Operating Rooms, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan.
J Anesth. 2021 Jun;35(3):412-419. doi: 10.1007/s00540-021-02914-y. Epub 2021 Mar 7.
Ionized magnesium (iMg) is considered to be the biologically active fraction of circulating total serum Mg (tMg). However, only the relationship between tMg and postoperative shivering has been studied. To our knowledge, hitherto no clinical studies have investigated the association between serum ionized magnesium concentration ([iMg]) and postoperative shivering. Therefore, we aimed to retrospectively examine this association, focusing on hypomagnesemia and depletion of [iMg].
This retrospective study involved 421 patients who underwent pancreaticoduodenectomy under general anesthesia at our center from December 2012 to September 2019. Logistic regression analysis was performed to estimate the odds ratio (OR) for the incidence of postoperative shivering.
Postoperative shivering developed in 111 out of 421 patients. The post-surgical concentration of [iMg] was significantly associated with postoperative shivering in the non-adjusted model, but not in the multivariable-adjusted model. In multivariable-adjusted analysis, progressive decrease of [iMg] by 0.1 mmol/L significantly increased the risk of postoperative shivering (OR: 1.64, 95% CI 1.02-2.64, p = 0.04). The multivariable-adjusted OR for postoperative shivering was 3.65 (95% CI 1.25-13.55, p = 0.02) in subjects with post-surgical [iMg] less than 0.6 mmol/L and decrease in [iMg] during surgery compared with those with post-surgical [iMg] more than 0.6 mmol/L and constant or increased of [iMg] during surgery.
A decrease in the [iMg] during surgery was significantly associated with postoperative shivering. Subjects who had an [iMg] lower than 0.6 mmol/L post-surgery and decreased [iMg] during surgery had a significantly higher risk of postoperative shivering. Intraoperative depletion of [iMg] was significantly associated with shivering.
离子化镁（iMg）被认为是循环总血清镁（tMg）中具有生物活性的部分。然而，仅研究了 tMg 与术后寒战之间的关系。据我们所知，迄今为止，尚无临床研究调查血清离子化镁浓度（[iMg]）与术后寒战之间的关系。因此，我们旨在回顾性检查这种关联，重点关注低镁血症和 iMg 耗竭。
这项回顾性研究涉及 2012 年 12 月至 2019 年 9 月在我们中心接受全身麻醉下胰十二指肠切除术的 421 例患者。使用逻辑回归分析来估计术后寒战发生率的优势比（OR）。
421 例患者中有 111 例出现术后寒战。未调整模型中，术后 iMg 浓度与术后寒战显著相关，但多变量调整模型中无此关联。在多变量调整分析中，iMg 浓度每降低 0.1mmol/L，术后寒战的风险显著增加（OR：1.64，95%CI 1.02-2.64，p=0.04）。与术后 iMg 大于 0.6mmol/L 且手术期间 iMg 保持不变或增加的患者相比，术后 iMg 小于 0.6mmol/L 且手术期间 iMg 下降的患者术后寒战的多变量调整 OR 为 3.65（95%CI 1.25-13.55，p=0.02）。
手术期间 iMg 下降与术后寒战显著相关。术后 iMg 低于 0.6mmol/L 且手术期间 iMg 下降的患者术后寒战风险显著增加。iMg 术中耗竭与寒战显著相关。
