Incidence Of Postanesthetic Shivering Research Articles

Comparison of Preemptive Post-Intubation 15 Mg/KgBW Paracetamol to 0.35 Mg/KgBW Meperidine in Incidence of Post-Anesthetic Shivering

Post anesthesia shivering (PAS) is a repetitive involuntary movement of one or more muscle groups as a result of a decrease in core body temperature. Pharmacological therapy in preventing PAS may include meperidine and paracetamol. This study compared the effectiveness of paracetamol to meperidine in reducing the incidence of post-anesthesia shivering. This study used an experimental randomized double-blind comparative analytic design on patients underwent exploratory laparotomy surgery under general anesthesia at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from September 2021 to August 2022. Patients with 50 ASA 1-2 physical status were included and divided into two groups. One group received 15 mg/kg group paracetamol and the other received 0.35 mg/kg meperidine. Data on tympanic membrane temperature and hemodynamics before and after induction and after extubating were collected. Furthermore, data on the results of the assessment of the incidence and grade of shivering in each treatment group were also collected. The results of this study showed that there was a decrease in the frequency of PAS in patients receiving intravenous 15 mg/kg paracetamol (p<0.05), as well as less side effects in the form of nausea and vomiting (p < 0.05). The incidence and degree of shivering after general anesthesia using intravenous 15 mg/kg paracetamol was lower compared to the use of 0.35 mg/kg meperidine. In the meperidine group, the decrease in body temperature was lower than in the paracetamol group, while the incidence of nausea and vomiting in the paracetamol group was lower than in the meperidine group. In conclusion, paracetamol reduces the incidence of post-anesthesia shivering better than meperidine.

Efficacy of dexmedetomidine in the prevention and treatment of postanesthetic shivering after cesarean section

Purpose: To assess the efficacy of dexmedetomidine in the prevention and treatment of postanesthetic shivering in cesarean section.Methods: A total of 144 pregnant women who underwent anesthesia for cesarean section between March and December 2022 were randomly divided into the study group (n = 72) and control group (n = 72). The pregnant women were given combined spinal-epidural anesthesia. Following childbirth, those in the study group were given dexmedetomidine, while those in the control group were given normalsaline. The dose of spinal anesthesia was administered based on the following criteria: intraoperative infusion, atropine usage, ephedrine usage, intraoperative bleeding, intraoperative dosage, mean arterial pressure, heart rate, blood oxygen saturation, incidence of shivering, and sedation score. Incidence of adverse reactions were recorded and compared between the two groups.Results: Intraoperative infusion volume, bleeding volume, levels of atropine and ephedrine usage, and spinal anesthesia dose were similar between the two groups (p > 0.05). At 10 min post-treatment, the study group had lower mean arterial pressure, heart rate and incidence of postanesthetic shivering, as well as higher postoperative sedation score than the control group. Compared with the control group, the study group had slightly higher incidence of pregnancy-related adverse reactions, but the difference was non-significant.Conclusion: Dexmedetomidine has good efficacy in preventing and treating postanesthetic shivering in cesarean section patients. However, further clinical trials are required prior to its adoption in clinical practice.

THE DIFFERENCES IN THE EFFECTIVENESS OF PROVIDING THICK BLANKETS AND ELECTRIC BLANKETS WITH REDUCING SHIVERING INCIDENCE ON POSTOPERATIVE PATIENTS IN SURGICAL INSTALLATIONS DR. SITANALA HOSPITAL TANGERANG, INDONESIA IN 2019

Introduction: Post Anesthetic Shivering (PAS) or the incidence of post-anesthetic shivering is reported to be around 33-65% in patients undergoing general anesthesia and about 33-56,7% in patients undergoing spinal anesthesia. The treatment can be done pharmacologically with drugs and non-pharmacologically one of them with a warm blanket. The purpose of this study was to determine the differences in the effectiveness of giving thick cloth blankets and 380C electric blankets with a reduction in the incidence of shivering in postoperative patients at the Surgical Installation dr. SitanalaTangerang Hospital. Methods: The research method was a quantitative study with a quasi-experimental design with a pre-test post-test with control group design. The number of samples were 30 patients. Data was collected by observing shivering responses. The intervention was carried out by firing 380C electric blankets and thick cloth blankets. Result: The results showed that of the 15 postoperative patients before being given an electric blanket, almost half were 7 (46,7%) having grade 3 shivering, where as in patients given thick cloth blankets almost half were 6 (40%) having grade 2 shivering. Electrical heating is almost half that is 6 (40%) does not experience shivering (grade 0), where as in patients given regular blankets almost half are 6 (40%) experiencing grade 2 shivering. Statistical test results were obtained (p-value = 0.001, ? : 0.05) and (p-value = 0.005, ?: 0.05). Conclusion: there was an electric warm blanket or thick cloth blanket that influences the incidence of shivering in postoperative patients at the Surgical Installation dr. Sitanala Tangerang Hospital, but electric blankets are more effective than thick blankets. Suggestion is that the hospital is expected to make an intervention to provide electric warm blankets with a temperature of 380C postoperatively can be used as a fixed procedure for the service of surgical patients to prevent complications of shivering

Efficacy of flurbiprofen axetil for preventing postanesthetic shivering in patients undergoing gynecologic laparotomy surgeries

BackgroundPostanesthetic shivering is an unpleasant adverse event in surgical patients. A nonsteroidal anti-inflammatory drug has been reported to be useful in preventing postanesthetic shivering in several previous studies. The aim of this study was to evaluate the efficacy of flurbiprofen axetil being a prodrug of a nonsteroidal anti-inflammatory drug for preventing postanesthetic shivering in patients undergoing gynecologic laparotomy surgeries.MethodThis study is a retrospective observational study. I collected data from patients undergoing gynecologic laparotomy surgeries performed between October 1, 2019, and September 30, 2020, at Kumamoto City Hospital. All the patients were managed with general anesthesia with or without epidural analgesia. The administration of intravenous 50 mg flurbiprofen axetil for postoperative pain control at the end of the surgery was left to the individual anesthesiologist. The patients were divided into two groups: those who had received intravenous flurbiprofen axetil (flurbiprofen group) and those who had not received intravenous flurbiprofen axetil (non-flurbiprofen group), and I compared the frequency of postanesthetic shivering between the two groups. Additionally, the factors presumably associated with postanesthetic shivering were collected from the medical charts. Intergroup differences were assessed with the χ2 test with Yates’ correlation for continuity category variables. The Student’s t test was used to test for differences in continuous variables. Furthermore, a multivariate logistic regression analysis was performed to elucidate the relationship between the administration of flurbiprofen axetil and the incidence of PAS.ResultsI retrospectively examined the cases of 141 patients aged 49 ± 13 (range 21-84) years old. The overall postanesthetic shivering rate was 21.3% (30 of the 141 patients). The frequency of postanesthetic shivering in the flurbiprofen group (n = 31) was 6.5%, which was significantly lower than that in the non-flurbiprofen group (n = 110), 25.5% (p value = 0.022). A multivariate logistic regression analysis showed that administration of flurbiprofen axetil was independently associated with a reduced incidence of postanesthetic shivering (odds ratio 0.12; 95% confidence interval, 0.02-0.66, p value = 0.015).ConclusionsMy result suggests that intraoperative 50 mg flurbiprofen axetil administration for postoperative pain control is useful to prevent postanesthetic shivering in patients undergoing gynecologic laparotomy surgeries.

Effect of Granisetron Plus Dexamethasone versus Granisetron Alone on Postoperative Shivering in patients undergoing Gynecological surgery under general anesthesia

Abstract Background and rational Shivering, a very common complication of surgery owing to postoperative pain and post anesthesia hypothermia, is distressing for both patients and clinicians. It can be defined as involuntary and oscillatory muscular activities that increase the metabolic rate by two to three folds to maintain the core temperature. Both neuraxial (epidural and spinal anesthesia) and general anesthesia are associated with a significant incidence of shivering. The incidence is 40%-60% in regional anesthetic patients and up to 60% in general anesthetic ones. Patients and Methods This study was conducted at Ain Shams University Hospitals between September 2018 and February 2019, after obtaining approval of research ethical committee and patients’ informed consents, 150 patients were included in the study and underwent elective gynecological, and received general anesthesia. Results this study show incidence of post anesthetic shivering is significantly reduced after combination of granisetron and dexamethasone compared to control group Conclusion Combination of granisetron and dexamethasone significantly reduced Post anesthetic shivering (PAS) compared to granisetron alone. It is difficult to establish which drug can be considered the gold standard in prevention of PAS after general anesthesia. Because many research centers have reported that the effects of different anti-shivering drugs are similar, it is wise to administer the cheapest and safest drugs.

The effects of tramadol on postoperative shivering after sevoflurane and remifentanil anesthesia

BackgroundsRemifentanil has been reported to cause post-anesthetic shivering (PAS). Higher doses of remifentanil reportedly induce more intense PAS. Tramadol, a synthetic opioid that acts at multiple sites, is considered to be an effective treatment for PAS, but the evidence for its therapeutic benefit after remifentanil anesthesia is limited. We investigated the effect of tramadol on the incidence of PAS after remifentanil anesthesia.MethodsSixty-three patients who had undergone upper abdominal surgery under general anesthesia were studied retrospectively. Tramadol was administered at induction of anesthesia. The patients were divided into four groups: HT(+), high dose remifentanil (1–1.5 μg/kg/min) with tramadol; HT(−), high dose remifentanil without tramadol; LT(+), low dose remifentanil (0.15–0.25 μg/kg/min) with tramadol; and LT(−), low dose remifentanil without tramadol. We recorded perioperative changes in nasopharyngeal temperature and episodes of PAS on emergence from anesthesia.ResultsThe incidences of PAS in both tramadol treatment groups were significantly lower than the groups that did not receive tramadol. Nasopharyngeal temperature after surgery fell significantly more from baseline in the tramadol treatment groups compared with the non-treatment groups.ConclusionTramadol administered at induction of anesthesia appears to suppress PAS following remifentanil anesthesia.

Comparison of effect of electroacupuncture and nefopam for prevention of postanesthetic shivering in patients undergoing urologic operation under spinal anesthesia.

BackgroundShivering during spinal anesthesia is a frequent complication and is induced by the core-to-peripheral redistribution of heat. Nefopam has minimal side effects and prevents shivering by reducing the shivering threshold. Electroacupuncture is known to prevent shivering by preserving the core body temperature. We compared the efficacies of electroacupuncture and nefopam for the prevention of shivering during spinal anesthesia.MethodsNinety patients scheduled for elective urological surgery under spinal anesthesia were enrolled in the study. Patients were randomly divided into the control group (Group C, n = 30), the electroacupuncture group (Group A, n = 30), and the nefopam group (Group N, n = 30). Groups C and A received 100 ml of isotonic saline intravenously for 30 minutes before spinal anesthesia, while Group N received nefopam (0.15 mg/kg) mixed in 100 ml of isotonic saline. Group A received 30 minutes of electroacupuncture before receiving anesthesia. Shivering scores, mean arterial pressure, heart rate, body temperature and side effects were recorded before, and at 5, 15, 30, and 60 minutes after spinal anesthesia.ResultsThe incidence of postanesthetic shivering was significantly lower in Group N (10 of 30) and Group A (4 of 30) compared with that in Group C (18 of 30)(P < 0.017). Body temperature was higher in Group N and Group A than in Group C (P < 0.05). Hemodynamic parameters were not different among the groups.ConclusionsBy maintaining body temperature during spinal anesthesia, electroacupuncture is as effective as nefopam in preventing postanesthetic shivering.

Effect of palonosetron on postanesthetic shivering after propofol–remifentanil total intravenous anesthesia

The authors conducted a prospective, randomized, double-blind study to evaluate the anti-shivering efficacy of palonosetron for patients after gynecological laparoscopy under total intravenous propofol-remifentanil anesthesia. Sixty female patients were randomly assigned to one of two groups and administered palonosetron 0.075 mg (palonosetron group, n = 30) or the same volume of normal saline (control group, n = 30) immediately after anesthesia induction. Anesthesia was induced and maintained with propofol and remifentanil, using a target-controlled infusion device. Esophageal and index finger temperatures were measured immediately after anesthesia induction (baseline) and at 15-min intervals until the end of the surgery. Postanesthetic shivering and side effects were assessed in a postanesthetic care unit. Incidence of shivering was comparable in the control and palonosetron groups (10/30 vs. 8/30, respectively, P = 0.779). No significant intergroup differences were observed between esophageal and index finger temperatures. Compared with baseline values, esophageal temperatures decreased immediately after pneumoperitoneum in the control group and from 30 min after pneumoperitoneum in the palonosetron group. Use of palonosetron (0.075 mg) did not reduce the incidence of postanesthetic shivering after gynecological laparoscopy under propofol-remifentanil anesthesia. Further study including other 5-HT3 antagonists or male patients would elucidate the effect of palonosetron on shivering after propofol-remifentanil anesthesia.

An Intraoperative Small Dose of Ketamine Prevents Remifentanil-Induced Postanesthetic Shivering

Patients undergoing gynecological laparotomy were randomized to receive either 0.5 mg/kg ketamine at induction of anesthesia followed by an infusion of 0.3 mg/kg/h until the end of surgery (ketamine group, n = 32), or an equivalent volume of normal saline (control group, n = 32). Anesthesia was maintained with IV propofol, a fixed infusion rate of remifentanil (0.25 μg/kg/min), and epidural ropivacaine. Postanesthetic shivering (PAS) was evaluated for 30 minutes after emergence. Intraoperative temperatures were similar between the 2 groups. The incidence of PAS was less frequent in the ketamine group (n = 2, 6%) compared with the control group (n = 12, 38%, P = 0.005). We conclude that, during the early recovery phase, intraoperative ketamine reduces remifentanil-induced PAS.