title: [Excessive shivering after remifentanil infusion in a muscular karate player for tracheal resection and construction surgery].
abstract: A 22-year-old muscular karate player was diagnosed to have a tracheal tumor with a diameter of 2.8 cm that existed 2 cm under the glottis and occupied 60% of his trachea. He was scheduled for trachea resection and construction surgery. After awake-fiber intubation, anesthesia was maintained by continuous infusion of propofol and remifentanil, together with thoracic epidural anesthesia (T4-5). After 431 minutes of surgery, 50 mm of trachea was rejected. To prevent him from extending his neck, the surgeon placed stay-sutures between the patient's chin and chest wall. Twenty minutes after the termination of propofol and remifentanil infusion, the patient became awake and was extubated. Subsequently, although the body temperature was 37.6 degrees C, excessive shivering occurred and his neck was nearly extended. We immediately injected 0.8 mEq of magnesium sulfate and 70 mg of pethidine. It took almost 10 minutes to stop shivering completely, and the patient became too sedated and required noninvasive positive pressure ventilation overnight. We speculate that intraoperative remifentanil infusion induced severe shivering in this case. Shivering after remifentanil infusion can be a fatal complication in tracheal resection and construction surgery, especially in muscular patients.
authors.affiliation: Department of Anesthesiology, School of Medicine, Keio University, Tokyo 160-8582.
authors.forename: Kamon
authors.initials: K
authors.lastname: Ando
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Moriyama
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hosokawa
authors.forename: Junzo
authors.initials: J
authors.lastname: Takeda
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D000771:Anesthesia, Intravenous; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000188:drug therapy; D008278:Magnesium Sulfate / Q000008:administration & dosage; D008297:Male; D016139:Martial Arts; D008614:Meperidine / Q000008:administration & dosage; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects*; D019651:Plastic Surgery Procedures; D000077208:Remifentanil; D012768:Shivering; D014132:Trachea / Q000601:surgery*; D014134:Tracheal Neoplasms / Q000601:surgery*; D014140:Tracheotomy; D055815:Young Adult
chemical_list: D010880:Piperidines; D008278:Magnesium Sulfate; D008614:Meperidine; D000077208:Remifentanil