Anti-shivering Drug Influences the Characteristics of Electroencephalographic Shivering Noise During Targeted Temperature Management: A Case Report

We report a case of a 75-year-old male patient who underwent targeted temperature management (TTM) following cardiopulmonary resuscitation and subsequently experienced uncontrolled shivering. Rocuronium was administered to alleviate shivering; however, the shivering recurred, necessitating continuous administration of dexmedetomidine. Analysis of the electroencephalography (EEG) recorded for neuromonitoring demonstrated that both pharmacological agents significantly reduced the power of the alpha and beta waves at 10 and 60 minutes post-administration. Dexmedetomidine also influenced the delta and theta waves, coinciding with the cessation of shivering, whereas muscle relaxants exhibited minimal effects on these frequency bands. These findings suggest that shivering-induced noise causing EEG changes is drug-dependent and predominantly affects high-frequency regions, potentially impacting the neurological prognosis predictions and detection of nonconvulsive status epilepticus (NCSE). This case illustrates the need to recognize the effects of shivering and anti-shivering medications on EEG monitoring during post-resuscitation care. Further research is warranted to evaluate the impact of these factors on EEG-based prognostication and NCSE detection, and to optimize strategies for managing shivering-induced artifacts during TTM.