Imperial College London
Portrait Picture

DrChristopherMullington

Faculty of Medicine, Department of Surgery & Cancer

Honorary Clinical Senior Lecturer
 
 
 
//

Contact

 

c.mullington

 
 
//

Location

 

Sir Michael Uren HubWhite City Campus

//

Summary

 

Publications

Citation

BibTex format

@article{Mullington:2020:10.1016/j.ijoa.2020.02.007,
author = {Mullington, CJ and Low, DA and Strutton, PH and Malhotra, S},
doi = {10.1016/j.ijoa.2020.02.007},
journal = {International Journal of Obstetric Anesthesia},
pages = {56--64},
title = {A mechanistic study of the tremor associated with epidural anaesthesia for intrapartum caesarean delivery},
url = {http://dx.doi.org/10.1016/j.ijoa.2020.02.007},
volume = {43},
year = {2020}
}
Download

RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundIt is not known if the tremor associated with an epidural top-up dose for intrapartum caesarean delivery is thermoregulatory shivering. A tremor is only shivering if it has the same frequency profile as cold stress-induced shivering. Thermoregulatory shivering is a response to a reduction in actual body temperature, whereas non-thermoregulatory shivering may be triggered by a reduction in sensed body temperature. This mechanistic study aimed to compare: 1. the frequency profiles of epidural top-up tremor and cold stress-induced shivering; and 2. body temperature (actual and sensed) before epidural top-up and at the onset of tremor.MethodsTwenty obstetric patients received an epidural top-up for intrapartum caesarean delivery and 20 non-pregnant female volunteers underwent a cold stress. Tremor, surface electromyography, core temperature, skin temperature (seven sites) and temperature sensation votes (a bipolar visual analog score ranging from −50 to +50mm) were recorded.ResultsThe mean (SD) primary oscillation (9.9 (1.9) Hz) frequency of epidural top-up tremor did not differ from that of cold stress-induced shivering (9.0 (1.6) Hz; P=0.194), but the mean (SD) burst frequency was slower (6.1 (1.2)×10−2Hz vs 6.9 (0.7)×10−2Hz, respectively; P=0.046). Before the epidural top-up dose, the mean (SD) core temperature was 37.6 (0.6)°C. Between the epidural top-up dose and the onset of tremor the mean (SD) core temperature did not change (–0.1 (0.1)°C; P=0.126), the mean (SD) skin temperature increased (+0.4 (0.4)°C; P=0.002) and the mean (SD) temperature sensation votes decreased (−12 (16) mm; P=0.012).ConclusionThese results suggest that epidural top-up tremor is a form of non-thermoregulatory shivering triggered by a reduction in sensed body temperature.
AU  - Mullington,CJ
AU  - Low,DA
AU  - Strutton,PH
AU  - Malhotra,S
DO  - 10.1016/j.ijoa.2020.02.007
EP  - 64
PY  - 2020///
SN  - 0959-289X
SP  - 56
TI  - A mechanistic study of the tremor associated with epidural anaesthesia for intrapartum caesarean delivery
T2  - International Journal of Obstetric Anesthesia
UR  - http://dx.doi.org/10.1016/j.ijoa.2020.02.007
UR  - https://www.sciencedirect.com/science/article/pii/S0959289X20300315?via%3Dihub
UR  - http://hdl.handle.net/10044/1/79793
VL  - 43
ER  -
Download