovery room

Ahmad Nasiri, Ayob Akbari, GholamReza Sharifzade, Pooya Derakhshan


Background: Shivering is a common complication of general and epidural anesthesia. Warming methods and many drugs are used for control of shivering in the recovery room. The present study is a randomized clinical trial aimed to investigate the effects of two interventions in comparison with pethidine which is the routine treatment on shivering in patients undergoing abdominal surgery with general anesthesia.


Materials and Methods: Eighty‑seven patients undergoing abdominal surgery by general anesthesia were randomly assigned to three groups (two intervention groups in comparison with pethidine as routine). Patients in warmed intravenous fluids group received pre‑warmed Ringer serum (38°C), patients in combined warming group received pre‑warmed Ringer serum (38°C) accompanied by humid‑warm oxygen, and patients in pethidine group received intravenous pethidine routinely. The elapsed time of shivering and some hemodynamic parameters of the participants were assessed for 20 min postoperatively in the recovery room. Then the collected data were analyzed by software SPSS (v. 16) with the significance level being P < 0.05.


Results: The mean of elapsed time in the warmed intravenous serum group, the combined warming group, and the pethidine group were 7 (1.5) min, 6 (1.5) min, and 2.8 (0.7) min, respectively, which was statistically significant (P < 0.05). The body temperatures in both combined warming and pethidine groups were increased significantly (P < 0.05).


Conclusions: Combined warming can be effective in controlling postoperative shivering and body temperature increase.



General anesthesia; humid-warm oxygen inhalation; pethidine; postoperative shivering; shivering; warmed intravenous fluids

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Miller R D, Manuel C. Pardo, Jr.Basic of anesthesia 2007; 6: 641.

Poorsheykhian M, Emami Sigaroodi A, Kazamnejad E, Raoof M. Incidence of post general anesthesia complications in recovery room. J Guilan Univ Medical Sci 2012;21:8‑14.

Emadi SA, Nasiri E, Zamani A, Kabirzade A, Ebadi A. A comparison of pethidine and tramadol on post operative shivering. J Mazand Univ Med Sci 2010;20:36‑40.

Akhlaghi M, Azizifarsani H, Khairi S, Rahimi R. The effect of hemoglobin change on postoperative shivering. J Shahrekord Univ Med Sci 2011;13:67‑71.

Oshvandi K, Shiri FH, Fazel MR, Safari M, Ravari A. The effect of pre‑warmed intravenous fluids on prevention of intraoperative hypothermia in cesarean section. Iran J Nurs Midwifery Res 2014;19:64‑9.

Kiakkas P, Poulopoulou M, Papahatzi A, Souleles P. Effect of hypothermia and shivering on standard PACU monitoring of patients. AANA J 2005;73:47‑53.

Crowley LJ, Buggy DJ. Shivering and neurexial anesthesia. Reg Anesth Pain Med 2008;33:241‑52.

Oshvandi K, Hasan Shiri F, Safari M, Fazel M, Salavati M, Hasan Tehrani T. Effect of pre‑warm intravenous fluid therapy on prevention of postoperative shivering after cesarean section.

Hayat 2011;17:5‑15.

Hasankhani H, Mohhammadi E, Naghizade MM, Moazzami F, Mokhtari M. The effects of warming intravenous fluid on perioperative hemodynamic status, postoperative shivering and recovery in orthopedic surgery. Shiraz E‑Med J 2004;5.

Mohammadi Bandari A, Khezri MB, Asefzadeh S. Effects of diclofenac suppository on postoperative shivering in caesarean section. J Qazvin Univ Med Sci 2012;16:10‑4.

Manouchehri Pour M, Jabbari Moghadam M. The study of effect of duration of anesthesia on appearance of post anesthesia shivering after limb surgeries. RJMS 2007;14:165‑71.

Sahmedini MA, Khademi S, Majidi F. Comparison of effects of meperidine and tramadol treatment on postoperative shivering in elective cesarean section. RJMS 2007;14:83‑90.

Modir H, Norouzi A, Pazoki Sh. Comparison the efficacy of different classes of drugs for the prevention of shivering after general anesthesia. Arak Med Univ J (AMUJ) 2013;16:71‑8.

Hoseinkhan Z, Behzadi M. Morphine, Pethidine and Fentanyl in postoperative shivering control: A randomized clinical trial. Tehran Univ Med J 2007;64:57‑63.

Atashkhoyi S, Niazi M, Iranpour A. Effect of tramadol administration previous to induction of General Anesthesia on prevention of postoperative shivering. J Zanjan Univ Med Sci Health Serv 2008;16:29‑36.

Díaz Lobato S, Mayoralas Alises S. Effectiveness of high‑flow oxygen therapy with warm humidification in a COPD patient with chronic cough. Arch Bronconeumol 2011;47:420‑1.

Chung SH, Lee BS, Yang HJ, Kweon KS, Kim HH, Song J, et al. Effect of preoperative warming during cesarean section under spinal anesthesia. Korean J Anesthesiology 2012;62:454‑60.

Parsa T, Dabir S, Radpay B. Efficacy of pethidine and buprenorphine for prevention and treatment of postanesthetic shivering. Tanaffos 2007;6:54‑8.

Zamiri HK, Ghahreman M. Comparison of iv pethidine and clonidine for treatment of post‑operation shivering. J Qazvin Univ Med Sci 2003;6:14‑7.

Frank SM, Hesel TW, El‑Rahmany HK, Tran KM, Bamford OS. Warmed humidified inspired oxygen accelerates postoperative rewarming. J Clin Anesth 2000;12:283‑7.

Camus Y, Delva E, Cohen S, Lienhart A. The effect of warming intravenous fluids on intraoperative hypothermia and postoperative shivering during prolonged abdominal surgery.

Acta Anaesthesiol Scand 1996;40:779‑82.

Xu HX, You ZJ, Zhang H, Li Z. Prevention of hypothermia by infusion of warm fluid during abdominal surgery. J Perianesth Nurs 2010;25:366‑70.


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