title: Total intravenous anesthesia with propofol and remifentanil is associated with a nearly twofold higher incidence in postanesthetic shivering than desflurane-fentanyl anesthesia.
abstract: BACKGROUND
  Postanesthetic shivering (PAS) is a frequent side effect of general anesthesia. Previous reports on the incidence of PAS of propofol for the induction or maintenance of anesthesia have been controversial, but have not been studied in detail. The aim of the present study was to evaluate the incidence and severity of PAS in total intravenous anesthesia (TIVA) with propofol and remifentanil compared with an inhalative anesthesia.
  
  
  METHODS
  After ethics committee approval and written informed consent from the patients, 53 patients scheduled for urologic, gynecologic, or surgical operations were studied for shivering postoperatively using a five-point rating scale. They received desflurane-fentanyl based anesthesia (n=27) or TIVA with propofol and remifentanil (n=26). Hemodynamics and temperature were measured after induction of anesthesia (T0), and 5 min (T1), 15 min (T2), 30 min (T3), and 60 min (T4) after reaching the postanesthetic care unit (PACU).
  
  
  RESULTS
  In the TIVA group, 18/26 (69.2%) patients suffered from PAS compared with 10/27 (37%) in the desflurane-fentanyl group (P<0.02). The severity of shivering was significantly higher with TIVA than with desflurane (P<0.02), whereas temperature showed no significant difference between the study groups.
  
  
  CONCLUSIONS
  Postanesthetic shivering appears significantly more frequently and intensively after TIVA with propofol and remifentanil compared with an inhalative anesthesia with fentanyl and desflurane.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany.
authors.forename: Kerstin D
authors.initials: KD
authors.lastname: Röhm
authors.forename: Jörn
authors.initials: J
authors.lastname: Riechmann
authors.forename: Joachim
authors.initials: J
authors.lastname: Boldt
authors.forename: Stefan W
authors.initials: SW
authors.lastname: Suttner
authors.forename: Swen N
authors.initials: SN
authors.lastname: Piper
mesh_terms: D000368:Aged; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D000077335:Desflurane; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage*; D015742:Propofol / Q000008:administration & dosage*; D000077208:Remifentanil; D012768:Shivering; D013696:Temperature; D013997:Time Factors
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077335:Desflurane; D007530:Isoflurane; D000077208:Remifentanil; D005283:Fentanyl; D015742:Propofol