The hemodynamic and metabolic effects of shivering during acute normovolemic hemodilution.

Perez-De-Sa V, Cunha-Goncalves D, Schou H, Jonmarker C, Werner O
Anesth Analg 2003;97:972-978.
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In this rather sophisticated experimental study, the authors observed that severe acute normovolemic hemodilution (target hemoglobin concentration of 5.2 g/dL) significantly reduced the ability of the anesthetized animals to sustain a major increase in tissue oxygen demand resulting from shivering. They also provided further evidence that in these conditions of increased oxygen demand, the heart is at particular risk of developing hypoxia.

– Philippe Van der Linden