Background: Shivering is common after cardiac surgery and may evoke harmful hemodynamic changes. Neither those changes nor factors increasing probability of shivering are well defined.
Objectives: (1) To identify factors linked with risk of shivering by comparing age, weight, body surface area, gender, intraoperative details, anesthetics, postoperative temperatures, hemodynamics, and therapeutics in shivering vs nonshivering patients. (2) To describe temperatures, hemodynamics, therapeutics, myocardial oxygen consumption correlates (rate-pressure product, heart rate, systemic vascular resistance) in shivering and nonshivering groups, and shivering and nonshivering periods. (3) To characterize the electromyogram to determine whether the tremor is cold-induced.
Methods: A descriptive design with a time series component was used to study a convenience sample of 10 shivering and 10 nonshivering adults for 4 hours during early recovery from cardiac surgery. Pulmonary artery and skin (facial, calf, trunk) temperature were measured every 60 seconds; heart rate and arterial pressure, every 15 minutes; cardiac output, 3 times. Electromyogram was recorded intermittently. Medications and treatments were noted.
Results: Lower skin temperature was significantly related to shivering risk. Heart rate was significantly higher initially in shiverers and remained higher by 13.6 beats per minute. Significantly more nitroprusside was used to control arterial pressure before than after shivering. No significant differences were noted between groups in core temperature, age, weight, body surface area, anesthesia type, intraoperative temperature; or surgery, circulatory bypass, or cardiac cross-clamp duration. The electromyogram pattern during shivering was typical of that produced by cold.
Conclusions: These results suggest that true shivering occurs after cardiac surgery. Skin, but not core, temperature and elevated heart rate predict shivering. Shivering may be more likely in hemodynamically unstable patients.
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J Neurosurg Case Lessons
January 2025
Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Background: Medically refractory hypertonia (MRH) within the pediatric population causes severe disability and is difficult to treat. Neurosurgery for mixed MRH includes intrathecal baclofen (ITB) and lumbosacral ventral-dorsal rhizotomy (VDR). Surgical efficacy limitations can be mitigated by combining the two into a multimodal strategy.
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January 2025
Divisions of Cardiac Surgery (H.T., A.Q., R.E., R.V., M.M., J.H.C., S.V.), Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health Toronto, Ontario, Canada.
Int J Surg
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Department of Cardiovascular Surgery, Xijing Hospital, Xi'an, Shaanxi, China.
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Materials And Methods: A total of 1480 consecutive patients undergoing TF-TAVR using a new-generation transcatheter heart valve at 12 institutes were included in this retrospective study.
Int J Surg
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Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou; Chang Gung University, Taoyuan, Taiwan.
Background: Detecting kidney trauma on CT scans can be challenging and is sometimes overlooked. While deep learning (DL) has shown promise in medical imaging, its application to kidney injuries remains underexplored. This study aims to develop and validate a DL algorithm for detecting kidney trauma, using institutional trauma data and the Radiological Society of North America (RSNA) dataset for external validation.
View Article and Find Full Text PDFInt J Surg
January 2025
Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, Jiangsu, China.
Background: Type A aortic dissection (TAAD) remains a significant challenge in cardiac surgery, presenting high risks of adverse outcomes such as permanent neurological dysfunction and mortality despite advances in medical technology and surgical techniques. This study investigates the use of quantitative electroencephalography (QEEG) to monitor and predict neurological outcomes during the perioperative period in TAAD patients.
Methods: This prospective observational study was conducted at the hospital, involving patients undergoing TAAD surgery from February 2022 to January 2023.
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