Incidence Of Postoperative Shivering Research Articles

Intrathecal Fentanyl Versus Intravenous Ondansetron for Shivering Prevention in Cesarean Section: A Comparative Study

Background: The incidence of postoperative shivering (PS) following intrathecal anesthesia is a common complication in Cesarean section with potential negative impacts on patient outcomes. The present study aims to evaluate the effectiveness of intrathecal fentanyl versus intravenous ondansetron in preventing post-spinal anesthesia shivering in cesarean section patients. Materials and Methods: A randomized controlled trial was conducted from Feb 2023 to August 2023, involving pregnant women scheduled for cesarean section under intrathecal anesthesia. The study subjects were divided into three groups: group F received intrathecal fentanyl (15 μg) with spinal anesthesia, while group O received intravenous ondansetron (8 mg) added to the usual saline solution. The control group (group C) received only IV fluid before spinal anesthesia and intrathecal bupivacaine without fentanyl. Shivering occurrences were observed and recorded during procedure in the study. Results: The incidence of shivering was significantly lower in the Intrathecal fentanyl and IV ondansetron groups compared to the control group (p=0.0123). Both intrathecal fentanyl and IV ondansetron administration showed effectiveness in reducing shivering during spinal anesthesia. Conclusion: The administration of intrathecal fentanyl and intravenous ondansetron significantly reduced the occurrence of shivering during spinal anesthesia in C-section patients. The present study contributes to advancing knowledge in the field by providing evidence of the preventative effects of these medications on post-spinal anesthesia shivering.

Comparison of Preemptive Effect of Intravenous Ketorolac Versus Nalbuphine on Postoperative Shivering and Pain in Patients Undergoing Surgery Under Spinal Anesthesia: A Prospective, Randomized, Double-Blind Study.

Postoperative pain and postanesthesia shivering are the two common problems in patients undergoing surgery under spinal anesthesia (SA). The present study aimed to compare the preemptive prescription of the single dose of intravenous (IV) ketorolac versus nalbuphine on postoperative shivering and pain in patients undergoing surgery under SA. Present study was a prospective, randomized double-blind study, conducted on patients of either gender, with American Society of Anesthesiologists physical status class I or II, aged 21-60 years, posted for elective lower abdominal surgeries under SA. Patients were randomized by computer-generated random numbers into two groups of 50 patients each: group N (received 0.2 mg/kg nalbuphine IV) and group K (received 0.5 mg/kg ketorolac IV). The incidence of postoperative shivering was 22 % and 36 % in groups N and K respectively and the difference was statistically significant. The first request for analgesia (minutes) was later in group N (295.17 ± 54.62) than in group K (223.80 ± 15.34) and the difference was statistically significant. Increased total analgesic consumption was noted more in group K (131.34 ± 43.27) than in group N (79.23 ± 21.34), and the difference was statistically significant (P < 0.0001). The incidence of side effects was comparable among both groups. Preemptive nalbuphine had less incidence of postoperative shivering, delayed first request for analgesia, and less total analgesic consumption than ketorolac in patients undergoing surgery under SA.

Fentanyl Versus Ondansetron for Shivering Prevention in Cesarean Section: A Comparative Study.

The incidence of postoperative shivering (PS) following intrathecal anesthesia is a common complication, with potential negative impacts on patient outcomes. This study aims to evaluate the effectiveness of intrathecal fentanyl versus intravenous ondansetron in preventing post-spinal anesthesia shivering in cesarean section patients. A randomized controlled trial was conducted from July 2021 to April 2023, involving pregnant women scheduled for cesarean section under intrathecal anesthesia. The participants were divided into three groups: group F received intrathecal fentanyl (15 μg) with spinal anesthesia, while group O received intravenous ondansetron (8 mg) added to the usual saline solution. The control group (group C) received only intravenous fluid before spinal anesthesia and intrathecal bupivacaine without fentanyl. Shivering occurrences were observed and recorded during the procedure. The incidence of shivering was significantly lower in the fentanyl and ondansetron groups compared to the control group (p=0.0123). Both intrathecal fentanyl and intravenous ondansetron administration showed effectiveness in reducing shivering during spinal anesthesia. The administration of intrathecal fentanyl and intravenous ondansetron significantly reduced the occurrence of shivering during spinal anesthesia in cesarean section patients. This study contributes to advancing knowledge in the field by providing evidence of the preventative effects of these medications on post-spinal anesthesia shivering.

Perioperative administration of dexamethasone to prevent postoperative shivering: a systematic review and meta-analysis of randomized controlled trials.

To evaluate the perioperative administration of dexamethasone to prevent postoperative shivering. We searched PubMed, Embase, Google Scholar, Web of Science, and Cochrane Library for relevant studies of the administration of dexamethasone to prevent postoperative shivering published through 31 May 2023. The primary outcome was the incidence of postoperative shivering. Secondary outcomes comprised the incidence of postoperative nausea, vomiting, and postoperative nausea and vomiting (PONV). RevMan 5.3 software was used for the data analysis. We included 12 randomized controlled trials (1276 participants). The results revealed a benefit favoring the perioperative administration of dexamethasone to prevent postoperative shivering (relative risk [RR]: 0.39; 95% confidence interval [CI]: 0.23-0.63), as well as the grade of shivering. The administration of dexamethasone also reduced the incidence of postoperative nausea (RR: 0.54; 95% CI: 0.39-0.73), postoperative vomiting (RR: 0.37; 95% CI: 0.20-0.65), and PONV (RR: 0.50; 95% CI: 0.26-0.95) compared with the control group. This study indicated that perioperative administration of dexamethasone prevented postoperative shivering and decreased the incidence of other complications.PROSPERO registration number: CRD42020164488.

Comparative effects of warming systems applied to different parts of the body on hypothermia in adults undergoing abdominal surgery: A systematic review and network meta-analysis of randomized controlled trials

Study objectiveThe prevention of perioperative hypothermia after anesthesia induction is a critical concern in patients undergoing abdominal surgery. The effectiveness of various warming systems for preventing hypothermia and shivering when applied to specific areas of the body remains undetermined. DesignSystematic review and network meta-analysis. SettingOperating room. InterventionFive electronic databases were searched, including only randomized control trials (RCTs) reporting the effects of warming systems applied to specific body sites on the intraoperative core temperature and postoperative risk of shivering in adults undergoing abdominal surgery. A multivariate random-effects network meta-analysis with a frequentist framework was implemented for data analysis. MeasurementsThe primary outcome was the core body temperature 60 and 120 min after anesthesia induction for abdominal surgery. The secondary outcome was the incidence of postoperative shivering. ResultsThis review comprised a total of 24 RCTs including 1119 patients. At 60 and 120 min after anesthesia induction, a forced-air warming system applied to the upper body (0.3 °C and 95% confidence intervals = [0.3 to 0.4], 1.0 °C [0.7 to 1.3]), lower body (0.4 °C [0.3 to 0.5], 0.9 °C [0.5 to 1.2]), and underbody (0.5 °C [0.5 to 0.6], 1.2 °C [0.9 to 1.6]) was superior to passive insulation in terms of core body temperature regulation. Compared with passive insulation, the forced-air warming system applied to the lower body (odds ratio = 0.06) or underbody (0.44) and the electric heating blanket to the lower body (0.02) or the whole body (0.07) significantly reduced the risk of shivering. ConclusionsThe results of this NMA revealed that forced-air warming with an underbody blanket effectively elevates core body temperatures in 60 and 120 min after induction of anesthesia and prevents shivering in patients recovering from abdominal surgery.

Paracetamol Versus Ondansetron for Prevention of Postoperative Shivering in Liposuction Surgeries Under Combined General Epidural Anaesthesia: A Randomized Controlled Trial.

Postoperative shivering (POS) is considered one of the most common complications that is encountered by the anaesthetists worldwide. Despite using several treatment options, there has not been a clear consensus regarding this issue. This trial was conducted to investigate the efficacy and safety of paracetamol and ondansetron in preventing POS in patients undergoing liposuction procedures under combined general epidural anaesthesia. One hundred twenty patients scheduled for liposuction were randomly allocated to one of three groups: group P (paracetamol group) which received 1 g paracetamol intravenously, group O (ondansetron group) which received 8 mg of ondansetron intravenously, and group S (saline group), which received 100 mL normal saline intravenously; all medications were given postoperatively. The primary outcome was the incidence of POS, and the secondary outcomes included shivering score, tympanic temperature, and the occurrence of side effects. The incidence of occurrence of POS was found to be lower in groups P and O compared to group S with values of 25% and 37.50% vs. 77.50%, respectively, with a P value <0.001. Additionally, the severity of POS was found to be lower in groups P and O compared to group S (P <0.001). Tympanic temperature and complications were comparable between the groups with no significant differences. Prophylactic use of paracetamol or ondansetron at the end of the procedure was shown to be of great value in reducing the incidence and severity of POS, with no statistically significant difference between the paracetamol and ondansetron groups. Moreover, no significant drawbacks were reported as a result of using these medications.

A study on the effect of preoperative warming on post-induction core temperature and incidence of postoperative shivering in patients under general anesthesia

BackgroundInadvertent perioperative hypothermia (IPH) defined as core temperature below 36.0 °C is a common complication of general anesthesia with prevalence up to 70%. Warming of peripheral tissues prior to induction of anesthesia reduces the central to peripheral temperature gradient, thereby minimizing central heat loss due to heat redistribution, after induction of anesthesia. This study aimed to evaluate the effect of prewarming on post-induction core temperature and incidence of perioperative inadvertent hypothermia leading to postanesthetic shivering (PAS) in patients undergoing general anesthesia.This is a single-arm study performed after authorization from the scientific review committee (IRB no.:10/2015/05) in a cohort of patients between the ages of 18 and 65 years in ASA I and II physical status, undergoing GA for elective surgeries lasting less than 3 h. Rates of IPH and PAS in 60 patients who were warmed before anesthesia over a 30-min period with a forced-air warmer set at 38.0 °C were compared with existing data from an equal number of cohorts who received only intraoperative warming, during similar surgical procedures according to routine GA.Comparisons between the two groups were made using the Student’s t-test and chi-square test. A paired t-test or Wilcoxon’s signed rank test was applied for pairwise comparisons. The results were considered statistically significant when the P-value was < 0.05.ResultsThe mean decrease in core temperature in the unwarmed group was 0.7 °C (+ /- 0.23) compared with a 0.2 °C decrease (+ /- 0.06) in the prewarmed group of patients. A total of 31.70% of patients in the unwarmed group developed IPH compared with one patient (1.7%) in the prewarmed group shortly after onset. Twenty-six patients (43.30%) in the unwarmed group had hypothermia at the end of surgery, compared with one patient (1.7%) in the prewarmed group. Shivering was observed in 46% of patients in the unwarmed group, while no shivering was observed in the prewarmed group.ConclusionsPreoperative warming is an effective intervention to reduce the frequency of core temperature drops after induction of anesthesia, thereby preventing inadvertent perioperative hypothermia and the incidence of postoperative shivering.

Amino acids versus magnesium sulfate infusion for controlling postoperative shivering in patients undergoing percutaneous nephrolithotomy surgery: a randomized clinical trial.

General anesthetics disrupt the thermoregulatory mechanisms by reducing vasoconstriction and shivering thresholds. Postoperative shivering is a challenging anesthesia-related complication with an incidence range of 20-70%. Amino acids that induce thermogenesis and magnesium sulfate are centrally acting mechanisms that could minimize shivering. Thus, this trial was designed to compare the effect of amino acid versus magnesium sulfate infusion on postoperative shivering in patients undergoing elective percutaneous nephrolithotomy (PCNL) surgery under general anesthesia. Eighty adults, American Society of Anesthesiologists I and II patients, were randomly assigned into one of two groups. Group A received general anesthesia and perioperative IV amino acid infusion. Group M received general anesthesia and perioperative IV magnesium sulfate infusion. There was a statistically significant difference in shivering score, which was lower in group A than M (0.8±1.1 versus 1.5±1.3; P value=0.01). The incidence of postoperative shivering was lower in group A (4 [10%]) versus (11 [27.5%]) in group M. A less decrease in the core intraoperative temperature (Celsius) was observed in group A than in group M (35.5±0.2 versus 35.1±0.2; respectively, P<0.001) and at the end of surgery (36.1±0.3 versus 35.7±0.3; respectively, P<0.001). Perioperative amino acids infusion is more effective and better tolerated than magnesium sulfate in preventing postoperative shivering in patients undergoing percutaneous nephrolithotomy surgery. Cost effectiveness should be kept in mind, and amino acids infusion should be reserved in high-risk surgeries for shivering.

Cross-sectional Study on Effects of Ondansetron and Meperidine in the Prevention of Postoperative Shivering after Spinal Anesthesia

Purpose: Post-anesthesia shivering is one of the most common problems after surgery and may lead to multiple complications such as hypoxemia, lactate acidosis and catecholamine release. The purpose of this study was to compare the effects of intravenous meperidine and ondansetron on postoperative shivering in patients having an elective cesarean section under spinal anesthesia. Design: Cross-sectional study Methods: In this cross-sectional study, 105 patients with the age of 18-45 years and ASA class I-II undergoing elective cesarean section were randomly assigned into three groups. Group O was administered 8mg ondansetron, group M patients were given 0.4mg/kg meperidine and group P was placebo that was administered with 2cc of saline intravenously after the delivery. The incidence and intensity of shivering and postoperative nausea was monitored and recorded by the trained nurse. The data obtained was analyzed using SPSS v18. Results: All three groups (n=35) had no significant difference in terms of age, weight and time of spinal anesthesia. Postoperative shivering was reported in 4 patients (11.4%) in group A and 3 patients (8.6%) in group B and in 14 patients (40%) in group C. The incidence of postoperative shivering was significantly less in groups A and B as compared to the placebo, p=0.03. The intensity of shivering was greater in group C as compared to groups A and B, p=0.01. The incidence and intensity of postoperative nausea was significantly less in group A, p=0.03, p&lt;0.001, respectively, while no difference was reported in groups B and C, p&lt;0.05. Conclusion: 8mg ondansetron and 0.4 mg/kg of meperidine are equally effective in managing postoperative shivering; however, ondansetron has an additional effect of reducing the incidence of postoperative nausea among patients undergoing caesarean section with spinal anesthesia.

Effect of Forced-Air Warming Blanket on Perioperative Hypothermia in Elderly Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer.

The study aimed to evaluate the effect of forced-air warming blanket combined with conventional thermal insulation measures on inadvertent perioperative hypothermia (IPH) in elderly patients undergoing laparoscopic radical resection of colorectal cancer. A total of 70 elderly patients undergoing laparoscopic radical resection of colorectal cancer with general anesthesia were included, and divided into conventional warming treatment (CT) group or forced-air warming treatment (FT) group. In the FT group, based on the conventional warming strategy, patients received prewarming with the forced-air warming blanket (38°C) for ≥20 minutes before induction of anesthesia, and received this treatment continuously during operation. The core body temperature, recovery time from anesthesia, extubating time, and length of stay in the postanesthesia care unit were recorded. The incidence of IPH and postoperative shivering was observed. The incidence of IPH was significantly lower, and average minimum body temperature during the operation was significantly higher in the FT group than that in the CT group (5.7% vs. 22.8% and 36.23°C vs. 35.89°C, respectively). The intraoperative body temperature decreased less (0.32°C vs. 0.69°C), the recovery time from anesthesia was faster (12.8 minutes vs. 17.1 minutes), and the incidence of postoperative shivering was less (2.8% vs. 28.6%) in the FT group than the CT group. In elderly patients undergoing laparoscopic radical resection of colorectal cancer, use of forced-air warming blankets combined with conventional warming measures is more effective to maintain normal body temperature during the perioperative period and reduce the incidence of IPH.

Comparison of two forced air warming systems for prevention of intraoperative hypothermia in carcinoma colon patients: a prospective randomized study.

Hypothermia is common occurrence in patients undergoing colonic surgeries. We hypothesized that the underbody forced air warming blankets will be better than conventional over-body forced air warming blankets for prevention of hypothermia during laparoscopic colon surgeries. After ethics approval, sixty patients undergoing elective laparoscopic colon surgeries were randomly divided into two groups to receive warming by underbody forced air warming blanket (n = 30) or over-body forced air warming blanket (n = 30). In the operating room, epidural catheter was inserted and thereafter warming was started with the forced air warmer with temperature set at 44°C. Intraoperatively core temperature (using nasopharyngeal probe), vitals, incidence of postoperative shivering and time to reach Aldrete Score of 10 in the postoperative period were recorded. The core temperature was higher with an underbody blanket at 60min (36.1 ± 0.5°C vs. 35.7 ± 0.5°C, P = 0.005), 90min (35.9 ± 0.5°C vs. 35.6 ± 0.5°C, P = 0.009), 120min (35.9 ± 0.5°C vs. 35.5 ± 0.4°C, P = 0.007), and 150min (35.9 ± 0.5°C vs. 35.6 ± 0.4°C, P = 0.011). In the post anesthesia care unit, the time to reach an Aldrete score of 10 was also less in the underbody blanket group (14.3 ± 2.5min vs. 16.8 ± 3.6min) (P = 0.003). However, there were no clinically meaningful differences in any outcome. Underbody and over-body blankets were comparably effective in preventing hypothermia in patients undergoing laparoscopic colorectal surgery under general anaesthesia.Trial registration CTRI (2019/06/019,576). Date of Registration: June 2019, Prospectively registered.

A prospective study on the comparison of general anesthesia and tea (thoracic epidural anesthesia) for perioperative outcomes in patients undergoing modified radical mastectomy

The 2nd most common tumor among women is breast cancer. Surgery is usually done by general anesthesia (GA). TEA is one of the anesthetic procedures that can be performed using local anesthetic epidural administration. TEA may boost pain relief without the potential for respiratory muscle weakness and sedation. An epidural catheter was inserted in T4 to T5 for the T-group, with a 10-15 ml injection of 0.75% ropivacaine. Intermittent supplements of 5-10 ml 0.75% ropivacaine maintained anesthesia. General anesthesia was caused by fentanyl of 1-2 μg/kg, accompanied by propofol (1.5-2 mg/kg), with sevoflurane. We evaluated intraoperative hemodynamics, post-operative patient parameters like nausea and vomiting, shivering, respiratory depression. Overall patient satisfaction is compared between two groups. The demographic data was similar in both groups. Intraoperative hypotension observed in 33.3% of group T patients and 16.6% of group G patients. 20% of the group T patients showed intraoperative bradycardia, whereas 6.66% of group G patients showed intraoperative bradycardia. Incidence of vomiting &amp; nausea is 26.6% in group G, whereas in group T it is 6.66%. The incidence of post-operative shivering is equal in both groups. Post-operative respiratory depression is not observed in both groups. 86.6% of the group T patients are satisfied overall, whereas it is 60% in group G.

Effects of a preoperative forced-air warming system for patients undergoing video-assisted thoracic surgery: A randomized controlled trial.

Background:The incidence of intraoperative hypothermia is still high despite the proposal of different preventive measures during thoracoscopic surgery. This randomized control study evaluated the effects of 30-minute prewarming combined with a forced-air warming system during surgery to prevent intraoperative hypothermia in patients undergoing video-assisted thoracic surgery under general anesthesia combined with erector spinae nerve block.Methods:Ninety-eight patients were randomly and equally allocated to prewarming or warming groups (n = 49 each). The primary outcome was the incidence of intraoperative hypothermia. Secondary outcomes were core temperature, irrigation and infused fluid, estimated blood loss, urine output, type of surgery, intraoperative anesthetic dosage, hemodynamics, recovery time, the incidence of postoperative shivering, thermal comfort, postoperative sufentanil consumption and pain intensity, patient satisfaction, and adverse events.Results:The incidence of intraoperative hypothermia was significantly lower in the prewarming group than the warming group (12.24% vs 32.65%, P = .015). Core temperature showed the highest decrease 30 minutes after surgery start in both groups; however, the rate was lower in the prewarming than in the warming group (0.31 ± 0.04°C vs 0.42 ± 0.06°C, P < .05). Compared with the warming group, higher core temperatures were recorded for patients in the prewarming group from T1 to T6 (P < .05). Significantly fewer patients with mild hypothermia were in the prewarming group (5 vs 13, P = .037) and recovery time was significantly reduced in the prewarming group (P < .05). Although the incidence of postoperative shivering was lower in the prewarming group, it was not statistically significant (6.12% vs 18.37%, P = .064). Likewise, the shivering severity was similar for both groups. Thermal comfort was significantly increased in the prewarming group, although patient satisfaction was comparable between the 2 groups (P > .05). No adverse events occurred associated with the forced-air warming system. Both groups shared similar baseline demographics, type of surgery, total irrigation fluid, total infused fluid, estimated blood loss, urine output, intraoperative anesthetic dosage, hemodynamics, duration of anesthesia and operation time, postoperative sufentanil consumption, and pain intensity.Conclusion:In patients undergoing video-assisted thoracic surgery, prewarming for 30 minutes before the induction of anesthesia combined with a forced-air warming system may improve perioperative core temperature and the thermal comfort, although the incidence of postoperative shivering and severity did not improve.

The comparative efficacy of nalbuphine and tramadol in controlling postoperative shivering in rabbits

Background: Postoperative shivering is a major dilemma in most major surgeries. It is a consequence of perioperative hypothermia, attributed to the use of obsolete anesthetic regiments being used in the field of veterinary medicine. Shivering is a protective mechanism to compensate for the thermoregulatory status of the individual. This phenomenon is most aptly observed in small mammals and rodents while recovering from anesthesia induced by ketamine and xylazine combination. Objectives: This study used rabbits as a model to demonstrate and qualitatively analyze the comparative efficacy of nalbuphine and tramadol to control postoperative shivering. Materials and Methods: Twenty rabbits were randomly divided into three different groups, i.e., A, B, and C. The average values of temperature, pulse, and respiration in Group A (control) were 101.37 ± 0.99, 112 ± 27.32, and 80 ± 10.06, respectively. Results: Similarly, the values of these parameters obtained from Group B (nalbuphine) were 102.37 ± 0.67, 102.8 ± 29.68, and 74.9 ± 28.72 as compared to Group C (tramadol) were 101.79 ± 0.82, 102.3 ± 22.47, and 66.8 ± 14.55. The incidence of postoperative shivering was significantly lesser in Group B, whereby 80% of the individuals completely stopped shivering, whereas in case of Group C, only 65% of the individuals underwent complete cessation of shivering. Conclusion: administering opioids perioperatively can profoundly inhibit the incidence of postanesthetic shivering and may counteract the malicious effects of anesthesia and surgical procedure.

Association Between Bispectral Index (BIS) Value and Postoperative Shivering in Patients Undergoing Orthopedic Surgery.

BACKGROUND:Postoperative shivering is one of the most common adverse effects after general anaesthesia.AIM:This study aimed to evaluate the association between the Bispectral index (BIS) monitoring value and postoperative shivering in patients undergoing orthopaedic surgery.MATERIAL AND METHODS:This cross-sectional study was conducted in Shahid Beheshti Hospital in Sabzevar city, from August 2017 to September 2018. Patients who underwent orthopaedic surgery, using general anaesthesia, were enrolled. Recording of the depth of anaesthesia using BIS monitoring was started exactly 5 minutes after intubating the patient and continued until the discharge from post-anesthesia care unit (PACU). The incidence of postoperative shivering was evaluated using a scale proposed by Crossley and Mahajan.RESULTS:A total number of 80 patients were evaluated. 32.5% of patients experience postoperative shivering grade 2, with mean BIS score 41.85. The univariate and multivariate linear regression analysis indicated a statistically significant relationship between shivering score and patients’ heart rate, blood pressure, BIS score, temperature, age, height, gender and blood cell distribution width (RDW) (p < 0.05).CONCLUSION:The results of this study indicate a significant positive association between BIS value and postoperative shivering in patients undergoing orthopaedic surgery, so that, patients with higher BIS score experienced significantly more postoperative shivering. It seems that BIS-guided anaesthesia can reduce the risk and incidence of postoperative shivering in patients undergoing orthopaedic surgery.

The influence of high-dose intraoperative remifentanil on postoperative sore throat: a prospective randomized study: A CONSORT compliant article.

Background:Endotracheal intubation for general anesthesia causes postoperative sore throat (POST). This study is designed to evaluate the effect of high-dose remifentanil on the incidence of POST in patients after general anesthesia.Methods:Ninety-two patients scheduled for orthopedic lower extremity surgery under general anesthesia were randomly assigned into 1 of 2 groups. In the high-dose remifentanil (HR) group (n = 46), remifentanil was infused at a rate of 0.25 μg/kg/min and subsequently increased or decreased by 0.05 μg/kg/min per clinical demand. In the low-dose remifentanil (LR) group (n = 46), remifentanil was infused at a rate of 0.05 μg/kg/min. The incidence of POST was monitored at 0, 2, 4, and 24 hours postoperatively. Complications regarding opioids were compared between groups.Results:The overall incidence of POST was higher in the HR group compared with that in the LR group [33 (72%) vs 18 (39%), P = .022]. The incidence of POST at 0, 2, and 24 hours after surgery was higher in the HR group compared with that in the LR group (P < .001, P = .001, and P = .001, respectively). The incidence of postoperative nausea, vomiting, drowsiness, and headache was similar between the groups. The incidence of postoperative shivering was higher in the HR group than in the LR group [10 (22%) vs 2 (4%), difference 17%, 95% CI 2%–33%, P = .027].Conclusion:A relatively large dose of intraoperative remifentanil increased the incidence of POST in patients for orthopedic surgery under general anesthesia.Trial Registration:Clinicaltrials.gov Identifier: NCT03173339.

Comparative effectiveness of pharmacologic interventions to prevent shivering after surgery: a network meta-analysis.

Although many drugs have been studied to prevent postoperative shivering, their comparative effectiveness is unknown. We attempted to assess the comparative effectiveness of the pharmacologic strategies to prevent shivering after surgery including intravenous (IV) and intrathecal (IT) meperidine, IV and IT dexmedetomidine, IV and IT clonidine, nefopam, tramadol, ketamine, and serotonin receptor antagonists. We implemented a frequentist network meta-analysis of randomized trials. Random effect model was selected according to deviance information criteria. The incidence of moderate or severe shivering and the overall incidence of postoperative shivering were compared in all patients and subgroups of general and spinal anesthesia. Seventy trials with 6062 participants were included. All interventions except clonidine IT and dexmedetomidine IT significantly decreased the incidence of moderate or severe shivering. All interventions except clonidine IT significantly decreased the overall incidence of shivering. Nefopam IV was ranked best regarding both the incidence of moderate or severe shivering (odds ratio [OR] 0.04, 95% confidence interval [CI] 0.04-0.25, SUCRA 86.2, moderate quality-evidence), and the overall incidence of shivering (OR 0.07, 95% CI 0.03 to 0.15, SUCRA 85.7, moderate quality-evidence), which was consistent in the subgroups of anesthesia. Nefopam was ranked best regarding both severity and incidence of postoperative shivering. In addition to nefopam, tramadol, meperidine IV and IT, and dexmedetomidine IV were ranked high. However, there was significant heterogeneity regarding the individual drug regimen and surgery type, precluding firm conclusion. Further randomized trials are required to compare the efficacy of the drugs with high rank.

Effect of Preemptive Clonidnine Versus Pethidine and Ketamine on Postoperative Shivering During Spinal Anesthesia

Introduction: Postoperative Shivering is an early postoperative complication. Incidence of postoperative shivering (POS) following surgeries varies between 20 to 60%. There is still no consensus on treatment modalities especially in opioid-dependent patients. Aim: To compare the effect of preemptive clonidine, ketamin and pethidine in controlling postoperative shivering in addicted patients who undergo spinal anesthesia. Methods: In a clinical trial, 81 patients who underwent spinal anesthesia for elective orthopaedic surgery for lower limb were enrolled and assigned to groups of 27 patients of the study based on accidental numbers, and 2 patients in Pethidine group and 2 patients in ketamine group were excluded from the study. Clonidine 2 mg was administered orally prior to surgery. Ketamin 2mg/kg and pethidine 0.5 mg/kg were administered in recovery to the patients. Postoperative shivering was measured in patients during stay in post anethesia care unit. Blood pressure and heart rate was recorded during 30 minutes after spinal anethesia in operating room. Results: No significant differences in blood pressure and heart rate were observed between patients. Incidence of postoperative shivering was 28% in clonidine, 36% in pethidine and 48% in ketamin group. Risk of shivering was significantly reduced in patients received clonidine in compare to ketamine (RR: 0.34, 95% CI: 0.138-0.856, p=0.022) which was significant and compare to pethidine (RR=0.79, 95% CI: 0.272-2.323, p=0.67) which was not significant. Conclusion: preemptive Clonidine has superior effect compare to postoperative ketamin and pethidine in controlling postoperative shivering.

Prevention of hypothermia by infusion of warm fluid during thoracoscopic-assisted esophagectomy

Objective To describe the core temperature curve and access the effect of infusion of warm fluid in patients receiving thoracoscopic-assisted esophagectomy. Methods Fifty patients undergoing elective thoracoscopic-assisted esophagectomy under general anesthesia were divided into two groups by random number table (n=25). In the warming group, fluids were infused at 40 ℃, while in the control group, fluids were infused at room temperature. The intraoperative rectal temperature and the incidence of postoperative shivering were recorded respectively. Results In the control group, the core temperature curve divided into three stages, by time points at 80 min and 200 min. Statistically significant decline in core temperature was appeared at 50 min and 200 min post-anesthesia in control and warming group respectively. Compared with the control group, the overall time of intraoperative core temperature higher than 36 ℃ was longer in the warming group(33.3% vs 15.3%)(P<0.05). And the time of decline with 1 ℃ in core temperature was longer in the warming group[(139±69) min vs (76±33) min](P<0.05). At the end of anesthesia, the core temperature in warming group was higher than that in the control group[(35.48±0.48) ℃ vs (34.90±0.57) ℃](P<0.05). The incidence of postoperative shivering was also lower in warming group. Conclusions Infusion of warm fluids is effective in decreasing the rate and magnitude of the decline in core temperature during surgery, reducing the overall time of hypothermia and the incidence of shivering. But it doesn′t change the redistribution process of core temperature during anesthesia induction and prevent hypothermia at the end of surgery. Key words: Fluid warmer; Thoracoscopic-assisted esophagectomy; Hypothermia; Postoperative shivering

Postoperative Shivering Among Cannabis Users at a Public Hospital in Trinidad, West Indies

Postoperative shivering has been anecdotally observed to be frequent and severe in Cannabis smokers following general anesthesia in the Caribbean. The aim of this study was to compare the frequency and intensity of postoperative shivering in Cannabis users versus non-users. A prospective, cross-sectional, observational design was used. Demographic data were obtained. Patients were grouped into Cannabis users and non-users. All patients received standardized general anesthesia and were administered warmed fluids intraoperatively. Ambient room temperatures and clinical data were recorded. Patients' core body temperature was recorded at 10-minute intervals both in the operating room and the post-anesthesia care unit (PACU). Postoperatively an independent observer assessed the patients who had shivering using a scoring system ranging from 0 to 3. Treatment for shivering and post-treatment shivering scores were also recorded. Fifty-five patients were studied, of which 71% were male. There were 25 (45%) Cannabis users, of which 50% smoked < 5 joints per week, and 35% smoked >10 joints per week; 30 (55%) patients were non-users. The overall incidence of postoperative shivering was 36%; 16% had a shivering score of '3', 13% had '2' and 7% had a score of '1'. The incidence of postoperative shivering among Cannabis users was 40% while it was 33.3% in non-users. Also, 90% of Cannabis users had shivering scores of 2 and 3, compared to 70% of non-users. There was a higher incidence and intensity of shivering in Cannabis smokers, although the study could not establish a statistically significant difference in the frequency and severity of shivering between Cannabis users and non-users.