Free Online CME

Findings from the Department of Outcomes
Research and Outcomes Research Consortium

Perioperative Shivering:
Physiology and Pharmacology

 

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How to Obtain AMA PRA Category 1 Credit

  1. Read the online review.
  2. Complete the CME posttest (each question must be answered correctly).
  3. Log into your myCME account.
  4. Complete the credit and evaluation form.
  5. Print your personalized CME certificate.

Technical Requirements

Release Date:  May 20, 2008
Renewal Date:   August 27, 2014
Expiration Date:   August 27, 2015

Estimated Time of Completion:  2 Hours

Description

In homeothermic species, a thermoregulatory system coordinates defenses against cold and heat to maintain internal body temperature within a narrow range, thus optimizing normal physiologic and metabolic function. The combination of anesthetic-induced thermoregulatory impairment and exposure to a cool environment makes most unwarmed surgical patients hypothermic (1-7). Although shivering is but one consequence of perioperative hypothermia, and rarely the most serious. It occurs frequently (i.e., 40%-60% after volatile anesthetics) (8, 9 ) and it remains poorly understood. While cold-induced thermoregulatory shivering remains an obvious etiology, the phenomenon has also been attributed to numerous other causes.

Learning Objectives

  1. Discuss the etiology of normal and postoperative shivering-like tremor.
  2. Describe pharmacological modulation of shivering by biogenic amines, cholinomimetics, peptides, NMDA receptors and analeptic agents.
  3. Discuss the special anti-shivering efficacy of meperidine.

Target Audience

This activity is intended for anesthesiologists and other physicians and nurses caring for perioperative and critical-care patients.

Accreditation

The Cleveland Clinic Foundation Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Cleveland Clinic Foundation Center for Continuing Education designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Participants claiming CME credit from this activity may submit the credit hours to the American Osteopathic Association for Category 2 credit.

Activity Director

Daniel I. Sessler, MD
Chairman, Department of Outcomes Research
Cleveland Clinic
Cleveland, OH

Faculty

Jan L. DeWitte, MD
Attending Anesthesiologist
Department of Anesthesia and Intensive Care
OLV Hospital
Aalst, Belgium

CME Disclaimer

The information in this educational activity is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition. The viewpoints expressed in this CME activity are those of the authors/faculty. They do not represent an endorsement by The Cleveland Clinic Foundation. In no event will The Cleveland Clinic Foundation be liable for any decision made or action taken in reliance upon the information provided through this CME activity.

Disclosures

In accordance with the Standards for Commercial Support issued by the Accreditation Council for Continuing Medical Education (ACCME), The Cleveland Clinic Foundation Center for Continuing Education requires resolution of all faculty conflicts of interest to ensure CME activities are free of commercial bias.

The following faculty has indicated that he may have a relationship which, in the context of his presentation, could be perceived as a potential conflict of interest:


Daniel I. Sessler, MD

3M Consulting
Independent Contractor (including contracted research)
Membership on advisory committee or review panels
 
  37Company Membership on advisory committee or review panels
 

CareFusion Consulting
 

Molnlycke Membership on advisory committee or review panels
 

The following faculty has indicated that she has no relationship which, in the context of her presentation, could be perceived as a potential conflict of interest:

Jan L. DeWitte, MD

 

This CME activity was produced by The Cleveland Clinic Foundation
Center for Continuing Education and the Outcomes Research Consortium.

 

 
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Center for Continuing Education | 9500 Euclid Avenue, KK31, Cleveland, OH 44195
Copyright © 2000-2014 The Cleveland Clinic Foundation. All Rights Reserved.
Center for Continuing Education | 9500 Euclid Avenue, KK31, Cleveland, OH 44195