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A mechanistic study of the tremor associated with epidural anaesthesia for intrapartum caesarean delivery.

Mullington, CJ, Low, DA, Strutton, PH and Malhotra, S (2020) A mechanistic study of the tremor associated with epidural anaesthesia for intrapartum caesarean delivery. International Journal of Obstetric Anesthesia. ISSN 0959-289X

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Abstract

BACKGROUND: It is not known if the tremor associated with an epidural top-up dose for intrapartum caesarean delivery is thermoregulatory shivering. A tremor is only shivering if it has the same frequency profile as cold stress-induced shivering. Thermoregulatory shivering is a response to a reduction in actual body temperature, whereas non-thermoregulatory shivering may be triggered by a reduction in sensed body temperature. This mechanistic study aimed to compare: 1. the frequency profiles of epidural top-up tremor and cold stress-induced shivering; and 2. body temperature (actual and sensed) before epidural top-up and at the onset of tremor. METHODS: Twenty obstetric patients received an epidural top-up for intrapartum caesarean delivery and 20 non-pregnant female volunteers underwent a cold stress. Tremor, surface electromyography, core temperature, skin temperature (seven sites) and temperature sensation votes (a bipolar visual analog score ranging from -50 to +50 mm) were recorded. RESULTS: The mean (SD) primary oscillation (9.9 (1.9) Hz) frequency of epidural top-up tremor did not differ from that of cold stress-induced shivering (9.0 (1.6) Hz; P=0.194), but the mean (SD) burst frequency was slower (6.1 (1.2) × 10-2 Hz vs 6.9 (0.7) × 10-2 Hz, respectively; P=0.046). Before the epidural top-up dose, the mean (SD) core temperature was 37.6 (0.6) °C. Between the epidural top-up dose and the onset of tremor the mean (SD) core temperature did not change (-0.1 (0.1) °C; P=0.126), the mean (SD) skin temperature increased (+0.4 (0.4) °C; P=0.002) and the mean (SD) temperature sensation votes decreased (-12 (16) mm; P=0.012). CONCLUSION: These results suggest that epidural top-up tremor is a form of non-thermoregulatory shivering triggered by a reduction in sensed body temperature.

Item Type: Article
Uncontrolled Keywords: 1114 Paediatrics and Reproductive Medicine
Subjects: R Medicine > RG Gynecology and obstetrics
Divisions: Sports & Exercise Sciences
Publisher: Elsevier
Related URLs:
Date Deposited: 11 Jun 2020 08:24
Last Modified: 11 Jun 2020 08:30
DOI or Identification number: 10.1016/j.ijoa.2020.02.007
URI: http://researchonline.ljmu.ac.uk/id/eprint/13083

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