Many mothers who have undergone cesarean section under combined spinal-epidural anesthesia share a common experience: inexplicable chills and uncontrollable shivering during the procedure, even when the operating room temperature doesn't feel particularly low. This shivering brings discomfort and anxiety, and some even worry about its impact on their own health and that of their baby.

In fact, shivering during cesarean section is an extremely common complication following neuraxial anesthesia. Clinical data shows that the incidence of intraoperative shivering in these mothers can reach as high as 85% . What seems like a minor issue actually conceals several health risks. Fortunately, clinical research has long identified effective solutions. Today, we will explore everything about cesarean section shivering, based on professional clinical research.

Data source for this article: Chen Yuanzhen, Liang Yongtao. "Clinical Study on Warmed Infusion Combined with Intraoperative Sedation for Shivering Response during Cesarean Section under Combined Spinal-Epidural Anesthesia" [1]

I. Shivering During Cesarean Section: More Than Just "Feeling Cold"

Many people mistakenly believe that intraoperative shivering is simply due to the mother being sensitive to cold or feeling chilly. However, under combined spinal-epidural anesthesia, shivering is primarily influenced by two core factors, each closely related to the surgical and anesthesia process:

(1) Hypothermia is the core trigger: Neuraxial anesthesia blocks the body's thermoregulatory function, causing heat to rapidly redistribute from the core to the periphery. Additionally, the routine intraoperative infusion of room-temperature fluids, along with the use of disinfectants and irrigation solutions, further depletes body heat, leading to a drop in the mother's core temperature and triggering a shivering response.

(2) Anxiety exacerbates discomfort: The mother's fear of surgery and concern for the baby's health can cause tension and anxiety. This mental stress can amplify physical discomfort, further inducing or worsening shivering, creating a vicious cycle.

Do not underestimate intraoperative shivering. It not only causes significant distress for the mother but also increases oxygen consumption, adds to the burden on the respiratory and circulatory systems, interferes with anesthetic monitoring and surgical manipulation, and in severe cases, may even lead to fetal distress. It has adverse effects on both postoperative recovery and the baby's health.

II. Two Interventions Effectively Reduce the Incidence of Shivering

To address the clinical challenge of intraoperative shivering during cesarean sections, a team at Ya'an People's Hospital in Sichuan Province conducted a specialized clinical study. They selected 90 healthy first-time mothers, randomly divided them into three groups for a controlled trial, carefully managed the study variables, and reached scientifically reliable conclusions, providing an important reference for clinical obstetric anesthesia and care.

1. Study Design: Rigorous Grouping and Controlled Intervention

The study selected 90 healthy first-time mothers (ASA grade I-II) undergoing elective cesarean section under combined spinal-epidural anesthesia between October and December 2011. Mothers with cardiac, pulmonary, liver, or kidney dysfunction, or severe pregnancy complications were excluded. They were randomly divided into three groups of 30 each using a random number table. There were no statistically significant differences in general data (age, weight, etc.) among the three groups, ensuring the study's balance:

(1) Group I (Control Group): Received intraoperative infusion of unheated, room-temperature fluids and an injection of 5mL normal saline after umbilical cord clamping.

(2) Group II (Warmed Infusion Group): Received intraoperative infusion of fluids warmed to 37°C and an injection of 5mL normal saline after umbilical cord clamping.

(3) Group III (Warmed Infusion + Sedation Group): Received intraoperative infusion of fluids warmed to 37°C and an injection of 0.04 mg/kg midazolam (diluted to 5mL with normal saline) after umbilical cord clamping.

2. Study Results: The Combined Intervention Showed Superior Efficacy

Comparing the data from the three groups revealed significant differences, all statistically significant (P<0.05). The key findings are clear:

(1) The total incidence of shivering was 56.7% in the control group, 30.0% in the warmed infusion group, and only 6.7% in the warmed infusion combined with sedation group.

(2) The total shivering incidence and the incidence of grade 2 severe shivering in Groups II and III were significantly lower than in the control group, with the combined intervention group showing the most significant reduction.

(3) Compared to warmed infusion alone, warmed infusion combined with intraoperative sedation further reduced the incidence of shivering, completely eliminated shivering after fetal delivery, and also provided rapid relief for shivering that had already occurred.

Notably, the sedative was administered after umbilical cord clamping, completely avoiding potential effects on the newborn. This approach balances safety and efficacy, meeting the practical needs of obstetric clinical practice.

III. Reassuring Tips for Mothers: No Need to Panic About Cesarean Shivering

For mothers about to undergo a cesarean section, understanding this clinical knowledge can alleviate preoperative anxiety and help them better cooperate with medical staff for a smoother surgery:

(1) Stay calm before surgery: Excessive tension and anxiety can worsen shivering. Communicate with your medical team before the procedure, understand the surgical process, and relax to reduce discomfort from mental stress.

(2) Trust the medical team's interventions: Obstetric anesthesia teams in regular hospitals will take measures such as warming and fluid warming based on clinical protocols, and implement postoperative sedation if necessary. There's no need to worry excessively about intraoperative shivering.

(3) Provide feedback promptly after surgery: If shivering or discomfort occurs during surgery, inform your medical team immediately. There are established clinical protocols to quickly relieve symptoms and ensure the surgery proceeds safely.

The primary goal of a cesarean section is to ensure the safety of both mother and baby. However, intraoperative comfort management is equally crucial. By leveraging clinical research findings to optimize perioperative interventions, we can reduce the occurrence of complications like shivering and help mothers welcome their new arrival more comfortably and with greater peace of mind.

References:

[1] Chen YZ, Liang YT. Clinical study on warmed infusion combined with intraoperative sedation for shivering response during cesarean section under combined spinal-epidural anesthesia. Medical Recapitulate. 2013;19(1):198-199.

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